8:30 am -
11:45 am

The shift towards value-based care, consistent downward reimbursement pressure, and the ever-changing health care policies are making the roles of Physician Advisors and Medical Directors ever more important within their organization. Navigating through the intricacies of utilization management, medical necessity, and appropriate documentation can be daunting, especially as the role continues to evolve. In this workshop, establish the foundation needed to successfully meet expectations and maximize the potential of the role.


Evaluate Your Organization’s Bandwidth to Determine Opportunities for the Role
  • Break down the responsibilities of a Physician Advisor
  • Learn how to justify the value of the role to organizational leadership
  • Identify available resources internally and externally to assist you in balancing clinical and administrative time
  • Discuss what elements a comprehensive program should include

Policy Update: Refresh on Regulations to Master Medical Necessity and Utilization Review Requirements
  • Review nuances of the CMS Two-Midnight Rule and MOON notice, and understand the exceptions
  • Discuss your role in the utilization review committee to maximize your impact
  • Condition Code 44 and W2, and determine how to appropriately use them

CDI Update: Discuss Best Practices of Documentation and Denial Management
  • Explore methods to improve clinical documentation workflow
  • Discuss strategies to address appeals and denials, and the levels of appeals
  • Review CMS and commercial payer policy on readmissions
Maria M. Garcia
Maria M. Garcia, MD, MPH, FACP
Professor of Medicine, Physician Advisor for Utilization and Care Coordination
UMass Memorial Medical Center

David Goldner
David Goldner, MD, FACC
Medical Director, Utilization Management and Appeals
Lehigh Valley Health Network

8:30 am -
11:45 am

Untangle the complexities involved with the operation of observation units. Uncover best practices to implement a highly productive unit in order to increase patient satisfaction and decrease length of stay.

Gain administrative buy-in
  • Garner actionable information that can be presented to the leadership
  • Examine how to determine administrative and operational resources needed and project ROI of an observation unit Determine the optimal staffing model
  • Evaluate the staffing models that work best in different types of observation units
  • Discuss methods to measure productivity in observation units and how to manage staffing retention

Establish clinical and logistical resources and infrastructure needed to run an unit
  • Create necessary protocols and order set templates for common diagnoses
  • Implement and optimize EHR use in observation units to increase productivity
  • Determine the team structure needed to succeed: physician advisors, medical directors, nurse leaders, etc.
Blaine Stringer
Blaine Stringer, MSN, RN, CEN, NE-BC
Adult Observation Unit Director
Rush University Medical Center

Amit Wadhwa
Amit Wadhwa, MD, FAAEM
Medical Director, Utilization and Care Management
Holy Cross Health