TLC 2020

Erica Remer, MD, FACEP, CCDS

President, Erica Remer, MD, Inc.

Dr. Erica Remer practiced as an emergency physician for 25 years and has extensive coding, CDI, and ICD-10 expertise. She was a Physician Advisor of a large multi-hospital system for four years before transitioning to independent consulting in July 2016. Her passion is educating CDI specialists, coders, and healthcare providers with engaging, case-based presentations on documentation, CDI, ICD-10, and denials management. She has written numerous articles and serves as the co-host of Talk Ten Tuesdays, a weekly national podcast. Dr. Remer is on the ACDIS Advisory Board, the Board of Directors of ACPA, and is the ACPA CDI Education Co-chair.

CDI and Quality

Timothy Brundage, MD, CCDS

Medical Director, Brundage Group

Dr. Timothy Brundage is medical director of Brundage Group. He earned his CCDS certification through the Association of Clinical Documentation Improvement Specialists (ACDIS) and is a past ACDIS board member. He is a diplomate of the American Board of Internal Medicine and is the co-chair of the CDI committee for the American College of Physician Advisors (ACPA). Dr. Brundage travels the country educating physicians, with a focus on breaking down departmental silos by unifying clinical documentation across quality, utilization, denials, and CDI. He is also passionate about increasing the value of the physician advisor role within hospital organizations.

Silo-Free Documentation and the Sepsis Conundrum

Alvin Gore, MD, CHCQM

Utilization Management Director, St. Joseph Health, Sonoma Co.

Dr. Alvin Gore is a Director for Utilization Management at two hospitals at St. Joseph Health. While performing all traditional responsibilities of the Physician Advisor, he is also involved with less traditional duties such as cost of care reduction projects, bundle payments, population health, and full-risk cohort management, as well as CDQI (quality) projects.

New Frontiers – Physician Advisor 2.0

Howard Stein, DO, MHA, CHCQM-PHYADV

Associate Director of Medical Affairs; Senior Physician Advisor Care Management, Centrastate Medical Center

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.

Multidisciplinary Rounds and Cost Containment

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

Senior Director of Care Management, Cleveland Clinic Main Campus/Cleveland Clinic Akron General; Immediate Past President, Case Management Society of America

Dr. Mary McLaughlin Davis became a certified care manager in 1993. She has provided care coordination services for inpatients, outpatients, and health care plans. As a Clinical Nurse Specialist, Dr. McLaughlin Davis has worked extensively with patients having chronic disease, notably congestive heart failure and stroke. She is a Senior Director of Care Management for the Cleveland Clinic and a guest lecturer at Ursuline College. Dr. McLaughlin Davis serves as national immediate past president for the Case Management Society of America (CMSA). She is involved with The Public Policy Committee for CMSA and for the Nursing Institute at the Cleveland Clinic. She speaks on care coordination topics across the country. She has written numerous articles about care coordination and published the Case Management Guide to Population Health through HCPro. Dr. McLaughlin Davis recently released, The Practice of Hospital Case Management: A White Paper through CMSA

Hospital Case Management and the Physician Advisor: Past, Present and Future

Anuja Mohla, DO, CHCQM-PHYADV

Senior Physician Advisor; Medical Director, Patient Access and Flow, Christiana Care Health System

Dr. Anuja Mohla is a Board-certified Internal Medicine physician and practicing hospitalist. She has worked closely for nearly five years with the Clinical Operations Director at Christiana Hospital while serving as the senior physician advisor and medical director of patient access and flow. Dr. Mohla is an active member of the ACPA Observation Committee.

Efficient Management of Denials, Observation Patients and Short Stays

Beth Wolf, MD, CPC, CCDS

Medical Director for HIM and Physician Consultant

Dr. Beth Wolf is board certified in Palliative Medicine, Internal Medicine, and Clinical Informatics. She is a Physician Consultant for 3M and Medical Director for HIM at Roper St. Francis Healthcare, a 3-hospital system in South Carolina. She works with Providers to bridge the gap between clinical language and codified translations. Answering 'the why' and 'the how' in this complex time of endless data and evolving technology, she focuses on empowering people to find their passion and perform at their best.

