Monday, October 12
8:15 – 9:00 AM General Session
Value Based Purchasing/Reporting Health Reform
Neil Goldfarb, Associate Dean for Research, Jefferson School of Population Health; Director, Ambulatory Care Performance Improvement, Jefferson University Physicians, Thomas Jefferson University
handout, evaluation survey
9:00 – 9:45 AM General Session
Quality of Care Medical Necessity and Reasonableness of Services
Audrey Andrews, CCO, Tenet Healthcare Corporation
Steven Muni, Deputy Attorney General, California Department of Justice, Bureau of Medi-Cal, Fraud and Elder Abuse
handout, evaluation survey
- A practical approach to investigating quality of care issues
- How to coordinate peer review, patient safety and billing considerations
- Tips on what to do and what not to do
9:45 – 10:30 AM General Session
Enforcement: Quality of Care Enforcement Used in the False Claims Act
Laura Ellis, Senior Counsel in the Administrative and Civil Remedies Branch of the Office of Counsel to the Inspector General, Washington, DC
Cheryl Wagonhurst, CCEP, Partner, Foley & Lardner LLP
handout 1, handout 2, handout 3, handout 4, evaluation survey
- How the government and whistleblowers are using the FCA to address alleged quality failures
- Recent quality of care enforcement actions and settlements
- What health care providers can do to avoid quality-of-care enforcement actions
11:00 AM – 12:00 PM Concurrent Breakouts
101 Peer Review
Donald L. Mellman, MD, President, Donald & Mellman,
MD, Inc
handout 1, handout 2, handout 3, handout 4, evaluation survey
- Why get involved?
- What risks should a compliance program worry about?
- How to get involved without having your head taken off.
102 Closing the Execution Gap: Quality Improvement Action Planning for Compliance Professionals
Beata E. Chapman, PhD, Compliance Officer and Organization Development Consultant, Health Care Quality and Compliance, Inc.
Rachel C. Bennett, COO, Country Villa Health Services
handout, evaluation survey
- Master proven steps for team action planning that yield true quality improvement
- Learn how to validate the efficacy of action plans
- See a process for teaching teams to action plan
- Experience a broad strategy for assessing success and moving forward, including real life examples
1:00 – 2:00 PM Concurrent Breakouts
201 How Effective Compliance Assists in Ensuring Patient Safety
David Hoffman, President, David Hoffman & Associates
handout, evaluation survey
- Define an operational definition of neglect
- Discuss the Patient Safety and Quality Improvement Act of 2005
- Discuss trends in patient safety
- Discuss reporting requirements
- Discuss medical errors and how to reduce through compliance
202 Mandatory Reporting
D. Scott Jones, Vice President, Corporate Compliance & Risk Management, American Healthcare Providers Insurance Services
handout 1, handout 2, evaluation survey
- Review Section 111 of the Medicare, Medicaid, and SCHIP Extension Act of 2007 affecting hospitals, physicians, insurers and self insurers, medical professional liability insurers and worker’s compensation insurers
- Examine specific mandatory reporting requirements for Responsible Reporting Entities (RRE’s)
- Understand CMS’s self-reporting goals under Medicare Secondary Payor rules and penalties for non-compliance, and how to ensure compliance in your organization
2:30 – 3:30 PM Concurrent Breakouts
301 Compliance Program: Components for Long Term Acute Care Hospitals LT ACH
Linda Sue Hayes, CCO, Solara Healthcare
handout, evaluation survey
- Define what an LTAC Hospital is
- Describe the Medicare Compliance Requirements
- Review how an LTAC hospital meets the requirements
- Discuss anticipated industry changes
302 Three CMS Quality and Compliance Mandates: One Concurrent Medical Review
Marilyn Jones, MBA, MN, RN, CCS, Manager, Huron Consulting Group
handout, evaluation survey
Accurate clinical documentation improvement can:
- Proactively prepare hospitals for regulatory audits from RAC, MIC, MAC, ZPIC
- Promote regulatory compliance that is consistent with CMS regulations
- Assist with accurate hospital and physician profiles
- Support quality care measures
- Validate the patient’s Severity of Illness (SOI) and expected Risk of Mortality (ROM)
- Facilitate accurate coding and appropriate reimbursement
4:00 – 5:00 Concurrent Breakouts
401 Disruptive Practitioners and the New 2009 Joint Commission Standards
Jonathan M. Joseph, Esquire, Partner, Christian & Barton, LLP
Michael C. Guanzon, Esquire, Clement & Wheatley, A Professional Corporation
handout 1, handout 2, handout 3, evaluation survey
- Identify implications for physician and nonphysician staff, including special groups such as the employed physicians and physicians under contract
- Outline code of conduct language and definitions needed in employment manuals and in the credentialing process to satisfy EP-4 requirement
