• Examine how hospitalist clinical documentation affects billing efforts and the hospital’s revenue stream.
• Discuss the differences between utilization review and utilization management.
• Explore processes and techniques to revitalize a health system’s utilization management programs.
• Recognize communication styles and techniques to make peer-to-peer communications successful.
• Optimize technology and artificial intelligence to improve outcomes for patients and providers.
• Incorporate the voice of the patient by providing equitable care, including the most vulnerable of our population.
• Implement strategies to reduce payment denials and appeals to maintain an organization’s investment.
• Identify educational needs of the team while integrating new systems and presenting quality data.
• Discuss quality reporting and why digital quality is important.
• Identify the roles of the interprofessional team in care transitions and coordination.
• Evaluate quality and safety efficiency components in the hospital system to deliver quality health services and mitigate risks.
• Recognize well-being goals to avoid clinician burnout and elevate leadership potential within your organization.

This course is intended for Physicians of all specialties, Nurses, and Other Health Care Professionals with appropriate CME / CE credit offered for each profession.

All participants must achieve a final assessment score of at least seventy percent (70%) for recertification and continuing education credits. You have 60 days to complete the course after ordering.

This activity is valid from October 1, 2024 through September 30, 2027. Originally presented September 11-12, 2024.

About the Authors:
Members of the Education Committee, Planners, and Faculty have no relevant financial relationships with ineligible companies to disclose, except as follows: Cheri Lattimer, RN, BSN, disclosed she was a speaker for Ferring Pharmaceuticals, and this relationship has since ended.

Sogol Sepehri, MD, MBA, CHCQM

Dr. Sogol Sepehri serves as HCA’s Corporate Vice President of Physician Advisors and Denials Medical Directors. She joined HCA in 2018 as the Division Physician Advisor for the Austin and El Paso markets. She also previously served as the medical director of several hospice agencies and skilled nursing facilities in addition to being a clinical assistant professor with Texas A&M. She is a certified hospice medical director and has been an ABQAURP Diplomate since 2018.

William J. Frederick Ill, MD, PhD, CHCQM-PHYADV

Dr. William Frederick is Physician Advisor Medical Director at Stanford Health Care where he is redesigning their Utilization Management program. Prior to moving to Stanford in 2023, Dr. Frederick was a Physician Advisor and Clinical Associate Professor of Medicine at UC San Diego Health. As the Course Director for 4th year medical students during inpatient medicine rotations across four hospitals, he provided ongoing education to faculty, staff, and trainees on topics of the ethical use of hospice, critical illness recovery hospitals, patient flow, and quality management. HCQM-certified in 2022, Dr. Frederick participated in the development of the Advanced Physician Advisor certification, and we’re pleased to have him here today.

Kathy Seward, MD, CHCQM-PHYADV

Dr. Kathy Seward is a consultant with over 20 years of industry and advisory experience in healthcare, including academic and community health systems. Kathy has experience in both physician advisor education, coaching and mentoring as well as in assisting clients with implementation of programs related to denials management, physician documentation, medical necessity, and level of care. She is also an ABQAURP Diplomate, member of the Advanced Physician Advisor development team, and Physician Advisor Editorial Committee member.

Melissa Buchner-Mehling, MD, CHCQM-PHYADV, FABQAURP

Dr. Melissa Buchner-Mehling is Associate Chief Medical Officer with Sound Advisory Services. Participating on numerous hospital committees and as Medical Director of Advisory Services, Melissa spends time as an attending hospitalist and seeking innovative ways of educating providers. As a hospitalist, she has volunteered for medical mission trips in the Honduras and Kenya. Another participant on the Physician Advisor certification development team, Melissa has been an ABQAURP Diplomate since 2016.

Richard B. Siegrist, Jr., MS, MBA, CPA

Mr. Richard Siegrist is senior lecturer on health care management at the Harvard School of Public Health, where he teaches physician, graduate, and executive education courses on financial management, cost accounting, management control, innovation, and entrepreneurship. He is also the faculty director of the DrPH program, director of the master in health care management program for physicians, and the director of innovation and entrepreneurship.

Douglas S. Brown

Mr. Douglas Brown is recently retired as President of Community Hospitals and Chief Administrative Officer for UMass Memorial Health, having served as a top executive in the system since 2003. With over 30 years of senior leadership experience in government, law, and health care, Doug’s greatest passion has been in his leadership of UMass Memorial’s pursuit of an Anchor Mission. The effort leverages the organization’s assets to get outside its walls to make investments in the community designed to address the social determinants of health. Mr. Brown’s former roles in public service include Massachusetts Assistant Attorney General, General Counsel of the Senate Committee on Ways and Means, and as a Medicaid Medical Director.  

