Informal discussions with thought leaders on topics of interest

1. Meeting of the Minds with the MAC
    Toni Sculimbrene, MD (Medical Director, Palmetto GBA)
    a. Define roles  of the Medicare Administrative Contractor
    b. List ways to optimally work with the MAC and your healthcare system

2. Medicare Advantage Plan Management and the Physician Advisor’s Role 
    Phil Baker, MD (Physician Advisor, Self Regional Healthcare)
    a. Discuss areas of opportunity available in working with your system and Medicare Advantage Plans
    b. Describe strategies to help successfully navigate opportunities for better MA alignment

3. Care Coordination Across The Continuum 
    Angie Roberson, RN (Spartanburg Regional), Suzanne Wilson, RN (AnMed Health), and Amy Deutzendorf RN (John Hopkins)
    a. Outline ways for optimal PA integration as an adjunct to the Case Manager’s needs

4. The Internal Physician Advisor Team: Strategies for Successful Deployment
    Julia Wren, MD (Tidelands Health) Michael Kunkle, MD (AnMed Health), and Ginger Boyle, MD (Spartanburg Regional)
    a. "Best Practice” of internal PA Team design, delivery

5. Expanding the PA professionally: What is after “status determination”
    Hossain Marandi, MD (President and Chief Executive Officer, Peyton Manning Children's Hospital at St. Vincent)
    a. Outline the types of clinical/administrative roles that await the PA

  • Day 1
    April 26
  • Day 2
    April 27
  • Day 3
    April 28


7:30AM - 8:30AM


8:30AM - 8:50AM



E.G. "Nick" Ulmer, MD, CPC
VP, Clinical Integration and Medical Director of Case Management
Spartanburg Regional Healthcare System, Spartanburg, SC


8:50AM - 9:40AM


Back to the Future: Healthcare Through the Ages

Thornton Kirby, FACHE
SC Hospital Association, Columbia, SC

  • Understand the foundation of the American healthcare system
  • Denote the reasons behind the various initiatives imbedded in our current programs
  • Understand the linkage to newer models of care based on past experiences


9:40AM - 10:30AM


Health Care System Transformation: Moving from Volume to Value

Jeff Farber, MD, MBA, FACP
Mount Sinai Care, LLC
Senior Vice President & CMO for Population Health
Mount Sinai Health System, New York, NY

  • Define “Population Health”
  • List ways CMS is driving this transformation in healthcare
  • Understand the implications of MACRA to physicians and the healthcare market
  • Know ways to best prepare for the new landscape, across all lines of business, Medicare, Medicaid, and Commercial
  • Why a Physician Advisor should learn about Clinical Integration


10:30AM - 10:50AM



10:50AM - 11:40AM

Looking in the mirror…. What do you see? Leadership in Transition

Larry Field, DO, MBA, CHCQM
Physician Advisor
Munroe Regional Medical Center, Ocala, FL

  • Review some reasons people are resistant to change.
  • Be informed of how changes in medicine have affected physician outlook.
  • Learn the components of gaining commitment and how proper engagement can be the key to behavior change.
  • Embrace the total value that a well-rounded PA can bring to an enterprise.


11:40AM - 12:30PM


How to NOT be a "bundling Idiot"

Jeff Farber, MD, MBA, FACP
Mount Sinai Care, LLC
Senior Vice President & CMO for Population Health
Mount Sinai Health System, New York, NY

  • Understand the basics behind the CMS Bundled Payment initiatives
  • Describe the metrics important for the success in these initiatives
  • Relate "best practice lessons learned" from the CHI experience in this space
  • How can Physician Advisors best serve supporting roles in these projects


12:30PM - 1:00PM


Working Lunch

1:00PM - 1:50PM


Clinical Integration and the Physician Advisor: The New Frontier

E.G. "Nick" Ulmer, MD, CPC
VP, Clinical Integration and Medical Director of Case Management
Spartanburg Regional Healthcare System, Spartanburg, SC

  • Explain the 2017 definition of Clinical Integration
  • Define areas within healthcare systems where silo’s exist
  • Outline steps that can be taken to streamline care and metrics to manage to monitor success


1:50PM - 2:40PM


The Basic Physician Advisor Primer: Where do I Start?

Physician Advisor and Medical Director of Care Management
Froedtert Hospital Assistant Professor of Medicine
Medical College of Wisconsin, Milwaukee, WI

  • Be able to discuss basic skill sets PAs need to master
  • Understand the basics behind Medicare’s Part A, Part B, and inpatient/observation discussion
  • Define the 2 Midnight Rule and the steps needed to follow related to cc44 and HINNs


2:40PM - 3:00PM



3:00PM - 3:50PM


The Highs and Lows of Big Data

Ralph Wuebker, MD, MBA
Chief Medical Officer
Optum Executive Health Resources, Newtown Square, PA

  • Describe areas that data management is most needed in integrated delivery systems
  • Outline data needs that are specific to the physician advisor functions
  • List a best practice on dashboard use for the physician advisor


3:50PM - 4:40PM


ICD-10-CM’s Impact on Inpatient and Outpatient Quality and Cost-Efficiency – From CC to Shining HCC.