- Discuss the types of medical staff policies, including zero-tolerance and non-retaliatory clauses, that should appear in medical staff bylaws
- Identify procedural steps to manage disruptive and inappropriate behaviors, and utilizing reliable tools to evaluate the safety culture
402 Never Events & Hospital Acquired Conditions: Impacts and Interventions
Stacy Borans, MD, Medical Director, IMEDECS
Joyce Muller, President and CEO, IMEDECS
handout, evaluation survey
- Overview of the current regulatory environment with respect to never events
- Delineation of the current list of “never” events and hospital acquired conditions
- Instruction on appropriate identification and coding of conditions
- Discussion of outsourcing peer review to an
IRO as a tool to mitigate recurrence
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Tuesday, October 13
8:15 – 9:15 AM General Session
Integrating Quality into Your Compliance Plan: Risk Opportunities
Margaret Hambleton, Sr Vice President, Ministry Integrity, Chief Compliance Officer, St. Joseph Health System
Shannon G. Dwyer, Sr Vice President, General Counsel, St. Joseph Health System
handout, evaluation survey
- Understand the key compliance risks related to quality of care
- Assessing and prioritizing quality risks and incorporating these into a compliance plan
- Contrast and discuss the roles of legal counsel, compliance, and quality in addressing risks
9:30 – 10:30 AM General Session
Patient Safety Organizations
Janice Anderson, Shareholder, Polsinelli Shughart PC
handout, evaluation survey
- Purpose of PSOs
- New provider confidentiality rules
- New privilege rules
- Interaction with HIPAA
11:00 AM – 12: 00 PM Concurrent Breakouts
501 Your Roadmap to Excellence
Jim DeLaura, Partner, PPS Results Group
handout, evaluation survey
- Effective compliance and quality of care competencies are best achieved when embedded into an organization’s culture
- Aligning People, Processes, and Strategic Plans is critical to achieving patient/customer loyalty and improved outcomes
- Leadership sets goals, utilizes a top-down approach, and reviews a dashboard of key organizational performance measures
502 Pay for Performance Documentation and Coding
Cheryl Wagonhurst, CCEP, Partner, Foley & Lardner LLP
handout, evaluation survey
- What does the government expect?
- What are the consequences if the government’s expectations are not met?
- How will P4P information contribute to a provider’s “footprint”?
1:00 – 2:00 PM Concurrent Breakouts
601 Compliance Responsibility and Healthcare Quality: What Does Your Board Need to Know?
Lisa Hancock, RN, CHP, CHC, MHA, Compliance Officer, Sutter Medical Foundation
handout, evaluation survey
- What information does the board’s need to understand and evaluate the organization’s quality and performance improvement programs?
- Once metrics and benchmarks are established, how frequently does the board receive reports about the quality efforts?
- How does the quality and improvement processes coordinate with the compliance program?
- How are quality of care and patient safety issues addressed in the organization’s risk assessment and corrective action plans?
602 The Quality of Care Imperative under the Obama Administration
Janice Anderson, Shareholder, Polsinelli Shughart PC
Judy Ringholz, Compliance Director- Health Care Group, Sonnenschein Nath & Rosenthal LLP
handout 1, handout 2, evaluation survey
- Discuss the building blocks established by CMS to transition to Value Based Purchasing, including key demonstration projects to pilot new payment methodologies
- Understand the provisions of the American Recovery and Reinvestment Act of 2009 and how they advance the quality imperative
- Describe the government initiatives to reduce Adverse Events in the American health care system
- Discuss strategies health care entities should be using today to meet the quality imperative
2:30 – 3:30 PM Concurrent Breakouts
701 Managing the Legal Risks Associated with Collaborating on Quality: Stark, Gainsharing, Antitrust, and More
Larry Vernaglia, Partner, Foley & Lardner, LLP
Jennifer Payton, JD, CHC, Compliance Auditor, Baptist Health
handout, evaluation survey
- Orientation for non-lawyers to the key compliance concerns in the core physician integration models
- Learn how to issue spot for transactions with greater risk
- Discuss compliance controls and safeguards that can reduce regulatory risk while maintaining quality and other integration goals
702 Medicare Conditions of Participation and Quality
John E. Steiner, Jr., Esq., Chief Compliance Officer, UK HealthCare
handout 1, handout 2, evaluation survey
- Highlight quality trends in the Conditions of Participation
- Discuss techniques for compliance with quality related conditions
- Review methods for internal reporting and monitoring
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