Fight Like A Lawyer!

LEARNING OBJECTIVES:

• Learn how common inappropriate payer denials are
• Learn techniques for appealing medical necessity denials when commercial inpatient criteria are not met
• Learn to use the payer's criteria to appeal 1 day stays

Dr. Barbara Abrams

Physician Advisor, Orlando Health

Graduate of Boston University School of Medicine (1986) and Florida State University College of Law (2005). Completed Pediatric internship and residency at Cleveland Metropolitan General Hospital. Over 20 years of clinical practice (inpatient and outpatient). Completed fellowship in Regulatory Medicine at Food and Drug Administration (FDA). Practiced Disability Law and also worked in areas such as Guardianship and Child Advocacy. Physician Advisor for Orlando Health covering both adult and pediatric patients since 2018.

Clinical Validation Denials: A Survival Guide for Success

LEARNING OBJECTIVES:

• Highlight a stepwise action plan to approach the increasing number of clinical validation denials with utilization of coding, clinical documentation specialists, and physician advisors.
• Propose keys to success in a forward thinking approach to clinical validation denials.

Dr. Carrie Alme

Physician Advisor, Hospitalist, Froedtert and the Medical College of WI


Dr. Alme is a Physician Advisor and Hospitalist at Froedtert and the Medical College of Wisconsin. She is an Assistant Professor in the Department of Medicine.

Dr. Julie Kolinski

Physician Advisor, Adult and Pediatric Hospitalist, Froedtert and the Medical College of WI


Dr. Kolinski is a Physician Advisor and an Adult and Pediatric Hospitalist at Froedtert and the Medical College of Wisconsin. She is also an assitant professor in the Department of Medicine.

Aligning Patient Safety and Quality with the Hospital Revenue Cycle

LEARNING OBJECTIVES:

• Describe how the Hospital Revenue Cycle and Hospital Acquired Conditions teams can collaborate to meet respective goals more efficiently
• Conceptualize the positive impact that knowledge of hospital finance can have on programs focused on patient safety and quality goals.

Dr. Wendy Arafiles

Medical Director - Clinical Documentation Integrity Program, Phoenix Children's Hospital

Dr. Arafiles has been a practicing pediatric hospitalist at Phoenix Children's Hospital for 15 years with a specific interest in children with medical complexity and technology dependence. She has also filled the role of medical director of the Clinical Documentation Integrity (CDI) program since 2018. In her dual roles, she is intertwining skills in medical education, innovations in quality improvement for children with medical complexity, and foundational understanding of hospital finance. Her goals are to optimize the institution's ability to describe the complexity of the patient population and develop high-value programs in patient and family service. Dr. Arafiles has presented on both CDI and Medical Complexity topics at several national conferences, and she is an active member of the Pediatric Documentation Research Collaborative, a research group that focuses on documentation-related issues in pediatric hospitals.

Dr. Amy Sanderson

Physician Advisor - Clinical Documentation Integrity Program, Boston Children’s Hospital

Amy Sanderson, MD, is a pediatric intensivist at Boston Children’s Hospital. She has been the physician advisor for the CDI program since its inception in 2014. She also serves as an assistant professor in Anaesthesia at Harvard Medical School. Dr. Sanderson has presented at several national conferences, has published scholarly articles on medical documentation and contributed to the book Pediatric CDI: Building Blocks for Success. In addition, Dr. Sanderson is a founding member of the Pediatric Documentation Research Collaborative, a research group that focuses on documentation-related issues in pediatric hospitals.

Reviewing the Behavioral Health Case with Significant Medical Issues

LEARNING OBJECTIVES:

• Identify the correct location for the patient, including outpatient, inpatient acute medical hospitalization, or acute inpatient psychiatric hospitalization.
• Understand how the presence of a psychiatric disorder impacts the decision for hospitalization, the need for observation vs. inpatient services, and the actual/predicted length of stay for the patient.
• Understand how documentation of the challenges in treating medical illness created by acute psychiatric symptoms can support medical necessity for acute medical level of care.
• Understand the challenges of segmentation of medical and psychiatric coverage and how to approach it.

