Institute for Healthcare Financial Improvement

February 9-10, 2012
The Hornberger Conference Center
Houston, Texas

Agenda and Information
Please check back frequently for updates...

Up to 12.5 CPE Credits Available
Sponsored by the Texas Gulf Coast Chapter of HFMA, Sponsor# 00713. See session descriptions below for Level, Prerequisites, Course Descriptions, and Learning Objectives. All sessions are presented as Group Live.

Conference Location:
The Edwin Hornberger Conference Center
2151 W. Holcombe Blvd. | Houston, Texas
Map and Directions

Conference Attire: Business Casual
However - be aware that meeting rooms are often cold. Please bring a light jacket or sweater if you feel it will be needed.

This month's charity is Dress for Success.
We are asking for donations of new or gently used Scarves and Black Handbags.

Sponsorship & Exhibit Opportunities

Thursday - February 9, 2012

7:30 - 8:55 am Registration | Continental Breakfast

7:55 - 8:05 am Welcome and Introductions

8:05 - 8:55 am
Contracts? We Don't Need No Stinking Contracts!
Course: 120201 | CPE Credits: 1.0 | Level: Basic | Prerequisites: None

Course Description: The topic will include a review of current issues in managed care, direct contracting and network contracting. Highlights of points to be covered include 1. risks and exposures of different categories of health plans; 2. Specific contract terms that need close attention; 3. Legal issues and legal remedies associated with disputes.

Learning Objectives: After this session, the attendees will have current information on the subject matter from a lawyer that litigates works with the managed care contracting process and litigates the issues being discussed.

Target Audience: CEOs, CFOs, COOs, Controllers, Managed Care representatives of providers and payors; others with responsibility or an interest in managed care contracting and/or the health care revenue cycle

T. Daniel Hollaway, Esq. - President and Managing Director, Hollaway & Gumbert | T. Daniel ("Danny") Hollaway is President and Managing Director of the law firm of Hollaway & Gumbert in Houston, Texas. Mr. Hollaway is a graduate of South Texas College of Law and has been representing health care providers since 1991. He is Board Certified in Health Law by the Texas Board of Legal Specialization and a member of several professional health care organizations. His practice involves representing physicians, provider organizations and hospitals of virtually all types and sizes in several numerous areas of health law.

8:55 - 10:10 am
Keynote Address: Health Care Reform - Crossing the Glacier
Course: 120202 | CPE Credits: 1.5 | Level: Basic | Prerequisites: None

Course Description: The topic will include an overview of the shifting healthcare landscape and review various elements of healthcare reform that will impact healthcare providers. Highlights will include 1.Healthcare reform overview; 2.How we got to where we are as an industry & why change is inevitable; 3.What to watch for in 2012.

Learning Objectives: After attending this session, the attendees 1. will have current information on the important aspects of healthcare reform and how they will impact the work of healthcare providers; 2. will be able to indentify key trends & what to watch for in the coming year as industry change occurs; 3. will have current information on the subject matter from a lawyer that litigates works with the managed care contracting process and litigates the issues being discussed.

Target Audience: CEOs, CFOs, COOs, Controllers, Managed Care representatives of providers and payors; others with responsibility or an interest in managed care contracting and/or the health care revenue cycle

Dr. Marc Boom, M.B.A., F.A.C.H.E. - President and Chief Executive Officer, The Methodist Hospital System | Marc L. Boom, M.D., M.B.A., F.A.C.H.E. currently holds the position of President and CEO of The Methodist Hospital System. Previously Dr. Boom held the positions of Senior Vice President and COO of The Methodist Hospital, President and CEO of Methodist Diagnostic Hospital and President/CEO/Medical Director of Baylor-Methodist Primary Care Associates, a network of primary care physicians. Dr. Boom is also an Assistant Professor of Medicine at Weill Medical College of Cornell University and previously was an Adjunct Professor of Management at Rice University. He represents The Methodist Hospital within the University HealthSystem Consortium (UHC) on the Board of Directors. He maintains a part-time clinical practice where his special interests are preventive medicine, lipid disorders, and hypertension. Dr. Boom was a finalist for the 2009 and 2010 Health Care Hero Award by the Houston Business Journal. In 1999, Modern Healthcare magazine named Dr. Boom one of healthcare’s newest leaders – the “Up and Comers.” In the 2007 Modern Healthcare “Up and Comers Yearbook” celebrating 20 years of the list, Dr. Boom was singled out as the “Star Student” of the “Up and Comers Class of 1999.” Also in 2007, the American Heart Association awarded Dr. Boom the “2006 Distinguished Service Award.”

