PALTC24 Practice Management Recordings Bundle

This bundle includes a selection of four Practice Management session recordings from PALTC24. Recorded sessions include: 

  • Audio synced to slides 
  • Ability to download session handouts

 Coding Changes that Impact Your PALTC Practice

This session will provide an overview of the revised evaluation and management criteria, including the medical decision-making tables. In addition, this session will provide an overview of codes beyond the usual nursing home set and how they may be appropriate for your practice. Advance care planning, chronic care management, complex chronic care management, non-face-to-face prolonged services, behavioral health integration, and other codes that have been established since 2016 will be examined. This session will provide examples of how and when to use these codes as the payment system moves from volume to value based.

 

Learning Objectives:

At the completion of this session, learners will be able to:

  • Explain the improvement in payment for care management services by CMS.
  • Describe the new codes that allow reporting of additional evaluation and management services.
  • Discuss how these codes have the potential to improve patient care.
  • Discuss CMS proposed changes to evaluation and management service codes.

 Value-Based Care: How Can the Dollars Make Sense?

This session will provide an overview of the expense management process in a large national ISNP. Topics will include the recommended makeup of a multidisciplinary team, how the team analyzes information to identify areas of potential cost savings, and various strategies to address these opportunities. The role of the Medical Director as an advocate for patient-centered decision making and ensuring quality of care will be explored. 

Ensuring that patient/family goals of care are met within a value-based environment will be addressed.  Examples of actual expense management initiatives and their outcomes will be shared.

 

Learning Objectives:

At the completion of this session, learners will be able to:

  • Define the role of the Medical Director in an expense management program.
  • With their leadership teams, compare which cost drivers can be impacted by an expense management program.
  • Recognize opportunities addressed within the vignette presented and within their own practices.

Legal and Practical Perspectives on Medical Director Agreements

Medical Director Agreements are critical to establishing obligations and boundaries between the provider and the physician. There are a number of key provisions that Medical Director Agreements should have, including (a) the duties of the medical director; (b) compensation; (c) the licensure, criminal history, and exclusion status of the medical director; and (d) insurance and indemnity. Recently the Department of Justice has investigated False Claims Act violations arising from the alleged payment of kickbacks in the form of sham medical director agreements and payments to the spouses of referring physicians. Session will review the nuances of key agreement terms and address Medical Director experiences in creating and negotiating an agreement.

 

Learning Objectives:

At the completion of this session, learners will be able to:

  • Identify key terms and provisions of their medical director agreement that can and should be negotiated.
  • Learn and hear first-hand  practitioner perspectives on creating and negotiating an agreement.
  • Identify key negotiation approaches to key terms and provisions of their medical director agreement.
  • Understand the key elements of noncompete clauses and the Biden Administration's initiative on those.

 

 The Last Mile in Value-Based Care: Transforming PALTC Care at the Bedside

This session will explore the essential policy/regulatory, technological, and clinical changes necessary to transition the PALTC delivery model from a volume-focused fee for service “churn and burn” approach to one that enables prevention and population health management. Topics to be covered include: (1) innovative payment and delivery models that align incentives and provide the essential resources for clinicians to focus on driving down unnecessary emergency department visits and hospitalizations, (2) technologies that enable providers to perform a wide range of diagnostics at the bedside and promote virtual access to specialty care; and (3) advances in EHRs that provide real-time data to inform care delivery at the bedside. The speakers will explore models and technologies that hold promise for transforming PALTC care delivery along with potential barriers to delivery system transformation and reasons for optimism.

 

Learning Objectives:

At the completion of this session, learners will be able to:

  • Identify the financial, technological, and cultural factors that have inhibited the adoption and diffusion of value-based care delivery models and population health management approaches in PALTC settings despite significant growth in managed care and alternative payment models, including Medicare Advantage plans and accountable care organizations.
  • Identify the changes to reimbursement arrangements for healthcare providers as well as emerging care delivery models and clinical technologies and care delivery models that will be essential to bringing value-based care--including a focus on prevention, early detection, care coordination and management--to the bedside in PALTC facilities along with the key drivers and inhibitors to these critical changes and technological advances.
  • Translate the insights from the data and real-world case studies provided in the session to practical steps that participants can take within their organization to develop more effective incentive models, acquire valuable new technologies, and adopt clinical practices that promote prevention and care coordination.
  • Describe the specific reimbursement models, technologies, and clinical practices that innovators in the PALTC industry have adopted to ensure that population health management is being delivered at the bedside in their facilities.

Robert Zorowitz, MD, MBA, CMD, FACP, AGSF

Robert Zorowitz, MD, MBA, CMD, FACP, AGSF, is Regional Vice President, Health Affairs, for the Northeast Region 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.  During his career, he was an attending physician or medical director at a variety of nursing facilities of varying sizes in the Atlanta and Metro New York city areas.  For the last 15 years, he has been the American Geriatrics Society Advisor to the American Medical Association's CPT Editorial Panel.  As part of that work, he was a member of the working group that revised the CPT Evaluation and Management code descriptors.  

Dallas Nelson, MD, CMD, FACP

Dallas Nelson, MD, CMD, FACP, is a Professor of Medicine at the University of the Rochester in the Division Geriatrics and Aging. She is medical director of the UR Medicine Geriatrics Group, a group that serves about 3000 patients across the spectrum of long term care in the Rochester, New York.  Dr. Nelson serves as a leader of Telehealth sub-committee for Society of Post-Acute and Long Term Care Medicine.  Dr. Nelson has published clinical trials on the use of Telemedicine to reduce Emergency Department Use by Geriatric Homes.  She has a passion for improving the care of the geriatric community.

