AGENDA: DAY 2
THURSDAY, JULY 20, 2017
7:00 am
MORNING PLENARY SESSION
8:00 am
Welcome, Overview, Audience Response System
President, AR Systems, Inc., Twin Falls, ID
8:30 am
Regulatory Update ó Impacts from DC and Payer Updates
Vice President, R1 Physician Advisory Services, Chicago, IL
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.
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 2015.
9:00 am
Managed Care Anguish and Why I Love the 2 MN Rule
President, AR Systems, Inc., Twin Falls, ID
9:30 am
Meet the Dream Team: 1) Contracting: Key Elements Within a Contract and Creating an Operational Focus for Contracting
President, AR Systems, Inc., Twin Falls, ID
CEO/Partner, PACE Healthcare Consulting, LLC, Bluffton, SC
She has over 25 years of experience as a hospital CEO and has served in teaching hospitals, and non-profit and investor owned sectors of healthcare where she developed forward thinking systems to improve quality and utilization.
Ms. Lamkin is CEO and Partner in PACE Healthcare Consulting, LLC offering strategy, operations, analytics and software solutions to hospitals, physicians and other sectors of healthcare.
Ms. Lamkin holds a Masterís in Healthcare Administration, from the University of South Carolina, Columbia BA Cum Laude, Core in Business Administration, from the University of South Carolina.
Chief Executive Officer, Creative Managed Care Solutions, LLC, San Antonio, TX
Prior to consulting, Mr. Montaine served as a senior hospital executive for two multi-facility integrated Texas hospital systems, and he served in senior executive roles developing and running national and regional health plans in Texas and Florida.
Mr. Montaine has been a member of HFMA since 1999 where he achieved the nationís highest score on HFMAís certification exam for Managed Care in 2008. He started with the Gulf Coast chapter where he was as an officer, Board member, and committee chair, before moving to the South TX chapter in 2003 where he was the South Texas Chapter President for 2009-10. He has been awarded the Follmer Bronze, Reeves Silver, and Muncie Gold merit awards and was awarded the Medal of Honor by the South Texas Chapter in 2011. He continues to serve the South Texas Chapter on the Texas statewide committee and on the Region 9 planning committee.
In addition to his Fellow status in HFMA, Mr. Montaine holds a certification in Risk Management from the American Academy of Health Law and has been a Diplomat of the American Board of Quality Assurance and Utilization Review Physicians since 1996. He serves on the BOD of the San Antonio Rugby Football Club where he enjoys playing Rugby as time permits, and scuba diving with his wife of over 30 years. They have 3 adult children.
10:25 am
Break
10:50 am
Welcome to Patient Financial Navigator
President, AR Systems, Inc., Twin Falls, ID
11:10 am
Meet the Dream Team: 2) Payer Relations
Each payer will address key areas of status disputes, contract issues and payer/provider challenges.
Anand Nilakantan, DO, MBA
Medical Director, Aetna Mid-America Region, Dublin, OH
Kathryn Lueken, MD, MMM, CPE
Regional Medical Director, Humana; Former Chief Medical Officer, WVP Health Authority, Durham, NC
Ferdinand Richards, MD
Medical Director, KePro Quality Improvement Organization; Internal Medicine and Emergency Medicine Physician, Tampa General Hospital; Associate Clinical Faculty, Department of Internal Medicine, University of South Florida College of Medicine, Tampa, FL
12:00 pm
Panel for Q&A
12:40 pm
Case Study Discussion: Payer Denial Anguish with Action Plan
2:00 pm
Presentation of Cases
2:45 pm
Break
3:15 pm
Meet the Dream Team: 3) Provider Challenges
BUILDING A CONTRACTING DATABASE FOR ONGOING PAYER CHALLENGES, PLUS CREATING A NEW PATH FOR PROVIDER/PAYER RELATIONSHIP. LEARN ABOUT HOW A GROUP OF HOSPITALS CAME TOGETHER FOR PRO-ACTIVE PAYER/PROVIDER DIALOGUE.
Sommer Slavin, RN, MS, MBA, CCDS
Program Coordinator, Utilization Management, Strong Memorial Hospital, University of Rochester Medical Center, Rochester, NY
Her educational background is in Nursing & Leadership in Healthcare with a focus in population health. Additionally she received her MBA from the Simon School in 2011 with a focus in Competitive & Organizational Strategy and Finance.
She assumed the role of Utilization Management Program Coordinator in 2016 after having been the Utilization Manager for 8 years. Current focuses include standardization of UM practices across the URMC enterprise, integration of UM, hospital operations, & contracting, and educational liaison for our newly developed Physician Advisor Program.
Marlene Allen, MBA, CHA, CHCO
Compliance/HIPAA Privacy Officer, Harrisburg Medical Center, Inc., Harrisburg, IL
System Physician Advisor and Medical Director, Promedica Health Network, Promedica Health System, Toledo, OH
ProMedica, a mission-driven, not-for-profit, nationally distinguished health care system serving northwest Ohio and southeast Michigan. Established in 1986, ProMedica is a locally owned, nationally recognized, not-for-profit healthcare network based in Toledo, Ohio. Our expansive network includes more than 2,300 physicians and more than 17,000 employees treating 4.7 million patients annually at 332 sites. It has been acknowledged as the Top 100 hundred hospitals and recognized as one the best employers for 2017 by Forbes magazine.
She joined the ProMedica family in Oct 2012. She comes with over twenty years of experience in the fields Of Utilization Review, Quality, Appeals, Joint Commission, Clinical Documentation, Safety and Infection Control. She is trained in LEAN methodology for system improvements.
Prior to working with ProMedica Health System, she worked with Mercy Health System, Lima memorial Health System and Liberty Medical Center. She has worked with Ohio State Medicaid board on several process improvement initiatives. She has worked as a private consultant to physician offices and Hospitals as well as writing a book called DRG Tools. She has recently been recognized with an ” Inventor of the year ” for a software solution that will help healthcare systems across the nation have compliant billing.
She lives in Toledo with her husband, two boys and three dogs. She is sits on the Lucas county suicide prevention board, and is associated with the National Physician Advisors Association, national and state case management associations and the National Association of Healthcare Quality.
Kathryn Lueken, MD, MMM, CPE
Regional Medical Director, Humana; Former Chief Medical Officer, WVP Health Authority, Durham, NC
Medical Director for Case Management and CDI, Self Regional Healthcare, Greenwood, SC
Jennifer L. Bartlett, CPAR
Coordinator of Clinical Audits and Disputes, Infirmary Health, Mobile, AL