Physician Advisor Role in Clinical Validation: Denial Prevention and Appeals

Denise Wilson, MS, RN, RRT

Senior Vice President, Denial Research Group/AppealMasters

Denise Wilson is a Registered Respiratory Therapist, Registered Nurse, and has a Master’s degree in Information Systems from the University of Illinois, Springfield. Ms. Wilson has over 30 years' experience in healthcare, including clinical management, education, compliance, and appeal writing. She has extensive experience as an appeals expert and has managed thousands of appeal cases and presented hundreds of cases at the Administrative Law Judge level. As a nationally known speaker and educator on denial and appeals processes, payer behaviors, and standards of care, she has educated thousands of healthcare professionals around the country in successfully overturning medical care denials.

Appealability: Assessing and Rating a Denial for the Possibility of Overturn

Edward Hu, MD, CHCQM-PHYADV

System Executive Director; Physician Advisor Services, University of North Carolina Health Care System

Dr. Edward Hu has been a Physician Advisor since 2012. He is currently working primarily in the areas of quality, cost reduction, and regulations. He is passionate about the work he does to improve health care delivery. Dr. Hu is board-certified in Internal Medicine and Health Care 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, NC. Currently, he serves as the UNC Health Care System Executive Director of Physician Advisor Services, supporting the development of Physician Advisor programs at 10 system hospitals. 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 2016-2019. Dr. Hu is married and has two children. In his spare time, he loves travel and all things Disney.

Creating Value, Breaking Down Barriers

Sewell I. Kahn, MD, FACP

Public and Medical Speaker Coach

Dr. Sewell Kahn has coached TEDx Charleston speakers for the last six years. As a practicing Nephrologist he was president of the medical staff of Kent County Hospital and worked on faculty at Brown University. He currently resides in Charleston, South Carolina where he was born, and is an active member of the Medical University of South Carolina (MUSC) ethics committee and ethics consultation service. Dr. Kahn is a member of the bioethics committee of the South Carolina Medical Association. He speaks to physicians and other healthcare workers on topics of interpersonal relations, communication, and burnout.

Speaking to Educate and Influence

Sheldon Berkowitz, MD, FAAP

Medical Director of Case Management, Utilization Management and Clinical Documentation Improvement, Children's Minnesota

Dr. Sheldon Berkowitz has been a pediatrician for over 35 years, the last 18 at Children’s Minnesota, a Quartenary Children’s Hospital. For the last five years he has been the hospital’s Physician Advisor and more recently, its Medical Director for Case Management, Utilization Management and Clinical Documentation Improvement (CDI). Dr. Berkowitz is also a Consulting Associate to Pediatric Resource Group. He enjoys sharing his expertise, including handling pediatric inpatient denials, working with case managers on removing barriers to discharge, working with CDI specialist to get documentation queries answered, and much more. Dr. Berkowitz has spoken nationally on issues of case management and CDI issues.

Physician Advisor for Pediatrics – The Essential Playbook

Stephanie Van Zandt, MD, FACOG, CHCQM-PHYADV

Medical Director for BayCare Physician Advisor Program

Dr. Stephanie Van Zandt practiced as a private OB/GYN for more than 25 years in Clearwater, FL prior to re-inventing herself as a Utilization Management Physician, first at UHC-Optum and then as a Physician Advisor at BayCare Health Systems. Dr Van Zandt helped expand the Physician Advisor Program employing hospital-based Physician Advisor's at each of BayCare's facilities providing proactive Physician Advisor leadership to UM/CM and CDI teams as well as compliance expertise and denials management. Dr. Van Zandt is married to Ben, an ID Physician, and they have three children and one labradoodle. She travels with her family across the globe on action-filled vacations.

Hospital-Based Physician Advisors

Trey LaCharité, MD, FACP, SFHM, CCS, CCDS

Medical Director for CDI and Coding, University of Tennessee Medical Center

Dr. Trey LaCharité previously served as the Medical Director for Clinical Integration for the University of Tennessee Medical Center and the University Physicians' Association, a 750-member IPA. He is a Clinical Assistant Professor in the Department of Internal Medicine serving as a resident teaching attending and as the curriculum director for the Internal Medicine Residency Program’s hospitalist rotation. Dr. LaCharité also has responsibilities in case management, utilization review, medical records, compliance, and performance improvement.

If Only I Had Known That: Lessons Learned as a CDI Physician Advisor

Ellen Fink-Samnick, MSW, ACSW, LCSW, CCM, CRP

Principal, EFS Supervision Strategies, LLC

Ellen Fink-Samnick is an award-winning industry thought leader and esteemed author of books, articles, white papers, and knowledge products. A subject matter expert on Case Management Ethics and the Social Determinants of Health, Ms. Fink-Samnick’s latest books, The Essential Guide to Interprofessional Ethics for Healthcare Case Management and Social Determinants of Health: Case Management’s Next Frontier (with Foreword by Dr. Ronald Hirsch) are published through HCPro. She is a panelist on Monitor Mondays, member of the RAC Monitor Editorial Board, CMSA Board of Directors, and past Commissioner for the Commission for Case Manager Certification.