Dr. Erin Boyd

Physician Advisor Team Lead, Sound Physicians

Erin Boyd, MD, CHCQM-PHYADV, is a physician advisor team lead for strategic accounts at Sound Physician Remote Advisory Services. She began her training in psychiatry after which she shifted her attention to full time internal medicine hospitalist work all while maintaining a passion for how to care for patients with both medical and psychiatric illness and do it most efficiently. Outside of her advisory team lead role, she served as hospitalist medical director of a large hospitalist group, has led the hospital utilization committee, and has worked collaboratively with several independent review organizations to help facilitate appeal of payer denials for numerous hospital systems. Interests outside of the med-psych utilization space include strengthening physician-care management relationships, bridging clinical and non-clinical leaders, physician mentoring, and clinical documentation improvement.

Skilled Nursing Facilities and Discharge Planning - Physician Advisors and Population Health

LEARNING OBJECTIVES:

• Understand the clinical risks and costs associated with skilled nursing facilities (SNFs).
• Understand the impact of SNF overutilization on health care costs and the central role that ensuring appropriate use of SNFs have within a value based care strategy
• Understand the Medicare Regulations related to skilled nursing facility skilled benefit requirements
• Understand the approach to discharge planning that Northshore University Healthcare has taken and the central role that physician advisors plan in discharge planning to this setting.

Dr. Christopher A. Boyle

Associate Chief Quality Officer, NorthShore

Dr. Boyle Joined NorthShore in 2015 and currently serves as the Associate Chief Quality Officer. He is a Hospitalist and Clinical Assistant Professor at the University of Chicago Pritzker School of Medicine.

Dr. Boyle attended Columbia University College of Physicians and Surgeons for medical school and completed his Internal Medicine training at the University of Washington with a specialty focus in HIV Medicine and primary care.

Transfer Centers - Physician Advisors Should Lead the Way!

LEARNING OBJECTIVES:

• Describe the basics of EMTALA regulations and recognize when these regulations apply to transfer requests.
• Describe how to integrate physician advisors into the transfer process to maximize their strengths.
• Devise and track quality and performance metrics for transfer center programs.

Dr. Scott Ceule

Lead Physician Advisor, University of Kansas Health System

Scott Ceule, M.D. is a Clinical Associate Professor of Medicine in the Emergency Department at the University of Kansas Health System. His training was in a combined Internal Medicine/Pediatrics residency but his clinical duties have always been based in the Emergency Department or the Emergency Department Observation Unit. He serves as the Vice-Chair for Administrative Affairs for the Emergency Department. He became the first physician advisor for the health system in 2017. He has helped build the program through serving as the the lead and mentor to other physician advisors. He continues to grow the program and now serves as medical director for the transfer center which will be supported by the physician advisor team. He is excited to share this new role and how it fits so well with his current physician advisor program.

Engaging Pediatricians to Help with Pediatric Population Denials

LEARNING OBJECTIVES:

• Identify common diagnoses that qualify for admission in pediatrics
• Recognize the differences in pediatric presentations of common diagnoses
• Develop a strategy to engage specialists in the denial process

Dr. Katharine Clouser

Pediatric Clerkship Director, Hackensack University Medical Center

Katharine Clouser received her MD from the University of New Mexico School of Medicine and then completed her Pediatric Residency at Rutgers New Jersey Medical school. She completed a chief residency at Hackensack University Medical Center, then joined the faculty in 2016. She has served as a pediatric hospitalist as well as the Physician Advisor for the Joseph M Sanzari Children's Hospital. She is the Pediatric Clerkship Director at the Hackensack Meridian School of Medicine where she has developed medical student education on Physician Advisor duties and quality reviews.

To Observe or Not to Observe? Questions at a Daily Huddle

LEARNING OBJECTIVES:

• Understand the role that a Physician Advisor can play in becoming a liaison between medical staff, the Utilization Review team, Case Management, and CDI.
• Evaluate interventions a multidisciplinary Utilization Review team may consider beyond bed status when frequently reviewing patient beds.

