7:55 am
Christine C. Stallkamp
Christine C. Stallkamp, MD, FAAFP, CHCQM-PHYADV
System Director, Revenue Integrity and Care Coordination
Main Line Health

8:00 am

Every physician advisor must be able to adequately manage a care team, make improvements in UR and CDI, and understand the metrics and financial decisions associated with the role. Explore ways to maximize day-to-day functions of your role to drive improved financial and quality outcomes.

  • Identify the day-to-day responsibilities of the physician advisor
  • Discuss the pros and cons of being a “universal” physician advisor versus focusing on one domain (e.g. CDI or UR)
  • Utilize metrics on a case-by-case basis to justify the value of the role to hospital leadership and calculate ROI
  • Determine how to balance administrative time with clinical time to harness optimal efficiency and maintain clinical skills
Kalyana C. Kanaparthy
Kalyana C. Kanaparthy, MD, FHM, CHCQM-PHYADV
System Medical Director, Physician Advisor Program
Rochester Regional Health

Melissa M. King
Melissa M. King
Director, Physician Advisor Program,
Rochester Regional Health

9:00 am

In a world of shrinking resources and expanding, complex, payer developed rules, clinical leaders need to develop processes that can be replicated consistently throughout their health network. Improving processes allows physician advisors and medical directors to accomplish more efficient and consistent case reviews. Standardized processes utilized to monitor patient status determinations, peer-to-peer, retrospective appeals and assure inter-rater reliability are critical to the success of a physician advisor program. Optimization of these processes requires ongoing communication along with input and buy-in from physician advisors, case managers, finance, and senior leadership.

  • Discuss a standard process for Medicare and commercial payer status determinations
  • Identify methods for achieving inter-rater reliability through self-audits of short stay MC cases, peer-to-peer, and retrospective appeals
  • Explore methods for integration of new hospital sites into the physician advisor workflow
David Goldner
David Goldner, MD, FACC
Medical Director, Utilization Management and Appeals
Lehigh Valley Health Network

10:15 am

When the physician advisor, medical director, or hospitalist leads interdisciplinary rounds, they must determine how to influence the team to impact communication and collaboration. Hear strategies for orchestrating interdisciplinary rounds to promote learning and participation.

  • Review what must be discussed in IDR
  • Leverage team member insights to promote an interdisciplinary learning environment that is useful and worthwhile
  • Consider how to challenge but respect the decisions of physicians
  • Discuss how to best interface between staff and physicians
Rachel Cyrus
Rachel Cyrus, MD, FHM
Assistant Professor of Medicine, Northwestern University Feinberg School of Medicine; Clinical Director, Division of Hospital Medicine
Northwestern Medica l Group

11:15 am

Understanding and tracking metrics are a key component to the success of a physician advisor or medical director. Learn about these essential metrics and how to best tackle the documentation of medical necessity.

  • Understand MCC/CC
  • Appreciate the financial and quality impact that the CC and MCC capture rate has on specific DRGs
  • Discuss how these metrics affect an institution’s quality scores and financial metrics
  • Evaluate how to approach outpatient CDI metrics in terms of HCC documentation
Christine C. Stallkamp
Christine C. Stallkamp, MD, FAAFP, CHCQM-PHYADV
System Director, Revenue Integrity and Care Coordination
Main Line Health

12:15 pm
1:15 pm

Navigating the Two Midnight Rule is an essential function of any physician advisor or medical director. Understand how patient status affects your bottom line and review expert tips for determination of medical necessity.

  • Review how observation versus inpatient status affect hospital revenue
  • Discuss the role of advanced care practitioners in the order writing process and what constitutes a valid inpatient order
  • Examine when it is appropriate to convert observation to inpatient status, or re-evaluate medical necessity through a Condition Code 44
  • Understand exceptions to the 1-day inpatient stay
  • Learn how similar cases can have different status determinations if a payer is following commercial versus Medicare guidelines
Mohammad Shaheed
Mohammad Shaheed, MD, SFHM, CHCQHM-PHYADV
Medical Director, Physician Advisor, Rochester General and Eastern Region; Senior Hospitalist Attending, Rochester Regional Health ; Clinical Assistant Professor of Medicine, University of Rochester School of Medicine and Dentistry

2:15 pm

Accurate and appropriate use of observation status is important for Medicare billing purposes, as well as ensuring the most effective care is received. Discuss the goals of observation care and how observation units can have a positive impact.

  • Identify the challenges of observation status
  • Outline the process and flow of observation care
  • Understand the structure needed to establish a successful observation unit
Aziz Ansari
Aziz Ansari, DO, SFHM, FACP
Associate Chief Medical Officer, Clinical Optimization and Revenue Integrity; Associate Director, Division of Hospital Medicine; Medical Director, Observation Unit, Associate Professor of Medicine
Loyola University Medical Center

Carissa J. Tyo
Carissa J. Tyo, MD
Assistant Professor, Internal and Emergency Medicine; Director, Observation Unit
University of Illinois at Chicago

3:45 pm

Hospitals and health systems can have varying physician advisor program and staffing models, depending on the size and type of the facility. Consider the types of models that might fit for your organization, and determine how to best structure your care team.

  • Discuss how the role is defined depending on the health system, especially when a physician advisor is responsible for multiple domains in the mid-revenue cycle
  • Determine the stakeholders you need on your team to gain administrative and interdepartmental buy-in
  • Consider when it is and is not appropriate to outsource the physician advisor role
Aziz Ansari
Aziz Ansari, DO, SFHM, FACP
Associate Chief Medical Officer, Clinical Optimization and Revenue Integrity; Associate Director, Division of Hospital Medicine; Medical Director, Observation Unit, Associate Professor of Medicine
Loyola University Medical Center

Mohammad Shaheed
Mohammad Shaheed, MD, SFHM, CHCQHM-PHYADV
Medical Director, Physician Advisor, Rochester General and Eastern Region; Senior Hospitalist Attending, Rochester Regional Health ; Clinical Assistant Professor of Medicine, University of Rochester School of Medicine and Dentistry

Moderator:
Poonam Gutt
Poonam Gutt, MD
Former Physician Advisor, Main Line Health;
Hospitalist, Methodist Health System

4:45 pm
  • Identify the amount of time needed and steps devoted to preparation for an ALJ Hearing
  • Participate in a “mock” hearing based on a case example provided
Jessica L. Gustafson
Jessica L. Gustafson, Esq.
Founding Shareholder
The Health Law Partners, P.C.

Abby Pendleton
Abby Pendleton, Esq.
Founding Shareholder
The Health Law Partners, P.C.

Bob Soltis
Bob Soltis
Retired Administrative Law Judge
Office of Medicare Hearings & Appeals (joining remotely)