Overview

The forum will explore ways PALTC clinicians can leverage the new payment models to get reimbursed for delivering compassionate, coordinated, and effective care. The program will connect the dots between clinical work and the generation of the data that drives reimbursement in all models. Experts will share practical strategies valuable to your success, whether you are practicing in traditional fee-for-service or value-based payment models.

 

Topics Covered

• Defining value-based reimbursement models
• Evolution and trends of “traditional” CPT coding
• Impact of diagnosis coding/documentation on PDPM and value-based models – ICD-10/HCC scoring
• Value-based medicine reimbursement perspective 
• Opportunities in value-based reimbursement
  
  

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Sessions

Description
Morning Session Presentations: (1) Defining Value-Based Reimbursement Models (2) Evolution and Trends of “Traditional” CPT Coding (3) Impact of Diagnosis Coding/Documentation on PDPM and Value-Based Models – ICD-10/HCC Scoring Learning Objectives: Distinguish between various value-based models Recognize the nuances that may uniquely impact PAC practices Distinguish coding efforts can be on the billing or clinical coding and likely both. Describe the billing/coding trends that may impact the practice, value model and the facility Moderator: Tom Haithcoat Speakers: Chuck Crecelius, MD, PhD, CMD; Kerry Weiner, MD, MPH; Chris Mlot, MD
Value-Based Medicine Reimbursement Perspective - The Ground View Explore Successes and challenges of current models What are practical takeaways for finding your value in value-based reimbursement Learning Objectives: Compare data management tools that are available and participate in decisions about which tools to utilize Apply available data to drive meaningful changes in care delivery Identify how  shared savings from improved care delivery results in equitable reimbursement for the clinical team delivering care Identify improved clinical outcome metrics that should be monitored as part of value-based payment models Moderator: Victoria Walker, MD, CMD Speakers: Matt Wayne, MD, CMD; Jason Feuerman; Manoj Wadhwani; Ian Strand
Ask the Experts: Where are Your Opportunities in Value-Based Reimbursement Engage with speakers who are thriving in the current environment Learning Objectives: Actively participate in practice decisions about which value-based payment models to participate in Educate patients about how their participation in value-based payment models may impact the coverage of health care expenses Identify technology tools available to facilitate risk stratification Moderator: Victoria Walker, MD, CMD Speakers: Steve Buslovich, MD, CMD; Tom Haithcoat; Walter Lin, MD; Bob Zorowitz, MD, MBA, CMD

Speakers

 

Steve Buslovich, MD, CMD, is a practicing geriatrician and medical director of several nursing homes and post-acute care facilities, is an active committee member in the American Geriatrics Society (AGS), Advancing Excellence in Long Term Care Collaborative, Society for PALTC Medicine on the Public Policy and Clinical Practice Guidelines Committee, and has won AMDA's Shark Tank Innovation Award. Dr. Buslovich is working with CMS and ONC to standardize clinical data elements across all post-acute care settings. Dr. Buslovich has presented nationally on PDPM to audiences from many organizations and is a nationally recognized expert on frailty models of care. Dr. Buslovich is an Assistant Clinical Professor at University at Buffalo School of Medicine.

 Chuck Crecelius, MD, PhD, FACP, CMD, is the Medical Director, Post-Acute Care Services for BJC Medical Group, an over 600 provider, 12 associated hospital multispecialty group in the Greater St Louis area.  He is also a multi-facility medical director for Delmar Gardens Enterprises, and Associate Clinical Professor of Internal Medicine and Geriatrics at Washington University School of Medicine.  He helped found the St Louis Post-Acute and Long Term Care Roundtable, which brings together nursing homes, hospital systems and other stakeholders to improve the quality and transitions of care of nursing home residents in a service area of over 3 million persons.  He is a Past President of AMDA – The Society for Post-Acute and Long Term Care Medicine, was their 2019 Medical Director of the Year. and represents the Society at the AMA Relative Vallue Update Committee.

 Jason Feuerman,  is the founder, President and CEO of LTC ACO, the first Medicare Shared Savings Program (“MSSP”) of its type dedicated exclusively to management of the full Medicare spend of nursing facility residents throughout the United States. As the only MSSP ACO serving residents throughout the country, LTC ACO has been able to produce consistent and predictable results generating more than $60m in shared savings since 2016. It currently operates in more than 1,500 skilled nursing facilities with in excess of 2,500 participating providers. As the largest MSSP ACO of its type, it presently assumes risk for nearly 20,000 Medicare Fee-for-Service beneficiaries which consume in excess of $400m annually.

 Tom Haithcoat, is the President of Ceptor Consulting, LLC, a PAC Physician Practice consulting firm focused on Growth, M&A, and Value Model selection & strategy. Tom has over 25 years of senior living experience in both Nursing Home management and Post Acute Care physician practice management.

 Walter Lin, MD, is the Founder and Chief Executive Officer of Generation Clinical Partners, a medical practice focused on caring for frail Medicare beneficiaries in senior living communities. He also serves as the Missouri and Kansas Medical Director for TruHealth, the provider organization of an institutional special needs plan; Associate Medical Director for Landmark Health, a company providing home-based medical care for the seriously ill; and Medical Director of various skilled nursing and assisted living facilities. Dr. Lin is an active member of The Society for Post-Acute and Long-Term Care Medicine (AMDA), serving on its Public Policy Committee, HHS' Physician-Focused Payment Model Technical Advisory Committee (PTAC), and the board of the Missouri Association of Long-Term Care Practitioners

Christine Mlot, MD, is the Medical Director for Supportive Care and Risk Adjustment at CareConnectMD ACO and GeriNet Medical Associates in southern California. She is co- founder of GeriNet Medical Associates along with Kim Phan, providing long term and post acute care since 1996.  She was Medical Director for VITAS hospice San Diego, CMO at the Veteran’s Home of Barstow, CA, San Diego’s first PACE program Medical Director,  Associate Clinical professor at UCSD School of Medicine and had medical practices in Nepal, India and Mexico.  Dr Mlot has been focused on Risk adjustment and HCC coding for the past 5 years, educating physician partners across numerous states.