Dr. Jennifer Goodrich

CDI Physician Advisor, Dell Children's Medical Center


Dr. Jennifer Goodrich is a Pediatric Hospitalist and Physician Advisor at Dell Children's Medical Center, in Austin, TX. She joined the hospital's CDI team in 2020 and enjoys teaching efficient and effective documentation to medical staff. She has also contributed to documentation pearls in an upcoming publication of an educational guide for Pediatric Hospital Medicine put forth by the AAP.

Dr. Alyssa Riley

CDI Physician Advisor, Dell Children's Medical Center


Dr. Alyssa Riley is a pediatric nephrologist and physician advisor at Dell Children's Medical Center, in Austin, TX. She has worked with the hospital's CDI team since 2017 to teach physicians better documentation. As a lifelong numbers geek, teaching morphed into analytics, and since 2019, she's been a Physician Advisor, expanding from CDI to include UR & CM roles.

The Medicare Fee for Service Appeals Landscape: Utilizing Decisions to Guide Compliance and Prevent Denials

LEARNING OBJECTIVES:

• Through case study examples, discern the ways in which Administrative Law Judges are deciding hospital appeals for certain categories of claim denials (e.g., status denials, denials involving total joint procedures)
• Understand the importance of communication between those involved in the appeals process and those implementing workflows in the hospital to guide compliance and prevent future denials
• Describe potential changes to the Medicare appeals landscape resulting from the 2nd Circuit court decision in Barrows v. Becerra.

JESSICA GUSTAFSON

Founding Shareholder, The Health Law Partners, P.C.


Jessica L. Gustafson is a founding shareholder with The Health Law Partners, P.C. She represents hospitals, health systems, hospices, home health agencies, physicians, and other health care providers and suppliers in an array of health care legal matters. Ms. Gustafson devotes a substantial portion of her practice to representing providers in the Recovery Audit ("RAC") and Medicare audit appeals process. She also regularly assists clients with compliance and reimbursement matters, overpayment refunds, Medicare enrollment matters, and other health care regulatory matters.

Observation Services - Choosing and Billing It Right

LEARNING OBJECTIVES:

• Understand the appropriate role of Observation services for medical and surgical patients
• Determine the compliant way to prepare claims for Observation services to avoid overpayments
• Differentiate the handling of Observation services for governmental and commercial payers

Dr. Ronald Hirsch

Vice President Regulations And Education Group, R1 Rcm, Inc.

Member, ACPA Advisory Board
Editor, ACPA Update

Dr. Ronald Hirsch is a Vice President of the Regulations and Education Group at R1 RCM Inc. Dr. Hirsch was a general internist and HIV specialist and practiced at Signature Medical Associates, a multispecialty practice located in Elgin, IL. He was Medical Director of Case Management at Sherman Hospital in Elgin, IL from 2006 to 2012, where he was Chairman of the Medical Records Committee from 1995 to 2012, and also served on the Medical Executive Committee. Dr. Hirsch is certified in Health Care Quality and Management by the American Board of Quality Assurance and Utilization Review Physicians, certified in Revenue Integrity by the National Association of Healthcare Revenue Integrity, and on the Advisory Board of the American College of Physician Advisors. He is on the editorial board of RACmonitor.com. He is the co-author of The Hospital Guide to Contemporary Utilization Review, with the third edition published in 2021.

Emergency and Post-Stabilization Services

LEARNING OBJECTIVES:

• Apply the prudent layperson standard for emergency medical conditionsApply the prudent layperson standard for emergency medical conditions
• Understand the concept of stabilization of an emergency medical condition
• Explain the implications of care rendered to stabilize and emergency medical condition vs post-stabilization care
• Understand the statutory and regulatory protections built into Medicare Advantage and Managed Medicaid when beneficiaries present for emergency care

DR. Edward P. Hu

System Executive Director / Inpatient Physician Advisor Services, UNC Health

Past President, American College Of Physician Advisors

Edward P. Hu, MD, CHCQM-PHYADV, is the system executive director of hospital physician advisor services at UNC Health Care System, where he supports the development of physician advisor programs at 10 system hospitals. He completed his medical education at Washington University School of Medicine in St. Louis, Missouri, and went on to complete his residency in internal medicine at Duke University Medical Center in Durham, North Carolina. Hu is board certified in internal medicine and healthcare quality and management with a subspecialty certification as a physician advisor. He practiced as a hospitalist for 14 years and served as a medical director of case management at UNC Rex Hospital in Raleigh, North Carolina. His areas of interest include Medicare regulations, revenue cycle, compliance, patient safety and quality, and risk adjustment. He served as the second president of the American College of Physician Advisors from 2016 to 2019.