10:10 - 10:30 am Refreshment Break

10:30 - 11:45 am
ACO's - An Institutional Perspective
Course: 120203 | CPE Credits: 1.5 | Level: Basic | Prerequisites: None

Course Description: This informative and interactive session focuses on the latest developments with Accountable Care Organizations including the new Advance Payment ACO model. Highlights to be covered include status of Accountable Care Organizations at the local and national level, and actions that a hospital should be taking/doing now (or have already done) to prepare for the impending shift in how healthcare is delivered at the local/regional level.

Learning Objectives: After this session, the attendee will have gained an understanding of the impact that ACOs are predicted to have on the healthcare delivery system.

Target Audience: Healthcare financial professionals, hospital CEOs, CFOs, and associated staff

Dr. Ronald Walters - AVP, Medical Operations and Informatics.; Medical Director, Managed Care; Professor of Medicine, UT M.D. Anderson Cancer Center | Ron Walters is an associate vice president of medical operations and informatics at The University of Texas MD Anderson Cancer Center in The Texas Medical Center, applying more than 30 years of experience and knowledge at MD Anderson. Dr. Walters is a breast medical oncologist and is responsible for the professional aspects of Clinical Operations including Medical Informatics, the Tumor Registry, the Transfer Center, Managed Care Programs, Uncompensated Charity Care, Clinical Safety and Effectiveness and our Physicians Network. He serves on multiple institutional committees striving for improvements in patient care, research and our support systems.

11:45 - 1:00 pm Lunch and Networking

1:00 - 2:15 pm

Physician and Patient Management of Health Care for Medicare or Else What?

Course: 120204 | CPE Credits: 1.5 | Level: Basic| Prerequisites: None

Course Description: This session should inspired the attendees to think that everyone trying to change the way we have being doing Medicare is not crazy. Points to be covered include who will lead, by what rules, with what risk, and for how much money? Can it be done and how.

Target Audience: People who have something to gain or lose from Medicare and ultimately from a reformed medical care delivery system

Don McCormick - President, Linked IPAs Physicians ACO | Don McCormick graduated from the University of St. Thomas and received an undergraduate degree in History. He continued to take Advanced Studies in Property and Casualty Insurance at the University of Houston and in HMO Management Course at Mills College sponsored by Wharton School of Finance. McCormick operated a property and casualty agency for ten years and then went on to become president of Computechnology Corporation, a software firm that installed, customized, and maintained Medical Practice Management Systems. From 1987 to 1996, he served as executive director of National Association of Preferred Providers, an association of individual physicians, hospitals, Independent Practice Associations (IPAs) and Primary Health Care Organizations (PHOs). Since 1996 McCormick has been CEO of a Physician’s Management Company that runs Linked IPAs in Texas and North Carolina and beginning in 2011 the Physician’s ACO in Houston.

2:15 - 3:05 pm
Fraud: Patient and Insurer Scams, Controls, Risks
Course: 120205 | CPE Credits: 1.0 | Level: Basic| Prerequisites: None

Course Description:This session presents an update on current fraud activity and enforcement efforts. Highlights to be covered include the magnitude of the problem of fraud in health care, example of common fraud schemes, highlights of current fraude enforcement efforts, "Red Flags" of potential health care fraud activity.

Learning Objectives: After this session, the attendees will understand the magnitude of the problem of fraud in health care and have clues to assist in preventing fraudulent activity.

Target Audience: C-suite, managers with PFS/Revenue Cycle responsibility, managed care staff

Jeff Helton, Ph.D. - Assistant Professor, University of Texas School of Public Health | Jeff Helton PhD is an Assistant Professor in the Fleming Center for Healthcare Management at the University of Texas School of Public Health in Houston. He teaches graduate courses in healthcare operations management, health informatics, and health care fraud. His research focuses in the impacts of information technology on operational efficiency and quality in hospitals. Before moving into the academic ranks, Jeff held a variety of senior financial and operational positions in hospitals, health plans, and integrated health systems nationwide. Much of his work as a line manager focused on financial turnarounds, bringing healthcare organizations already in bankruptcy or receivership back to sustainable operation. He is a Certified Management Accountant, a Certified Fraud Examiner, and a Fellow of HFMA.