Cathy Lipton, MD, CMD

Cathy Lipton, MD, CMD, is the National Medical Director for Institutional Programs within the Senior Community Care segment of Optum. She manages a number of medical directors and supports the delivery of quality clinical care for Special Needs Plans focused on long term and post-acute care populations. Dr. Lipton has served on the American Health Care Association's Clinical Practice Committee and Professional Development Workgroup and is a Past President and long-standing board member of the Georgia Medical Directors Association.

Laurent Adler, MD, CMD

MD, CMD

Laurent Adler, MD, CMD is a Senior Medical Director for Optum’s ISNP Nursing Home Plan in Georgia, Alabama and Mississippi.  He is responsible for quality care by serving as a resource to field-based clinicians, drives critical thinking at the senior leadership team level and coordinates solutions to clinical challenges.  He is vice-president of the Georgia chapter of AMDA.

Erik Peloquin

Erik Peloquin is an Associate Director of Performance and Affordability at Optum. He works on identifying healthcare trends and driving more affordable care to our members. 

Sean Fahey, JD

Sean Fahey, JD, is a health attorney who helps skilled nursing facilities, assisted living facilities, home health providers, and hospice providers navigate regulatory and compliance matters. Sean represents physicians and providers in designing, negotiating, and drafting medical director agreements. Sean represents healh care clients in all areas of health care compliance, governance, transactions, Medicare enrollment, administrative appeals, and agreements. Sean counsels nonprofit clients on charitable operations and governance. 

Shivani Chopra

Shivani Chopra is a board-certified geriatrician and PALTC physician practicing in Las Vegas, Nevada. She completed her fellowship in Geriatrics at the Icahn School of Medicine's Brookdale Department for Geriatrics and Palliative Medicine. She was formerly the medical quality director for a 500-bed skilled nursing facility in New York City and is currently the medical director at two Las Vegas SNFs. 

Tom Haithcoat

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. In addition, Mr. Haithcoat is the Vice President of Network Development and Integration for CareConnectMD. A National PALTC aligned ACO Model.  Mr. Haithcoat is also the co-founder of Geriatric Medical Specialists, LLC. GMS is a Management Services Organization for small Post Acute Care physician practices. Tom sits on the Board of Directors for AMDA-The Society for Post Acute and Long Term Care Medicine and on the Board for the AMDA Foundation. Within AMDA Mr. Haithcoat Chairs the Practice Management Section(PGN) and Co-Chairs the Chief Medical Officer Leadership Meetings.

Adam Perry, MD

Adam Perry, MD is a geriatrician and emergency physician working at the evolving intersection of non-hospital-based acute care and value-based payment models.  He is a Health and Aging Policy Fellow, faculty with the Center for Excellence for Telehealth and Aging, and Medical Director with DispatchHealth, the nation’s largest provider of home-based acute care.  In recent years he has been Medical Director with the Innovation Project at ChenMed, a scaling delegated Medicare Advantage provider group, and Core Faculty with the Geriatric Emergency Department Collaborative.

  • 4.5 CME
  • 4.5 MOC
  • 4.5 CMD Management 

Release Date: 06/28/2024   |   Expiration: 06/27/2026

Credit Statements:

Accreditation: Post-Acute and Long-Term Care Medical Association is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians. 

CME Designation: Post-Acute and Long-Term Care Medical Association designates this enduring material for a maximum of 4.5 AMA PRA Category 1 Credit(s)™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

ABIM MOC: Successful completion of this CME activity, which includes participation in the evaluation component, enables the participant to earn up to 4.5 Medical Knowledge MOC points and patient safety credit in the American Board of Internal Medicine’s (ABIM) Maintenance of Certification (MOC) program. It is the CME activity provider’s responsibility to submit participant completion information to ACCME for the purpose of granting ABIM MOC credit.

CMD Credit Hours: This CME activity has been pre-approved by the American Board of Post-Acute and Long-Term Care Medicine (ABPLM) for up to 4.5 management hour(s) toward certification or recertification as a Certified Medical Director (CMD) in post-acute and long-term care medicine. Each physician should claim only those hours of credit actually spent on the activity.

The CMD Program is administered by the ABPLM. For further information, contact ABPLM at 410-992-3117 or at cmd@paltmed.org. 

Financial Disclosure Statement:

The following speaker disclosed a relevant financial relationship: 

  • Tom C. Haithcoat (Speaker): CareConnectMD: Advisory Board (Ongoing), Consultant (Ongoing), Employment (Ongoing), Stockholder/Ownership Interest (excluding diversified mutual funds) (Ongoing); Careline Health Group: Consultant (Ongoing)|; Ceptor Consulting, LLC: Board Member (Ongoing), Employment (Ongoing), Stockholder/Ownership Interest (Ongoing); Geriatric Medical Specialist, LLC: Board Member (Ongoing), Employment (Ongoing), Stockholder/Ownership Interest (Ongoing); HealthPivot: Consultant (Ongoing); PointClickCare: Consultant (Ongoing)

All relevant relationships have been mitigated by the Association. No one else in control of content disclosed any relevant financial relationships with ineligible companies whose primary business is producing, marketing, selling, re-selling, or distributing healthcare products used by or on patients.

 

Components visible upon registration.