The educational content is the cornerstone of this conference. Use the interactive schedule below to explore the educational content of this conference. Click on the name of a session to view its faculty and complete abstract. Then click on a speaker's name to learn more about the session's presenter.

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2011 Call for Presentations

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April 8th, 2010

8:00 - 1:45 Pre-Conference Workshop
1: RAC - Tracking the Impact at Small, Med. & Large Hospitals
- Recovery Audit Contractors (RACs) have imposed a significant new regulatory burden and work processes on hospitals. However, how providers of various sizes are able to successfully manage RAC requirements varies significantly. Larger organizations may face a high volume of RAC retractions - and must harness available organizational resources to manage the process. Smaller hospitals may face a smaller volume, but also have much more limited resources.
  
  This session brings together a panel that includes RAC experience - in the CMS RAC Demonstration - and represents large, medium, and small rural hospitals. The session will focus on practical information that attendees can easily take home and apply at their own organizations. The session will, for each of the various hospitals sizes, discuss (1) process flowchart for managing retraction notices and appeals, (2) processes and internal tracking tools that have proven successful in managing the process efficiently, (3) rights and expectations of the contractors, and (4) clear understanding of the audit, retraction, and appeal processes
2: CMS & Legis. Update - Looking to the Horizon of Healthcare
- Healthcare is changing quickly as the pressure for healthcare reform and cost reduction grows. Case management is increasingly being tasked with managing the impact of legislative changes. It is imperative that hospital leaders - including case management leadership - actively monitor legislative/public policy developments and continually evaluate how the proposed reforms affect case management. This session will identify and discuss the top healthcare issues on the legislative agenda that are likely to significantly impact case management, their development, and how case management leaders should prepare for them.
3: CMS Demonstration - Operational Experience in the Care Transitions Demo.
- Eliminating unnecessary hospital admissions and reducing readmissions is now a key priority for CMS, and through various demonstration programs CMS is investigating the most effective ways to reduce readmissions of Medicare beneficiaries. As with the RAC Demonstration, those projects that prove most effective are likely to be implemented much more widely by CMS. One of the largest such demonstration projects is the Care Transitions Project. The stated goal of the project is to "...improve health care processes so that patients, their caregivers, and their entire team of providers have what they need to keep patients from returning to the hospital for ongoing care needs."
  
  This session will present the experience of a hospital involved in the project, and how this impacted case management processes. In contrast to many past demonstrations, the Care Transitions Project involves care teams at the hospital scrutinizing processes to create improvements in seamless transitions. This session will also discuss several effective strategies developed to reduce readmissions for various patient populations, and present the outcomes achieved by each. Ultimately, participants will learn not only effective readmissions strategies they can implement at their organization, but also what their organization and case management department can expect if Care Transitions becomes a significant factor nationally.
8:00 - 1:45 NICM ACM Certification Review Workshop
- NICM offers a Certification Review Workshop to prepare individuals for the ACM™ Certification testing process. This unique certification is especially meaningful for Hospital Case Management professionals, and effective preparation is critical to success. NICM's structured educational workshop, coupled with a Case Management professional's practical experience, will prepare candidates to achieve the ACM™ Credential.
  
  Workshop Deliverables:
  1. Overview of the general base of Hospital Case Management knowledge tested on the ACM™ Certification exam
  2. Familiarization/preparation for the Practice Simulation portion of the ACM™ Certification exam
  3. All participants receive the NICM ACM™ Certification Study Guide with their registration
  4. All participants receive access to a one-time use online practice test
  The ACM™ Certification examination for Hospital Case Managers will be offered at the conclusion of Post Conference on April 11, 2010.
  
  Note: NICM does not have access to the ACM™ Examination or the examination content. NICM and NICM's ACM™ Workshops are not affiliated with or endorsed by ACMA.
2:00 - 3:15 ACMA Leadership Forum: Change Mgt. Plans for CM Process Improvement
- "People can change but they almost never do!"
  
  Have you ever known the technical solution to a problem but failed to make the change necessary due to unforeseen barriers, such as politics? Whether you are designing new programs or working to improve your work processes, this session will provide practical solutions to successfully implementing change. This session will help you identify the potential barriers to change and select strategies to address them. Attendees will see how the techniques were applied to achieve successful process improvement in the Sutter Health Sacramento Sierra Region case management department.
3:00 - 7:00 Poster Presentation Session
- The Poster Presentation Session provides a less formal and highly interactive eduational experience. Learn from poster presenters from around the country, and discuss with them topics that are most important to you and your organization.