3:05 - 3:20 pm Refreshment Break

3:20 - 5:00 pm
Panel Discussion: PPACA, Part D Donut Hole, Medication Management, Medicaid 340B Financial Impact, and Opportunities in Pharmacy Practice
Course: 12026 | CPE Credits: 1.5 | Level: Basic| Prerequisites: None

Course Description: As leaders of pharmacy, we invite you to engage in a panel discussion on The Patient Protection and Affordable Care Act’s (PPACA) financial impact and opportunities in pharmacy practice. Several provisions affecting the pharmacy practice include Medicare Part D’s “dounut hole”, medication therapy management and patient safety, durable medical equipment (DME) accreditation requirements, pharmacy benefit manager transparency, Medicaid payments for generic drugs, the 340B drug pricing program. The panel will be moderated by Isabell Pacheco,
MBA, Pharmacy Inventory Manager for Harris County Hospital District and 340B Peer-to-Peer mentor for the Health Resources and Services Administration’s Pharmacy Services Support Center. Panelists include Ryan K. Roux, PharmD., M.S., Chief Pharmacy Officer at Harris County Hospital District; Lisa M Scholz, PharmD, MBA, Vice President at the Health Resources and Services Administration’s Pharmacy Services Support Center; and Dan Metzen, Director of Pharmacy Services, Methodist Hospital.

Learning Objectives: Partipants will be able to: 1. Describe the pharmacy landscape and health reform impact after the passage of PPACA; 2. Describe pharmacy safety net opportunities (340B, Medicaid, Patient Safety, MTM); 3. Identify current and future initiatives as a result of PPACA; 4. Understand a health-system pharmacy plan to prepare for the changes and impact of changes that have already occurred since the passage of PPACA.

Target Audience: Chiefs of Pharmacy, Pharmacy Directors, Pharmacy Buyers, Pharmacists, CFO’s, In-house Counsel, Compliance Officers, Government Relations Directors

Isabell Pacheco, MBA - Pharmacy Inventory Manager for Harris County Hospital District and 340B Peer-to-Peer mentor for the Health Resources and Services Administration’s Pharmacy Services Support Center | Isabell Pacheco currently serves a dual role as the pharmacy inventory manager for the Harris County Hospital District in Houston, Texas, the nation’s fifth largest public metropolitan health system; and as a 340B Peer-to-Peer Network Mentor for the Health Resources and Services Administration’s Pharmacy Services Support Center, in Washington D.C. Isabell is also the co-author of “Exploring Cost Savings with Generic Switches”. Previously, she served as the senior regional coordinator at the Amerisource Bergen Corporation, one of the world’s largest pharmaceutical services companies, where she managed operations of patient assistance programs for seven years. Isabell earned a BS in business management and an MBA from the University of Phoenix; she has also maintained her certification as a pharmacy technician since 1997.

Lisa Scholz, PharmD, MBA - VP, Apha HRSA Pharmacy Support Center| Lisa Scholz is the Vice President for the American Pharmacists Association in Washington, DC. She manages the Health Resources Services Administration (HRSA) Pharmacy Services Support Center (PSSC), as the federal contractor for the Office of Pharmacy Affairs (OPA)-the federal resource for the practice of pharmacy and the administrator of the 340B Program. PSSC provides free technical assistance, a peer to peer mentor network, policy analysis, and program development to support over 15,000 healthcare sites across the country. Dr. Scholz’s 20 years of pharmacy operation experiences include: health-system management, retail pharmacy operations, ambulatory care clinical pharmacy programs, Aids Drug Assistance Programs, 330 grant school-based and homeless/provider-based clinics. She has held responsibility for a budget of $80 million with 400 FTE's to now helping HRSA support a $6 billion dollar 340B pharmaceutical budget. Her primary role currently is to provide leadership to the 340B community to help facilitate collaboration amongst health care providers, stakeholders, and leading practice sites to connect the safety net community and provide infrastructure to facilitate integrity and compliance with programs such as Medicaid, Medicare, and 340B -while keep the patient center. Dr. Scholz holds a Doctorate in Pharmacy from the University of Houston and an MBA from Madison University. She was nominated Shaker of the Year in 2007 by the Houston Chamber of Commerce, which recognizes professional women committed to the community by her actions in emergency management both professionally and as a volunteer for the Medical Reserve Corp. She is an active alum of the University of Houston participating on the College of Pharmacy Dean’s Advisory Committee and speaker for the James T. McCarty Leadership Lecture Series. She is a graduate and fellow of the Agency for Healthcare Research and Quality/VA Patient Safety Improvement Corp, where her team focused on medication reconciliation in the safety net community. She is a trained TeamSTEPPS instructor that utilizes an evidence-based teamwork system to improve communication and teamwork skills among all health care professionals to improve patient safety. She attended the Institute for Health Improvement Breakthrough Series College focused on methods to spread improvements throughout healthcare organizations where she has utilized her skills as a faculty member for the HRSA Patient Safety and Clinical Pharmacy Services National collaborative since 2008. She is an advocate for patient-centered, quality focused, interdisciplinary care models.

