Title: The Quest for Quality: Red Flags in Skilled Therapy and the Changes Required by the Planned Transition to the New Patient Driven Payment System (PDPM)
Date: Wednesday, May 1, 2019
Time: 7:00pm-8:30pm Eastern
Speakers: David Jackson, MD, PhD; Jonathan Evans, MD, MS, CMD; Alissa Vertes, BS, MSSLP, CHCCA
This presentation, using case examples, will focus on two major issues facing skilled nursing facility care: the risks and opportunities created by the combination of the current Resource Utilization Groups (RUGS) reimbursement system and the federal government’s increasing use of “Big Data” to identify potential outliers using a set of metrics; and the changes involved with the soon-to-be implemented Patient Driven Payment Methodology (PDPM).
- Explain the concepts of medical necessity, false claims and worthless care in relationship to the quality of care in the skilled nursing facility setting, and how to apply these concepts.
- Describe the processes The Centers for Medicare & Medicaid Services (CMS) and other governmental entities use to evaluate medical necessity, potentially false claims and potentially worthless care in post-acute care.
- Discuss how post-acute long-term care providers and medical directors may be asked to participate productively in these processes to provide clinical insight and interpretation to both resolve concerns and proactively minimize risk going forward.
- Define the soon-to-be implemented Patient Driven Payment Methodology (PDPM) and improve participants’ readiness to respond to this new reimbursement system for skilled care in skilled nursing facilities.
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 education for physicians. The Society designates this live activity for a maximum of 1.5 AMA PRA Category 1 CreditsTM. Physicians should only claim credit commensurate with the extent of their participation in the activity.
CMD Credit Statement
This live activity has been pre-approved by the American Board of Post-Acute and Long-Term Care Medicine (ABPLM) for a total of 1.5 management hours toward certification or recertification 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.
Maintenance of Certification (MOC)
Successful completion of this CME activity, which includes participation in the evaluation component, enables the participant to earn up to 1.5 MOC points and medical knowledge and patient safety credit MOC credit in the American Board of Internal Medicine’s (ABIM) Maintenance of Certification (MOC) program. Participants will earn MOC points equivalent to the amount of CME credits claimed for the activity. It is the CME activity provider’s responsibility to submit participant completion information to ACCME for the purpose of granting ABIM MOC credit.
David Jackson, MD, PhD, has had extensive experience in quality improvement, regulatory compliance, and systems improvement in the long-term care setting over the past 30 years. Dr. Jackson received his MD and PhD from Johns Hopkins University school of medicine. From 19803 to 1986, he served as the director of the Ohio Department of Health, with responsibility for oversight on all of the quality surveys conducted by the health department for all the State’s SNFs. In 1986, Dr. Jackson founded Jackson Associates Inc., a consulting group focused on quality improvement in the post-acute care system. He also served as National Medical Director for HCR Manor Care (2000-2005). Over the past 12+ years, he has worked as the Quality Monitor for multiple geriatric services companies that have entered into a Corporate Integrity Agreement with the US DHHS OIG. He has also led consulting engagements in quality improvement and regulatory compliance issues in over 35 states for the provider community, state and federal government entities and the courts. In the past 10 years, he has been very active as an expert witness for multiple lar firms on cases of either audit exception findings or false claims actions by the US Department of Justice related to medical necessity and reasonableness of services provided. For the past 24 years, he has been an Adjunct Professor of Geriatric Medicine at the Johns Hopkins University School of Medicine.
Jonathan Evans, MD, MS, CMD, is a geriatrician practicing post-acute and long-term care medicine in Charlottesville, Virginia. He is Board certified in Internal Medicine, Geriatric Medicine, Hospice and Palliative Medicine, as well as Medical Direction, and holds a master’s degree in Public Health and Epidemiology. Dr. Evans completed medical school, internal medicine residency, and geriatric medicine fellowship all at Mayo Clinic in Rochester, Minnesota, where he remained on the faculty for many years before moving to Virginia in 2001. Dr. Evans is the former Head of Geriatric Medicine and Palliative Medicine at the University of Virginia, where he held an endowed chair, and received the dean’s award for clinical excellence. He is the Past President of AMDA the Society of Post-Acute and Long-Term Care Medicine, and recipient of the Dr. James Pattee national teaching award. He currently serves as Chair of the Society’s Ethics Committee.
Alissa Vertes, BS, MSSLP, CHCCA, serves as the chief compliance officer for HealthPRO® Rehabilitation since 2010. Holding an MS in Speech Language Pathology and Board Certified in Healthcare Compliance by the HealthCare Compliance Association, she has managed rehabilitation departments across LTC/Hospital/Outpatient settings for 20+ years. Currently, Alissa is a national speaker on defensible documentation for rehabilitation specialists, audit environment and provider preparation and serves as compliance consultant and internal compliance investigation team lead for multiple organizations. She is a specialist in risk assessments for rehabilitation services, an expert on therapy documentation review, audit and denial management processes, as well as related compliance policies and procedure development.
Speakers are required to provide verbal disclosure prior to each talk. If the learner perceives any bias toward a commercial product or service, please report this to the Society’s staff. According to the Society and ACCME policy, all those in a position to control content are required to disclose any relevant financial relationships.
The following AMDA Education Committee members have financial relationships to report: John Loome – Genesis HealthCare: Full Time Employee; Diane Sanders-Cepeda, DO, CMD – UHG-Optum: Full Time Employee; all others have no financial relationships to disclose.
The Online Education Subcommittees have no financial relationships to disclose.
The speakers have no financial relationships to disclose.
AMDA staff have no financial relationships to disclose.Test