 Ian Strand, LNHA, began his healthcare career as a nursing home administrator, specializing in post-acute-rehab, opening new facilities and improving quality outcomes. It was there that he became passionate about improving quality of care and services through aligning the goals of providers, payers, and the patient. In 2016, Mr. Strand took on the role of operations lead to start and manage the first provider-owned I-SNP in the state of Oregon, and created a medical group of physicians and advanced practice clinicians to provide on-site medical care to patients living in over 32 different facilities of varying levels of care. It was this experience and passion that lead Ian to Patient Pattern, a technology company that has created a holistic care management tool to address these issues.

 Manoj Wadhwani, is the President of Saisystems International, a growing healthcare and technology services company headquartered in Shelton, CT. He currently manages operations, delivery and strategic direction with more than 25 years of experience in the health and technology industries. His specialties include strong delivery and application development, business consulting expertise and experience with a diverse portfolio of industry verticals. He strongly believes the two are meant to work in synergy and, when successfully managed, produce the best clinical and financial outcomes for providers, patients and payors.

 Victoria Walker, MD, CMD, FAAFP, is the Medical and Clinical Officer for the Ave eCARE Senior Care telemedicine program. She provides support and direction to an interdisciplinary team that supports nursing home staff and residents of post-acute, long-term care and assisted living in 24 states. Dr. Walker is also the Medical Director for Avera Health System Long Term Care and a Clinical professor of Family Medicine at the University of South Dakota Sanford School of Medicine.  She currently serves on the Clinical Issues Subcommittee of the Public Policy Committee, the Telemedicine Workgroup and the Education workgroup for the North Central Society of PALTC.

 Kerry Weiner, MD, MPH, has over 30-year experience in developing and managing clinical models in value based reimbursement strategies. He has served as CMO of Lakeside Medical Group, a delegated HMO Medical Group in CA and CMO of Acute and Post Acute care at Team Health. He is currently the Medical Director of the MSSP ACO at Careconnectmd.

 Matt Wayne, MD, CMD, is currently Chief Medical Officer for CommuniCare Family of Companies. CommuniCare operates 130 skilled nursing facilities in 7 states. Approximately 25% of CommuniCare’s residents are enrolled in a value based program, the 2 largest being ISNP and ACO Reach. Previously, Dr. Wayne was CMO for the New health Collaborative, Summa Health’s ACO, and oversaw a clinically integrated network that provided care to 90,000 lives.

 Robert Zorowitz, MD, MBA, CMD, is Regional Vice President, Health Affairs, for the Northeast at Humana. A graduate of Albany Medical College, he completed a residency in Internal Medicine at Long Island Jewish Medical Center and a fellowship in Geriatric Medicine at Mt. Sinai School of Medicine. He received his MBA from the Goizueta Business School of Emory University. He is board-certified in Internal Medicine, Geriatric Medicine, Hospice/Palliative Medicine and is a Certified Medical Director in Post-Acute and Long-Term Care. Over the years, his practice took him to the office, hospital and post-acute/long-term care settings. For the last 15 years, he has been the American Geriatrics Society Advisor to the American Medical Association's CPT Editorial Panel.

 

 

 

Credit Information

• 3.25 CME
• 3.25 CMD Management

Credit Statements

 

Physician CME: AMDA – The Society for Post-Acute and Long-Term Care Medicine is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians.

AMDA – The Society for Post-Acute and Long-Term Care Medicine designates this enduring material for a maximum of 3.25 AMA PRA Category 1 Credits^TM. Physicians should only claim credit commensurate with the extent of their participation in the activity.

CMD Credit: This self-study activity has been pre-approved by the American Board of Post-Acute and Long-Term Care Medicine (ABPLM) for a total of 3.25 management hours toward certification as a Certified Medical Director (CMD) in post-acute and long-term care medicine. The CMD program is administered by the ABPLM. Each physician should claim only those hours of credit actually spent on the activity.

ABFM Family Medicine Certification (formerly MC-FP): This activity may be eligible to help meet ABFM Family Medicine Certification (formerly MC-FP) Requirements. Participants may self-report AMA PRA Category 1 Credit(s)^TM to meet Certification requirements via the Physician Portfolio on the ABFM website. All CME credits are subject to final approval by the ABFM.

Disclosure Information:

The Society requires all speakers verbally disclosure all relevant financial relationships; presence of off-label use of a device or medication; and discussion of any experimental, new or evolving topic prior to each accredited education activity.

If the learner perceives any bias toward a commercial product or service, advocation of unscientific approaches to diagnosis or therapy, or recommendation, treatment, or manners of practicing healthcare that are determined to have risks or dangers that outweigh the benefits or are known to be ineffective in the treatment of patients please report this to the Society’s staff.

 

The following have disclosures:

• Jason Feuerman (Speaker): Founder, President and CEO of LTC ACO
• Tom Haithcoat (Speaker & Planner): President, Ceptor Consulting, LLC
• Manoj Wadhwani (Speaker): President, Saisystems International
• Ian Strand, LNHA (Speaker): Senior Director, Value Based Care Sales at PointClickCare

All other speakers and planners have no relevant financial relationships. All financial relationships were mitigated.