Burke Burnett

Burke Burnett is Director of Partnerships at the National Committee for Quality Assurance (NCQA). He leads partnership strategy working with health plans, health systems, and health technology organizations in implementing digital quality solutions, risk adjustment, and value-based care.

Cheri Lattimer, RN, BSN

Cheri Lattimer is Executive Director of the National Transitions of Care Coalition and CEO of Integrity Consulting & Advocacy in addition to serving as a Director on ABQAURP’s Board of Directors. Her leadership in quality improvement, case management, care coordination, integrated health care, developing interdisciplinary care teams and transitions of care is known on the national and international landscape.

Mary Lomberk, PharmD, BCACP, CPh 

Mary Lomberk is a Transitions of Care Pharmacotherapy Specialist at Tampa General Hospital. She is a board-certified ambulatory care pharmacist and consultant pharmacist who helped develop and expand the transitions of care program at BayCare Health System in Tampa to over 30 pharmacists to provide continuity of care for hospitalized patients by working with an interdisciplinary team to resolve medication errors, promote patient education, and reduce hospital readmissions. Mary also serves on NTOCC’s Pharmacist Advisory Committee.

Mary McLaughlin Davis, DNP, ACNS-BC, NEA-BC, CCM-R

Mary McLaughlin Davis is Program Manager for Care Management at Cleveland Clinic, providing care coordination and utilization management services for acute care patients, ambulatory patients, and patients enrolled in health plans. Previously a National President and Executive Board Member at the Case Management Society of America, she continues to serve on the editorial board for several publications.

 Jacqueline Vance, RNC, BSN, CDONA/LTC, FADONA, IP-BC, CDP, ASCOM, LBBP

Jacqueline Vance is the senior director of clinical innovation and education at Mission Health Communities in Tampa. She also serves as an independent legal nurse consultant, expert witness, and long-term care and geriatric nurse consultant through Vance Consulting Service. She is on the board of the Beneficiary and Family Centered Care QIO and is the President of the Board of Directors for the National Transitions of Care Coalition.

 Harjot Singh, MD

Dr. Harjot Singh is a national speaker, author, and leadership expert. Focusing on organizational change, he helps the health care team master skills on leadership and well-being to find success and live with joy. He speaks at national level meetings and in boardrooms across the country on leadership and well-being. He also focuses on organizational level change, working with C-suite leaders to design tailored programs. A practicing physician, a physician leader, and faculty at the American College of Healthcare Executives, his work is informed by all three perspectives. He has authored several textbook chapters - the latest one on Physician Engagement, published in August 2021.

Pranav Mehta, MD, MBA, FACHE, CPE

Dr. Pranav Mehta is the Chief Medical Officer for HCA Healthcare’s American and Atlantic Groups and the Vice President of Clinical Operations for HCA’s Clinical Services Group, leading quality initiatives at 89 hospitals to promote high quality, cost effective medical care. He oversees enterprise preparedness and emergency operations and leadership infection control, risk management, patient safety, patient experience, and medical staff credentialing functions to ensure the collaboration and coordination of all stakeholders in these processes. Dr. Mehta also serves as a senior examiner for the Malcolm a Baldridge Performance Excellence Program.

Keith Fulmer, MHSA, PMP

Mr. Keith Fulmer is Chief Technology and Information Officer at the Brundage Group in St. Petersburg. He works to develop innovative strategies to streamline service delivery throughout health care and technology to drive positive patient outcomes. In Keith's previous role as Senior Vice President of Enterprise Operations at Laser Spine Institute, he led a team of 400 employees in helping the organization to create a personalized path of clinical care that was effective, efficient, and provided an exceptional patient experience.

Kimberly Garner, MD, JD, MPH, FAAFP, CHCQM

Dr. Kimberly Garner is the Rehabilitation and Extended Care Integrated Lead for the South Central Veterans Health Care Network in Little Rock, Arkansas. She is the 2023 winner of the CHCQM Diplomate Achievement Award leading her team at the VA on their initiative to help Veterans plan for the future utilizing advanced care planning through group visits. Dr. Garner is also an Assistant Professor at the Donald W. Reynolds Center on Aging at the University of Arkansas for Medical Sciences. She is Board certified in Family Practice and has certificates of added qualifications in Geriatrics and Palliative Care. Her research interest is in the area of palliative medicine with an emphasis on caregiver needs. Dr. Garner was HCQM certified in 2014, elected to the Board of Directors in 2023, and is a member of the ABQAURP Education Committee.

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