Ryan Roux - Chief Pharmacy Officer, Harris County Hospital District|Ryan K. Roux, Pharm.D., M.S. is the Chief Pharmacy Officer for the Harris County Hospital District in Houston, Texas. He received his Pharm.D. from the University of Houston College of Pharmacy prior to earning a M.S. in Pharmacy Administration from The Ohio State University. He is currently responsible for leadership and oversight of Pharmacy Services for the Harris County Hospital District which consists of two acute care hospitals, fourteen ambulatory clinics, numerous school based clinics, and a geriatric/physical rehabilitation hospital facility. Dr. Roux is a past president of local pharmacy society, has served on the Texas Society of Health-System Pharmacists (TSHP) Board of Directors. He is on the University of Houston Dean’s Advisory Committee and Leadership Advisory Council for the University of Houston Pharmacy Master’s Program. Dr. Roux has testified before the Texas House of Representative’s Healthcare Committee on Healthcare Workforce Issues, served on Technician Registration Task Force, and participated in disaster management for the state of Texas.

Dan Metzen - Director Pharmacy Services, The Methodist Hospital|Daniel Metzen, Pharm.D., MBA is the Director of Pharmacy at The Methodist Hospital (TMH) in Houston, Texas. He received his Pharm.D. from the University of Kansas in 1999 and completed a Pharmacy Practice Residency at TMH prior to earning an Executive MBA from the University of Houston, Bauer College of Business. TMH is a large private, adult teaching hospital part of a five hospital system and one research institute totaling over 1,500 operating beds. He provides direct leadership and accountability for the performance of the medication management process caring for over 37,000 inpatients, 300,000 outpatients and 45,000 emergency room visits at TMH. Dr. Metzen presented recent topics on medication safety at the American Society of Health System Pharmacist Summer Meeting in Denver, Colorado and at the UHC Quality 2014 Symposium in Houston, Texas. He is member of Texas Society of Health-System Pharmacists (TSHP), American Society of Health System Pharmacist and Gulf Coast Society of Health System Pharmacists. He served as Health System Coordinator for the University of Texas School of Pharmacy and is actively engaged in the education and training of future Pharmacy leaders.

5:00 - 7:00 pm
International Wine Tasting and Food Pairing prepared by Trevisio's and Sponsored by MedAssets

Friday - February 10, 2012

7:30 - 8:55 am Registration | Continental Breakfast

7:55 - 8:00 am Welcome Back and Introductions

8:00 - 9:15 am
A Lean Approach to Audit Management (RAC, MAC, etc)
Course: 120207 | CPE Credits: 1.5 | Level: Basic | Prerequisites: Basic knowledge of Medicare and government audits

Course Description: This session will present a multi- hospital approach to effectively and efficiently manage the growing number of audits; RAC’s, MAC’s, Medicaid RAC’s and the rest of the audit alphabet soup as well as ways to operationally improve the risk area’s under review. Highlights of points to be covered include a review of Government audit landscape and, sample of reports to effectively communicate and identify opportunites for improvement with different stakeholders in your hospitals.

Learning Objectives: After this session, the attendees will have an insight on how to design a process to efficiently manage the increased volume of audits and appeals.

Target Audience: CEOs, CFOs, CMOs, VPMAs, compliance officers, case management directors, hospital clinical leaders, HIM directors

Dawn Crump - Network Director of Compliance - St. Louis, SSM Health Care St. Louis, Missouri | Dawn is currently the Network Director of Compliance for SSM Health Care St. Louis. She has healthcare experience in Education, Organization Development, Quality Improvement and Corporate Compliance and has been in the healthcare industry for over 15 years.. She is a six sigma trained black belt and is responsible for all RAC and other government post payment audit programs for all SSM Health Care acute care facilities in the St. Louis area, Depaul Health Center, St. Joseph Health Center, St. Joseph Health Center West, St. Mary’s Health Center, Cardinal Glennon Childrens Medical Center and St. Clare Health Center. She is a director on the board of the Greater St. Louis HFMA chapter and has served as Chair of the Networking committee and a team member for the Programs committee.