Myth vs Fact: Misconceptions about Pediatric CDI Programs

LEARNING OBJECTIVES:

• Differentiate between adult CDI and pediatric CDI programs
• Appreciate nuances of APR-DRG vs MS-DRG
• Use case examples to learn about Pediatric specific CDI opportunities.

Dr. Lucinda Lo

Attending Physician and Physician Advisor for CM and CDI, Children’s Hospital Of Philadelphia

Lucinda Lo, MD, is a practicing pediatric hospitalist at the Children’s Hospital of Philadelphia which she joined in 2003. She is a Clinical Assistant Professor of Pediatrics at the University of Pennsylvania School of Medicine and she is board certified with the American Board of Pediatrics. She is currently the physician advisor for CDI and CM. She provides both education to medical staff on topics related to CDI and feedback about their clinical documentation. She fully participates in utilization management and denial reviews as well as formulation of associated institutional policy and practice.

Dr. Sheilah Snyder

Associate Professor, Children's Hospital/University of Nebraska Medical Center

Sheilah Snyder, MD FAAP, is a board certified pediatric hospital medicine specialist, clinical associate professor, and CDI physician advisor for Children's Hospital & Medical Center in Omaha, Ne. Snyder serves as a physician champion for the Epic inpatient team, which allows her to leverage the EHR to produce excellent CDI outcomes. She teaches faculty, fellows, residents, and students about CDI and speaks nationally about pediatric CDI topics.

Financial Effects by Removal of Orthopaedic Procedures From Medicare's “Inpatient-Only” List

LEARNING OBJECTIVES:

• Better understand the differences in hospital payment between short-stay inpatient and outpatient orthopedic procedures under the DRG/C-APC models.
• Better understand the principles of the Maryland Global Budget Payment model and how this model mitigates differences in hospital payment between short-stay inpatient and outpatient orthopedic procedures

Dr. Charles Locke

Physcian, Associate COO BCCFH COVID Task Force, Johns Hopkins University School of Medicine

ACPA Treasurer and Past President

Dr. Charles Locke is the Executive Medical Director, Care Management for LifeBridge Health. Previously, he served as a Physician Advisor from 2011 to 2013 and the Senior Physician Advisor 2013 to 2021 for the Department of Utilization Review and Clinical Resource Management, Johns Hopkins Hospital. He is also an Assistant Professor in the Department of Medicine, Johns Hopkins School of Medicine. He has been active in areas CMS hospital payment and audit policy, including visit status determination, the 2-midnight rule and the Recovery Audit (RA) program. Dr. Locke served as ACPA President in 2019 and 2020 and he is currently the ACPA Treasurer.

Procedural Coding System Focused Reviews: Leveling Up Your Physician Advisor Program

LEARNING OBJECTIVES:

• Identify the physician advisor's role in supporting PCS-focused reviews.
• Outline a plan of action for the establishment of PCS-focused reviews.
• Identify key performance metrics for monitoring and demonstration of return on investment associated with PCS-focused reviews.

Dr. Adriane Martin

Vice President of Physician Services, Enjoin

Adriane Martin, DO, FACOS, CCDS, graduated from the University of North Texas Health Science Center with her Doctorate of Osteopathy. She completed her general surgery residency at OMCT/Ft. Worth in 2004. Dr. Martin has been practicing general surgery for 15 years and has been a part of the Enjoin team since 2014.

