7:30 am
What topics are on your mind?

Join your colleagues and discuss the latest industry trends over coffee

8:30 am
Kory T. Anderson
Kory T. Anderson, MD
System Physician Advisor and Lead Physician for Denials Management
Intermountain Healthcare

Mohammad Shaheed
Mohammad Shaheed, MD, SFHM, CHCQHM-PHYADV
Medical Director, Physician Advisor Group
Rochester Regional Health

8:45 am

The increasing rate of physician burnout is a severe epidemic in the United States that affects the health of doctors and patients alike. In this session, discuss current landscape of physician burnout and how institutions can play a larger role to truly decrease physician’s administrative burden and increase overall patient outcome and satisfaction.

  • Review current status and discuss the cause of physician burnout in the US
  • Assess the impact of physician burnout on patient care and quality measures
  • Discuss successful system-wide approaches to reduce physician burnout
  • Streamline the use of EHR to optimize workflow and compliance, and effectively integrate medical knowledge into documentation
Masood Safaee
Masood Safaee, MD
Medical Director, McKay-Dee Hospital
Intermountain Healthcare

9:30 am

Working and communicating with payer organizations is one of the crucial responsibilities and challenges that Physician Advisors face. In this session, discuss the decision-maker role that Physician Advisors and Medical Directors can have by providing the necessary information and analytics to their leadership when contracting with payer organizations.

  • Analyze available data to project potential financial impact of a contract from a hospital’s perspective
  • Learn how to extrapolate what an optimal contract should look like
  • Determine actionable information that can be used to assist leadership when negotiating contracts with payer organizations
  • Review a hypothetical case example
Kalyana Kanaparthy
Kalyana Kanaparthy, MD, FHM, CHCQM-PHYSADV
Associate Chief Medical Officer, Physician Advisor Program
Rochester Regional Health

10:45 am

Mitigating inaccurate claims or the inability to properly justify medical necessity is costly, and labor-intensive for providers. When cases are denied, physician leaders involved can use the opportunity provided through the peer-to-peer process to turn the case around. When conducted correctly, this process has the potential to significantly impact a hospital’s revenue cycle as it is a more cost-effective and financially sound process. In this session, move beyond administrative burdens that comes with appeals and denials, and successfully increase your peer-to-peer overturn rate, and discuss how to prep for success from the start by building a comprehensive physician orientation system.

  • Uncover techniques for managing peer-to-peer reviews when discussing with Medical Directors of commercial payers and Medicare Advantage plans
  • Discuss how to tackle the increasing overturn rate for managed care denials
  • Examine what your next steps are when you are denied a peer-to-peer review
Jose Alcantara
Jose Alcantara
Medical Director, Clinical Decision Support and Physician Builders Chair, Inpatinet Advisory Committee for Health Informatics Associate Physician Advisor
Rochester Regional Health

Kalyana Kanaparthy
Kalyana Kanaparthy, MD, FHM, CHCQM-PHYSADV
Associate Chief Medical Officer, Physician Advisor Program
Rochester Regional Health

11:30 am

Population health management is accelerating the health care movement from fee-for-service to value-based care. Some large national payers plan to have >75% of all members covered through value-based arrangements. Value-based goals encourage providers to curb unnecessary utilization, shift care to lower cost settings, collaborate as multi-specialty/multi-disciplinary/multi-setting teams, and improve patient’s health and overall quality of life, especially in the ambulatory and non-hospital setting. In this session, hear examples of population health and community initiatives that organizations are implementing, and how one hospital reduced readmissions of heart failure patients.

  • Understand the clinical and financial impacts of population health programs and what it takes to implement and administer them
  • Discuss the impact of value-based contracting on your institution’s finance and the structure and processes of care delivery required
  • Create guidelines and partner with primary care doctors to reduce preventable heart failure readmission from a population health standpoint
Zulma M. Berrios
Zulma M. Berrios, MD, MBA, CPE
Chief Medical Officer
West Kendall Baptist Hospital, Baptist Health South Florida

Don Lee
Don Lee, MD, MPH
Medical Director
Ascension Medical Group Wisconsin

Arshad Rahim
Arshad Rahim, MD, MBA, FACP
Senior Medical Director, Population Health
Mount Sinai Health System

12:15 pm
1:30 pm

Although telehealth has the potential to improve outcomes and access to care, the challenges with resources, billing, and compliance are preventing providers from fully embracing this innovation. In this session, identify the reimbursement barriers and infrastructure needed to assist your organization on implementing telehealth initiatives.

  • Outline the necessary resources and the practicality of implementing this technology
  • Understand the parameters needed for a successful program in the current reimbursement environment
Edward Kersh
Edward Kersh, MD, FACC
Clinical Professor, Medicine
UCSF Medical Director
Sutter Care at Home

2:15 pm

Shared with Observation Management Summit

In the 2018 OPPS Final Rule, CMS removed TKR from the Medicare IPO list. Since there is a significant difference between payment rates made via DRG system and outpatient observation services, hospitals and health systems must understand how to navigate through regulatory changes without having a negative financial impact.

  • Review the policy changes on TKA and the impact it has on providers and patients
  • Design workflows for inpatient and outpatient procedures and determine the best care setting for your patient
  • Discuss how appropriate documentation of medical necessity can help care facilitators
  • Assess lessons learned and current state of total knee replacements to uncover the future direction for this procedure
Amit Bansal
Amit Bansal, MD, FACP, FHM
Physician Advisor, Rochester Regional Health
Director of Quality, Rochester General Hospitalist Group
Clinical Assistant Professor of Medicine, University of Rochester School of Medicine & Dentistry

Deerajnath Lingutla
Deerajnath Lingutla, MD, MBA, CHCQM
Medical Director/Physician Advisor Program; Academic Hospitalist,
Rochester Regional Health/Unity Hospital
Clinical Assistant Professor of Medicine
University of Rochester

3:00 pm

Shared with Observation Management Summit

Determining the final status of a patient while being compliant to regulations is an essential yet complex function of Physician Advisors. A critical step to assessing the best care level for a patient is understanding the intricacies of length of stay in observation and in-patient settings and how they affect payment received by the hospital. In this session, explore innovative ways of managing observation and in-patient admissions, and how payment and documentation is affected under different settings.

  • Understand the equivalency of a DRG payment under observation status, and how it differs between Medicare and commercial payers
  • Examine what needs to be taken into consideration to build out documentation to support medical necessity for inpatient admission
  • Evaluate cases of one-day inpatient stay and identify critical clinical indicators that reveal the possibility of shorter stays of less than two midnights
Carissa J. Tyo
Carissa J. Tyo, MD
Assistant Professor, Internal and Emergency Medicine; Program Director, IMEM Combined Residency; Medical Director, Clinical Decision Unit; Physician Advisor,
University of Illinois at Chicago Hospital and Health Sciences Systems

3:45 pm