James S. Kennedy, MD, CCS, CCDS, CDIP
President, CDIMD – Physician Champions
Smyrna, Tennessee

  • Describe in general terms the ICD-10-CM-based quality and cost-efficiency integral to MACRA, MIPS, and other PPACA-based initiatives
  • Review ICD-10-CM-based documentation and coding rules integral to coding compliance
  • Outline disease definition and documentation challenges often addressed by physician advisors
  • Provide a suggested management action plan that can be implemented the following Monday


4:40PM - 5:00PM





7:00AM - 7:50AM


8:00AM - 8:10AM


Lisa Banker, MD
VP, Chief Physician Advisor
Case Management Services
McLeod Health System


8:10AM - 9:00AM


The CMS Quality Payment Program: MACRA, QPP MIPS and Alternative Payment Mechanisms (APMs)

Richard E. Wild, MD, JD, MBA, FACEP
Chief Medical Officer, Atlanta Regional Office
Centers for Medicare and Medicaid Services (CMS)

  • Define the over-arching goal of CMS to move from volume-based to value-based care
  • Be able to describe the two major aspects of the QPP: MIPS and APM
  • Outline some strategies to lead medical groups and systems into QPP success


9:00AM - 9:50AM


How Do I Observe Thee, Let Me Count the Ways?

Miles Hawley, MD, MBA
System Director, Hospital Medicine
Medical Director, Physician Advisor Program
Ohio Health

  • Know the general overview of observation trends, national info on what the scope of this looks like
  • Define the 2 MN rule and its application in a system-wide observation medicine strategy
  • Understand any system-level strategies OhioHealth has undertaken to address the observation issues faced
  • Overview of the use of Observation Units, and specifics related to provider types, staffing and operations


9:50AM - 10:20AM



10:20AM - 11:10AM


Length of Stay Management - A Change in Perspective

Pat Kramer, Ed.S., ACM, CCM, CSW, NCC
Senior Director, Case Management, Duke University Health System
Adrienne Coats, BA, MHA

  • Examine the creation of an internal Physician Advisor Program that integrates the PA role into active involvement in length of stay management
  • Appreciate the value of changing your focus from individual outliers to populations of patients
  • Review a model that can be easily replicated in your facility
  • Develop an appreciation for the power of data to capture the attention of decision makers


11:10AM - 12:00PM


The Super-Utilizer Saga and Addressing this At-Risk Population

Donna Simon, RN
Palmetto Health Richland
Columbia, SC

  • Be able to define what a “super-utilizer” is and the impact this population can have on a system
  • Understand best practice approaches to managing this patient group
  • List lessons learned from the implementation and metrics used to manage success


12:00PM - 12:30PM


Working Lunch

12:30PM - 1:20PM


The White House, Congress and Healthcare: What to Expect….?

David R. Zook, JD
Chair, Faegre Baker Daniels Consulting
Washington, DC

  • Outline how the new governmental structure is set to impact healthcare policy
  • What are some healthcare changes on the horizon that Physician Advisors need to prepare their respective physicians and systems


1:20PM - 2:10PM

Population Health Management at the level of the Community Hospital: a Multi-pronged Approach

Alvin Gore, MD, CHCQM
Deambra Bartlett, MSN, RN, CRRN, CNL 
Physician Advisor, Director Utilization Mgmt.     Clinical Coordinator, Population Health 
Providence St. Joseph Health    Providence St. Joseph Health 
Santa Rosa Memorial Hospital     Santa Rosa Memorial Hospital  

  • Describe how a population health management program can improve patient care outcomes and impact hospital metrics
  • Realize how the community is affected when the hospital develops a coordinated approach to care delivery
  • Define potential partners available in a community that can help with similar initiatives that affect PAs


2:10PM - 2:40PM



2:40PM - 3:30PM


Transitions of Care Strategies for Hospital and the Post-Acute Space

Amy Deutschendorf, MS, RN  
Vice President of Care Coordination and Clinical Resource Management The John Hopkins Hospital and John Hopkins Health System

  • Outline the areas that need to be addressed in the hospital and Post-Acute areas to optimize care coordination
  • Discuss initiatives used to address these needs, their outcomes and lessons learned through the process
  • Describe ways Physician Advisors can integrate their skills to help the care team in their work


3:30PM - 4:20PM


The End of Life Discussions That Need Not Wait Until the End

Michael A. Salvatore MD FACP CHCQM
Physician Advisor
Beebe Health System

  • Define Palliative Care
  • List areas of benefit to patients related to quality of life and cost
  • Explain how this clinical application is best to be used, and how a PA can apply this resource


4:30PM - 4:45PM





7:00AM - 7:50AM


8:00AM - 8:50AM


The Post-Acute Space: Facility and Modality Management Strategies

Lance Luria, MD
CMO, Mercy Care Management
Mercy Health

  • Define the major issues surrounding population health management with respect to the facility types available in the Post-Acute space
  • Explain best practice options to help direct patients to optimal clinical choices
  • Outline other modalities found in integrative medicine practices that can facilitate care delivery of Post-Acute services


8:50AM - 9:40AM


The RAC Contracts are Finally In …. So Now What? A 2017 Update on What This Means

Ronald Hirsch, MD, FACP, CHCQM
Vice President, Regulations and Education Group
R1 Physician Advisory Services

  • Overview of the RAC footprint in the US and the roles they will play
  • Update the current state of the audit/appeals process
  • Describe future plans the RAC, QIO, and MAC have for oversight


9:40AM - 10:10AM


Final Break

10:10AM - 12:00PM



  • Pooja Nagpal, MD
  • Al Gore, MD
  • Lisa Banker, MD
  • Miles Hawley, MD
  • Eddie Hu, MD


12:00PM - 12:10PM