As Vice President of Physician Services, Dr. Martin directs many initiatives within the company to support operations and ongoing company growth. She leads all internal and external efforts for our physician team to support our clients with actionable data and educational content. With her extensive knowledge of documentation and coding principles combined with her clinical surgical experience, she brings a level of clinical and coding acumen unparalleled in the industry.

Her commitment and passion to documentation integrity are demonstrated by her thought leadership and involvement in many industry meetings and events at the state and national levels.

Surfacing Healthcare Quality Improvement Tactics by Diving into Data

LEARNING OBJECTIVES:

• Highlight the role that Physician Advisors can have in educating peers to improve outcome metrics.
• Provide examples of simple data aggregation that promotes quick understanding for busy professionals.
• Identify tactics that align with improvement in publicly reported data.

Dr. Takiko May

Physician Advisor Educator
, Intermountain Healthcare

Takiko May, MD, a practicing adult hospitalist for nearly 20 years, has been a Physician Advisor Educator for CDI with Intermountain Healthcare since 2017. Most recently she served as Medical Director at Intermountain Logan Regional Hospital where she educated multiple stakeholders regarding the critical impact of CDI and UR on reportable metrics. She leveraged her knowledge of CDI with physicians and advance practice providers in multiple service lines to help move her facility to number 6 out of 211 in Vizient's community hospital cohort for 2021. Taki is board-certified in Internal Medicine with Focused Practice in Hospital Medicine, as well as in Hospice and Palliative Medicine. Providing care that is congruent with patient goals is her clinical passion.

Dr. Beau Bailey

MD, Intermountain Healthcare

Beau Bailey, M.D., is a practicing adult and pediatric hospitalist since 2015. He served as lead of hospitalist medicine and internal medicine department chair at Intermountain Utah Valley Hospital in Provo, UT until 2019 when he had the opportunity to transition to a role in Intermountain's physician advisor services. He is currently a provider educator on CDI and UR for adult and pediatric specialty based care. He also performs utilization reviews for admissions at Intermountain's Primary Children's Hospital. He has recently taken a key role in denials and appeals for the Intermountain system. Beau is board-certified in Internal Medicine and Pediatrics and works principally in hospital based care. Beau also works in Palliative Medicine as a general inpatient hospice provider for Inspiration Hospice.

The Physician Advisor Role: Improving Hospital Performance the Clinical Revenue Cycle

LEARNING OBJECTIVES:

• Gain a working understanding of revenue cycle components associated with patient status, clinical documentation improvement, coding, billing, and managed care and how Physician Advisors’ role impacts short-term acute care hospital reimbursement.
• Equip hospital Physician Advisors with effective strategies to obtain and maintain overall revenue integrity by effectively understanding their impact on all the areas of the revenue cycle.

Dr. Jerilyn P. Morrissey

Senior Vice President, Clinical and Regulatory Affairs, Versalus Health

Dr. Morrissey is passionate about using data and technology to help hospitals navigate complex Medicare regulations and understand payer practices and their impact on the hospital revenue cycle. Dr. Morrissey’s experience as a practicing physician, a Physician Advisor for a nationally recognized health system, and as a Director of Clinical Information for a national payer, afford her a unique perspective to solve utilization management’s evolving challenges.

Leading as a Physician Advisor: Elevating Your Role

LEARNING OBJECTIVES:

• Learning how to move from being a physician advisor by default to an intentionally driven leader by understanding your leadership style, your strengths and opportunities.
• Understand expectations from your major stakeholders and demonstrate clarity in your role and your value to the organization.
• Understand how to partner and leverage your stakeholders for unified success.

Dr. Ada Offurum

Assistant Professor, Medical Director, Physician Advisory Group, University of Maryland Medical Center

Dr Ada Offurum, MD, FACP is an Assistant Professor at University of Maryland Medical Center, Lead Physician Advisor and is the Assistant Dean of Faculty Affairs and Professional Development at University of Maryland School of Medicine. She co-chairs the VTE Prophylaxis Task Force and is certified in Lean Methodology and as a trainer in the American Academy for Communication in Healthcare. She is passionate about solutions to the most complex of discharges and has spearheaded the expansion of the UMMC Physician Advisor program to tackle LOS, Readmissions, Denials and Medicare compliance, Documentation in a large academic tertiary center. In her role as a clinician educator and Assistant Dean for Faculty development, she mentors students, residents, faculty and Physician advisors to achieve their career goals. Using Lean Methodology as a framework, she teaches how to identify barriers to one's goals, analyze gaps and create simple steps to achieve career success.