Social Determinants of Health: Proactive Management

Jessica Gustafson, Esq. & Abby Pendleton, Esq.

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

Jessica L. Gustafson is a founding shareholder with The Health Law Partners. Ms. Gustafson 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 Contractors (“RAC”) and Medicare audit appeals process. She also regularly assists clients with compliance and reimbursement matters, overpayment refunds, Medicare enrollment matters, as well as other health care regulatory matters.

Abby Pendleton is a founding shareholder with The Health Law Partners, P.C. She has been practicing health care law since 1996. She regularly provides counsel to health care providers and organizations in a number of areas, including but not limited to: compliance, Recovery Audit Contractors ("RAC"), Medicare and other payor audits, health care investigations, fraud and abuse, reimbursement matters, and HIPAA Privacy and Security, and physician staff privilege and licensure matters.

High Stakes of Compliance in an Evolving Regulatory Environment

Ronald Hirsch, MD, FACP, CHCQM, CHRI

Vice President, R1 RCM Inc.

Dr. Ronald Hirsch is a Vice President of the Regulations and Education Group at R1 RCM Inc. He completed his internal medicine residency at Kaiser Permanente Medical Center in Hollywood, CA. Dr. Hirsch was a general internist and HIV specialist 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 ABQAURP, on the Advisory Board of ACPA, and edits the monthly ACPA newsletter.

Medicare Regulatory Update

Arshad Rahim, MD, MBA, FACP

Vice President/Sr. Med Director, Population Health, Mount Sinai Health System

As the Vice President/Senior Medical Director for Population Health at Mount Sinai Health System, Dr. Arshad Rahim is responsible for physician engagement for 4,000 physicians within Mount Sinai Clinically Integrated Network (CIN) driving key quality, efficiency, and cost benchmarks. He has a leadership role in utilization management and cost control programs for Mount Sinai’s value-based contracts. Dr. Rahim has over 15 years of healthcare industry leadership experience at innovative organizations including VP Quality Improvement for Lumeris, GVP Quality Improvement and Innovation at Healthgrades, and Director at Sg2. He is an actively practicing hospitalist and assistant professor, hospital medicine.

Population Health Initiatives – Across the Care Continuum and Role of Physician Advisor

Joeseph Zebrowitz, MD

Founder & President, Versalus Health

Dr. Joseph Zebrowitz is Founder/President of Versalus Health, a company providing hospitals with next-generation analytic and operational solutions focused on the intersection of utilization management, revenue cycle, and compliance. Before, Dr. Zebrowitz served as EVP for Executive Health Resources (EHR) where he was a trusted advisor to thousands of hospitals and established the standard for medical necessity reviews. Dr. Zebrowitz’s career focus has been on assisting hospitals in gaining an accurate picture of their compliance and revenue integrity. He received a bachelor’s degree in Psychology from the University of Pennsylvania and his medical degree from Temple University School of Medicine.

Improving Hospital Performance

Kristi Rain-Jaras, MD & Michael Vitale, MBA

Kristi Rain-Jaras - Physician Advisor, Allegheny Health Network

Michael Vitale - Senior Operational Excellence Coach, Allegheny Health Network

Dr. Kristi Rain-Jaras has been a Physician Advisor for the last two years at a smaller community hospital within a larger network. She is boarded in Internal Medicine and Pediatrics and was active in private practice for five years before transitioning to her current role. She was hired to “fix” length of stay and has started and cultivated interdisciplinary rounds at her hospital. In that time, they have seen a decrease in length of stay by over half a day, improved mortality rates, and improved readmission rates. Her other role in the hospital is to act as liaison between providers and staff, helping everyone communicate and problem solve together (using operational excellence at the base of the process). With that comes quite a bit of education as well to the staff, physicians and APPs.

Michael Vitale is a lean transformation professional passionately dedicated to strategy execution and freeing people to be their best, by enhancing organizational culture to achieve long-term goals through the operational excellence daily management system. Known as a dynamic speaker and leader, able to bring the high-level objectives of the organization to the front-lines, driving organizational alignment and strategy ownership. He places a premium on leveraging strong relationships to build consensus when developing operational improvements centered on employee and patient safety, quality care, and a remarkable patient experience.

Expanding Focus from Length of Stay to Culture Change