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

CMS announced that as of January 1, 2018, total knee arthroplasty (TKA) will be removed from the Medicare IPO for procedures reimbursed only under IPPS. Now hospitals must decide if they should move these procedures to outpatient-only and receive a decrease in reimbursement. With total hip replacement likely a target for next year, discuss what happens when procedures come off the IPO.

  • Outline transitions in practice that must take place when a procedure comes off of the inpatient only list and what conversations are necessary with surgeons
  • Discuss how to document medical necessity with surgeries and how to write the orders
  • Understand how the change in total knee replacement policy impacts the Two Midnight Rule
  • Learn the financial impact of these policy changes on the hospital and patient
Simon Ahtaridis
Simon Ahtaridis, MD
National Clinical Advisor and Chief Medical Officer
Sound Advisory Services

9:00 am

A Hospital-Issued Notice of Noncoverage (HINN) is provided to patients when it is determined that the care they are receiving or are about to receive is not covered due to lack of medical necessity, inappropriate care setting, or an issue of “custodial care.” This session explains the HINN and how it is different from an ABN (Advance Beneficiary Notice of Noncoverage). Better understand how the HINN is delivered and the options a physician advisor has in order to fulfill Medicare requirements.

  • Discuss the differences between HINN 1, HINN 10, and HINN 12 and when to use them versus the ABN
  • Consider when, how, and who to deliver the notice, and the process that needs to be in place after it is delivered
  • Assess the liability that comes with using HINNs and how hospital finance, patient satisfaction, potential exposure to media, and medicolegal avenues are potentially impacted
Anita Shinde
Anita Shinde, MD
Physician Advisor
Lee Memorial Hospital

10:15 am

The goal of CMS’ HRRP (Hospital Readmissions Reduction Program) is to link payment to quality care, by focusing on 6 key diagnoses. Evaluate the common challenges with each diagnosis and how one hospital focused on CHF to reduce length of stay, readmissions, and mortality, while improving patient flow.

  • Review the challenges associated with impacting length of stay in patients with CHF
  • Consider how improved patient flow impacts ROI
  • Understand the multidisciplinary staff needed at multiple levels throughout the hospital to impact change
Marc Adler
Marc Adler, MD, MBA, FACP, CHCQM
Associate Chief Medical Officer
NYU Winthrop Hospital

11:15 am

With patients attributed under an ACO or value-based contract, hospitals see the financial benefit of keeping them out of the hospital. However, the benefit of shared savings, as well as the resources to achieve these goals, are often limited. Understand the role of the physician and the physician network in efficient utilization of acute care services, diagnostics, specialty care, and pharmacy costs.

  • Discuss what advanced value-based models look like and how are they beneficial to physician, hospital, and patient
  • Learn how most primary care and specialist physicians can succeed in value-based contracts and in other payment reforms
Arshad Rahim
Arshad Rahim, MD, MBA, FACP
Senior Medical Director, Population Health;
Assistant Professor, Medicine
Mount Sinai Health System

12:15 pm
1:15 pm

The care of patients with complex chronic diseases is getting more challenging. It is requiring greater skill to ensure that patient centered care is being offered at all times that is in alignment with patient and family values.

  • Define palliative care in a manner better understood by providers
  • Identify how palliative care can improve quality outcomes and provide cost savings
  • Discuss case studies of how palliative care can be utilized in patients with chronic illness
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

2:15 pm

Hospital-acquired infections (HAIs) are a constant threat to patients and lead to thousands of deaths each year. Learn about the impact of hospitalacquired infections on quality and the penalties incurred.

  • Review the most common and significant HAIs, and discuss how they may be impacted by documentation
  • Discuss the penalties associated with HAIs and how quality scores may be affected
  • Determine an action plan to evaluate quality and safety measures necessary to decreasing the prevalence of HAIs
Kevin Smith
Kevin Smith, MD
Associate Chief Medical Officer, Quality and Safety
Loyola University Medical Center

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

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)