Tiffany Ferguson

CEO, Phoenix Medical Management

Tiffany Ferguson is CEO of Phoenix Medical Management, Inc., the care management company. Tiffany serves on the board for Northern Arizona Gerontology Association and the American College of Physician Advisors (ACPA) Observation Subcommittee. Tiffany is a regular contributor to RACmonitor, Case Management Monthly, and commentator for Finally Friday. After practicing as a hospital social worker, she went on to serve as Director of Community Case Management and quickly assumed responsibilities in system level leadership roles for Health and Care Management and c-level responsibility for a large employed medical group which included value-based arrangements, PCMH, and outpatient care management. Tiffany is a graduate of Northern Arizona University and received her MSW at UCLA. She is a licensed social worker, ACM, and CMAC certified.

It’s a Kaleidoscope – The Evolution of a Physician Advisor Program

LEARNING OBJECTIVES:

• Explore stations within the spectrum of a physician advisor’s journey.
• Show the contiguous nature of healthcare silos in the eyes of the PA.
• Describe the leadership skills required to create and grow a IPAS.
• The opportunities for Health System Leadership from the PA role.

Dr. Alexander Ogedegbe

Medical Director of UM and CDI, Riverside Health System

Alexander Ogedegbe, MD, CHCQM, is a hospitalist and full-time lead physician advisor and Medical Director of UM and CDI of a 350-bed, four-hospital health system in eastern Virginia.

Dr. Emeric Palmer

Medical Director, Anthem Inc

Member, ACPA Board of Directors

ACPA National Physician Advisor Conference Champion

Dr. Palmer is a Medical Director with Anthem Inc. He has worked as a Physician Executive in the Revenue Cycle for the last decade. He served as Senior Medical Director Resource Utilization at Mary Washington Healthcare, Physician Advisor and Assistant Chief Medical Officer at Inova Mount Vernon Hospital in Northern Virginia, and Physician Advisor at Meritus Medical Center in Maryland. With the Revenue Cycle Solutions division of the Advisory Board Company Inc, he delivered engagement and training of physicians around physician documentation improvement in hospitals and healthcare systems across the country. He serves on the CDI committee with the American College of Physician Advisors (ACPA).

Healthcare Reform, Wayne Gretsky, Strategy and Success: An Integrated Clinician Advisor Program

LEARNING OBJECTIVES:

• Understanding the direction of healthcare reform in the US.
• Understanding the critical role that clinician advisors (physician advisors and pharmacist advisors) play in the success of healthcare reform in improving patient access to care, reducing the total cost of care and optimizing revenue for appropriate utilization of healthcare resources within many areas of an integrated healthcare system.

Dr. Christine Palermo

Medical Director of Business Services, Physician Advisor for the Revenue Cycle, Virginia Mason Franciscan Health

Christine Palermo is an internal medicine physician and the Medical Director of Business Services and Physician Advisor for the Revenue Cycle at Virginia Mason Franciscan Health. In this role Christine provides strategic direction and oversight of the Clinician Advisor Program which combines clinical acumen and business knowledge supporting the hospital revenue cycle, the pharmacy revenue cycle, the supply chain and value-based care arrangements and driving quality and economic outcomes and consummate performance. Christine is also a member of the Washington Health Alliance Health Economics Committee, the Washington State Medical Association Work Group for the Washington Healthcare Cost Transparency Board and the Board of Directors for the Rainier Health Network Accountable Care Organization bringing together healthcare providers, employers, patients and insurance payers in pursuit of affordable, high-quality healthcare through innovation and the transformation of healthcare delivery.