9:15 - 10:05 am
Enforcement Trends and Individual Liabilities
Course: 120208 | CPE Credits: 1.0 | Level: Basic | Prerequisites: None

Course Description: An enormous amount of resources are dedicated each year to healthcare investigations, the recovery of overpayments, and the prosecution of fraud. In addition, as part of the enforcement trends and healthcare reform, there is a greater focus on individual responsibility and liability. As government enforcement continues to be a focus in the combat against fraud and abuse, healthcare providers should understand the various enforcement trends and what can be done to prevent and mitigate such allegations.

Learning Objectives: Attendees will have a better understanding of enforcement trends and the role and liability of individuals in healthcare fraud investigations.

Scott McBride - Partner, Baker & Hostetler LLP | Mr. McBride focuses his legal practice on providing services to the healthcare industry with an emphasis on compliance and enforcement issues. He represents and advises clients in overpayment disputes, False Claims Act litigation, internal and external investigations, and regulatory enforcement proceedings. He counsels clients in corporate compliance matters, assisting and advising clients on internal investigations, self-disclosures and repayment matters. Mr. McBride also advises clients on Medicare, Medicaid and other government reimbursement and payment laws and represents clients through administrative appeals, such as the Medicare Claims Appeal process, RAC appeals, and ZPIC matters. Mr. McBride is listed in The Best Lawyers in America in healthcare law. Mr. McBride was also recognized as one of the Top 100 Super Lawyers in the Houston area for 2010. He has twice been named an “Outstanding Fraud and Compliance Lawyer” by Nightingale’s Healthcare News.

10:05 - 10:20 am Refreshment Break

10:20 - 11:10 am
Medicare Advantage: Shadow Billing Impacts on HITECH
Course: 120209 | CPE Credits: 1.0 | Level: Basic | Prerequisites: None

Course Description: This presenation will cover steps that hospitals can take to increase factors (Medicaid and Medicare Share) used in determining their HITECH Reimbursement amounts. Highlights to be covered include a general overview of the HITECH program, specific discussion on formulas used to determine HITECH payments, and strategies for increasing certain factors that drive HITECH payments.

Learning Objectives: After this session the attendees will have a better understanding of HITECH program and the formula(s) used for determining reimbursement.

Target Audience: Reimbursement and/or billing

John Garcia - Manager, Healthcare Payment Specialists |John Garcia has over 10 years experience in healthcare consulting services. He has worked extensively with providers on various Medicare and Medicaid reimbursement issues. Mr. Garcia’s focus is on the delivery of quality products and services to the hospital industry by leveraging technology-enabled business processes. He has personally developed or guided development of several HPS service lines. Mr. Garcia earned his MBA from the University Of Texas McCombs School Of Business and an undergraduate degree in Economics from the University of Texas. He lives in Fort Worth, TX.

11:10 - 12:00 pm
ICD-10 – To Boldly Go Where Coding Has not Gone Before
Course: 120210 | CPE Credits: 1.0 | Level: Basic | Prerequisites: None

Course Description: This session will present an overview of ICD-10, including a Decription and OVderview of the Codes and comparison with ICD-9, a discussion of GEMs and Crosswalks, Key Points with ICD-10, Testing Information, Impacts, Implementation Issues with ICD-10, and a discussion of the Healthcare Reform Act and additional changes upcoming as a result.

Learning Objectives: After this session the attendees will have gained basic information on ICD-10 and requirements for education and testing, along with insight into areas needing attention during implementation and upcoming initiatives that may impact resources and timelines.

Target Audience: Business Office Managers, Director of Patient Accounts

Pamela Grosze - Vice President, Payer Services, PNC Bank | Pam Grosze is the Vice President of Payer Services for PNC Bank’s Healthcare Division, which provides financial and revenue cycle management solutions for hospitals, healthcare providers, and other healthcare organizations. Pam has spent more than 20 years in healthcare environments, implementing and supporting healthcare EDI transactions for leading companies, including PNC Bank and RelayHealth. She has worked with numerous healthcare EDI transaction types, including claims, remittances, claim status, eligibility, and acknowledgements, with particular expertise with X12 837 Claims and X12 835 ERAs. She has extensive knowledge and expertise in clearinghouse operations, revenue cycle management, remittance posting products, and payer processing. Pam has been directly involved in industry committees and organizations, including X12, Workgroup for Electronic Data Interchange (WEDI), Committee on Operating Rules for information Exchange (CORE), and HFMA. In addition to attendance at these regular meetings, she has presented on multiple occasions on a variety of topics, including Electronic Funds Transfer, HIPAA, National Provider Identifier, 5010, and ICD-10, and currently co-chairs WEDI’s subworkgroup on Electronic Funds Transfer and X12’s workgroup on 835 Healthcare Claim Payments.