Amber Reeff

Senior Director Revenue Cycle and Patient Access, Virginia Mason Franciscan Health

Amber Reeff is in her twenty-fifth year at Virginia Mason Franciscan Health and is the Senior Director of the Revenue Cycle and Patient Access. In this role, Amber has provided strategic direction and oversight of the growth and development of a best-in-class Revenue Cycle. Amber is also a strategic colleague in a clinical and administrative dyad partnership with Dr. Christine Palermo in developing and implementing an innovative and successful organization-wide revenue optimization initiative that is now in its fourth year and going strong.

Walk the Line The Physician Advisors Role in Compliance

LEARNING OBJECTIVES:

• Recognize potential compliance concerns related to physician advisor communications with providers.
• Define the role of physician advisor in promotion and support of compliant CDI practices.

Laurie L. Prescott

Director CDI Education
, Simplify Compliance - ACDIS

Laurie L. Prescott RN, MSN, CCDS, CDIP, CRC is the CDI education director at HCPro, an H3.Group brand, in Middleton, Massachusetts. She is the developer and instructor of the CDI Boot Camps, a subject matter expert for the Association of Clinical Documentation Improvement Specialists (ACDIS), a member of the CCDS-O exam and the ACDIS Advisory Boards. She is also the author of The Clinical Documentation Improvement Specialist’s Complete Training Guide and ACDIS Pocket Guide series.

Geometric Mean Length of Stay - An Innovative Solution to Patient Throughput

LEARNING OBJECTIVES:

• Understand how variation in expected length of stay practices leads to delays in patient discharge
• Understand why geometric length of stay is a more precise tool to benchmark expected date of discharge
• Understand how the integration of geometric length of stay into multidisciplinary rounds can lead to improved care coordination and delivery

Dr. Siddharth Raghavan

System Director, Physician Advisor Service, Sutter Health

Dr. Raghavan implemented the systemwide internal physician advisor service (IPAS) at Sutter Health in 2020. As director of the program, he is responsible for a group of centralized and hospital based physician advisors, who provide guidance to care teams in making decisive judgments on medical necessity and help ensure smooth patient progressions through the continuum of care. His role also includes oversight of acute UM, hospital resource functions, level of care placement, clinical denials management, audit defense, and back-end revenue recovery.

Sick or Not: Only the Documentation Knows For Sure

LEARNING OBJECTIVES:

• Recognize how documentation can impact medical necessity determination,
• Understand how to teach providers how to improve their documentation to support medical necessity and intensity of service.
• Explain how to integrate medical necessity considerations into CDI review.

Dr. Erica Remer

President, Erica Remer, MD, Inc.

Member, ACPA Board of Directors
Co-Chair, ACPA Clinical Documentation Integrity Committee

A practicing emergency physician for 25 years and physician advisor of a large multi-hospital system turned independent consultant, Dr. Erica Remer is a national expert on documentation, CDI, and ICD-10. She has authored numerous articles and is the co-host of a weekly national podcast, Talk Ten Tuesdays. Remer is a member of the Board of Directors of ACPA and the co-chair of the CDI Committee, on the Editorial Board of ICD10Monitor, and a past member of the ACDIS Advisory Board. Her passion is educating CDI specialists, coders, physician advisors, and healthcare providers with engaging, case-based presentations and the goal of putting MENTATION back into Documentation.

Dr. Ronald Hirsch

Vice President Regulations And Education Group, R1 Rcm, Inc.

Member, ACPA Advisory Board
Editor, ACPA Update

Dr. Ronald Hirsch is a Vice President of the Regulations and Education Group at R1 Physician Advisory Services. He completed his internal medicine residency at Kaiser Permanente Medical Center in Hollywood, CA. Dr. Hirsch was Medical Director of Case Management at Sherman Hospital in Elgin, IL from 2006 to 2012 and also served on the Medical Executive Committee. Dr. Hirsch is certified in Health Care Quality and Management by the American Board of Quality Assurance and Utilization Review Physicians, is a member of the American Case Management Association, on the Advisory Board of the American College of Physician Advisors, a Fellow of the American College of Physicians, and on the advisory board of the National Association of Healthcare Revenue Integrity. He is the co-author of The Hospital Guide to Contemporary Utilization Review, which was published in 2021. In 1996 he was a guest on the Jerry Springer Show.

Clinical Champions for Education: Developing Institutional Programming for Success

LEARNING OBJECTIVES:

• Evaluate how one may engage providers for ongoing communication and education.
• Describe educational opportunities that may be addressed by a physician advisor program.

Dr. Alyssa Riley

Physician Advisor / Associate Professor, Dell Children's Medical Center

Dr. Alyssa Riley is a pediatric nephrologist and physician advisor at Dell Children's Medical Center, in Austin, TX. She has worked with the hospital's CDI team since 2017 to teach physicians better documentation. As a lifelong numbers geek, teaching morphed into analytics, and since 2019, she's been a Physician Advisor, expanding from CDI to include UR & CM roles.

Dr. Jennifer Goodrich

Assistant Professor / CDI Physician Advisor, Dell Children's Medical Center

Dr. Jennifer Goodrich is a Pediatric Hospitalist and Physician Advisor at Dell Children's Medical Center, in Austin, TX. She joined the hospital's CDI team in 2020 and enjoys teaching efficient and effective documentation to medical staff. She has also contributed to documentation pearls in an upcoming publication of an educational guide for Pediatric Hospital Medicine put forth by the AAP.

The 123s of HCCs

LEARNING OBJECTIVES:

• Define Hierarchical Condition Categories (HCCs) and provide examples of common HCCs.
• Understand the role of HCCs in risk-based contracting and value-based care as well as the impact on fee-for-service payers.
• Compliantly capture an HCC, including understanding MEAT (monitor, evaluate, assess, treat) criteria.
• Gain insight into how NorthShore University Health System has approached HCC education and capture.

Dr. Purvi K. Shah

Primary Care Internist / Physician Advisor
, NorthShore University HealthSystem

Purvi K. Shah, MD is a primary care internist and physician advisor at NorthShore University Health System in Evanston, IL. She graduated summa cum laude from Washington University in St. Louis and attended Vanderbilt University School of Medicine as a recipient of the Canby Robinson Scholarship. After completing her internal medicine residency at Northwestern University, she joined the professional staff at NorthShore University Health System, practicing primary care internal medicine for 10 years prior to joining the physician advisor program. Her areas of focus are HCC education, outpatient CDI, and care transitions.

Closed Observation Units

LEARNING OBJECTIVES:

• Review basics of observation levels of care (for new PA's), definitions, practical examples
• Compare/ Contrast Open and Closed Observation Units: operationally, use of dedicated observationalists, financial impact of observation medicine
• Discuss use of metrics to track performance
• Use of multidisciplinary rounds at observation units

Dr. Howard A. Stein

Associate Director Medical Affairs Centrastate Healthcare System, Centrastate Medical Center
Member, ACPA Board of Directors
RAC Relief Champion

Dr. Howard Stein has been a Physician Advisor since 1993. He is a guest on Monitor Monday and RAC Monitor, national speaker on multiple topics, founding ACPA board member, and ABQAURP Education committee member. Dr. Stein is a father of five and an avid Bruce Springsteen and New York Mets fan.

Reviewing the Two Midnight Rule and the Importance of D-Day Documentation

LEARNING OBJECTIVES:

• Understand the thought process behind documentation for exceeding the two midnight expectation of care
• Be able to define “D-Day Documentation” and apply it to capture of medical necessity to secure appropriate status determination
• State some clinical examples of appropriate “D-Day Documentation

Dr. Nick Ulmer

VP Clinical Integration, Medical Director of Case Management, SRHS
Chief Medical Officer, Regional HealthPlus PHO

Dr. Ulmer has been a practicing physician since 1991 and realized his love (and need) for the business of medicine through coding, documentation, and billing early in his career. He became a certified professional coder (CPC) in 2002, making him one of only 16 physicians in America at that time with the “MD/CPC” credentials. Since then, he has been active nationally as a speaker and advisor to healthcare systems and physician practices of all sizes helping optimize the business of healthcare as it pertains to outpatient and inpatient medicine.