April 9th, 2010

8:00 - 9:00 ACMA New Member Orientation
- Registering for the Main Conference includes and ACMA membership. If you are new to the association, attend this new member orientation to learn about how to utilize your member benefits, how ACMA serves and represents you, and how to get involved.
9:45 - 10:45 Keynote Address
- Keynote speaker Quint Studer is CEO and Founder of Studer Group, is considered by many to be the main impetus for developing tools and techniques for organizations attaining great results. The systems he and the Studer Group have invented hardwire techniques and behaviors to sustain these great results. Quint has a proven record of producing excellence in healthcare settings, and is also a nationally recognized speaker and a published author. Quint is called healthcare's fire starter for igniting the flame in each of us to make a difference. He will mix passion with prescriptions to help us achieve our goals and connect to purpose.
11:00 - 12:00 ACMA Annual Meeting
- The 2010 ACMA Annual Meeting will update members on ACMA activities, priorities and initiatives, as well as provide a forum for members to influence the development of ACMA initiatives. The ACMA Annual Meeting is open to ACMA members only. A nonmember NICM Main Conference registration includes a one-year ACMA membership.
1:00 - 2:00 Compare AD™ Informational Presentation
- While many organizations track delays in patient care, Compare AD is the only system that allows organizations to take the next steps in improving delays by comparing themselves to other organizations to unveil performance improvement needs, and by translating delay data into actionable information.
  
  This is a quick, convenient way to learn more about ACMA's innovative Compare AD system and how it can benefit your organization. This presentation will provide an overview of Compare AD, and present case examples of the performance improvements achieved through the Compare AD.
2:15 - 3:30Breakout Sessions A
1A: Positioning CM to Transform Care under Payment Reform
- Case management is an integral component of transforming care within payment reform. This session will identify how two academic medical center case management departments within the same health system positioned themselves as major contributors under payment reform. The presentation will examine the evolution of programs, strategies to position case management for success, and tools and metrics to demonstrate that case management is an essential component to successful transformation of care under payment reform. This session will provide an overview of the current status of payment reform, discuss several successful strategies for positioning case management within a hospital and health care system, identify supporting tools and outcome measures, and describe several initiatives where case management made major contributions to position the organization for success as payment reform evolves.
2A: Hospital Based Child Abuse & Neglect Teams: Best Practice Model
- Do you want your organization's response to child abuse and neglect to be "Best Practice?" Taking your program to the "Best Practice" level will lead to the ultimate goal of greater impact on protecting children in your community. This session will provide you with a "Best Practices" model for a hospital-based, multi-disciplinary, multi-agency SCAN (Suspected Child Abuse and Neglect) Team, dedicated to protecting vulnerable children through appropriate identification, reporting, and treatment of suspected victims of abuse and neglect. Learn about forming partnerships with child protection agencies and other hospitals to create "Dream Teams" and a network of resources. Attendees will also learn about a new collaboration of Pediatric Trauma Centers (PTCs) and community leadership to take advocacy and leadership to the next level. The PTCs project will develop clinical/forensic pathways for evaluations and reporting, and develop a network of resources for smaller community hospitals to obtain consultation with child abuse experts at children�s hospitals.
3A: Engaging Physicians in Cost Effective Care
- A hospital's financial health is critical for survival in an ever-changing environment of rules, regulations, contractual negotiations, payment cuts, and economic crises facing both payor and patient. Collaborative leadership is the pivotal position needed to move forward in the direction of cost effective care. This presentation will outline one community hospital's progressive approach - initiatives including the role of the physician advisor, the role of physician liaisons (specifically for CDI program and RAC audits), the role of support services, chart audits for variation in care, medical staff and hospital education, nursing partnerships, applying InterQual™ criteria for denial management, financial and clinical benchmarking, avoidable day management, care coordination, best practices and disease management.
4A: Managing Care Utilizing the Integrated CM Model
- As the regulatory requirements change and the national economy continues to stretch the health care dollar, hospitals are reviewing their case management models to determine the most cost effective model to accomplish the goals. This presentation presents the reasons why the integrated model of case management continues to provide the patient with a coordinated stay that addresses both the quality of the care as well as the cost of the stay.
5A: Creating a Continuum of Care for Older Adults - Seniors Emergency Center
- Holy Cross Hospital has created the Seniors Emergency Center; the first of its kind in the nation. The Seniors Emergency Center is an innovative 8-bed dedicated unit to serve the needs of a diverse older adult population. The implementation of a dedicated Senior Care Team provides emergency care to older adults and promotes a continuum of care that starts in the hospital and continues into the community. The Senior Care Team consists of a physician, emergency center staff nurse, Geriatric Nurse Practitioner and Geriatric Social Worker.
6A: Speed Learning
- Presentation 1: Queens Health Network Emergency Department Care/Case Management Initiative
  M. Beverly & A. Sullivan
  
  Queens Health Network's Emergency Department (ED) Care/ Case Management Initiative began implementation in May 2008 and has produced encouraging results. The purpose of the initiative is to develop an interdisciplinary team approach inclusive of physicians, physician advisor, case and care managers, home care nurse, social worker and clerical administrative staff to facilitate and coordinate care for patients admitted and those treated and released. The objectives are to enhance patient education and coordination of care, improve documentation and reduce unwarranted denials, improve access to primary care, provide appropriate alternative options to hospitalization (Redirected Care), and patient satisfaction. The philosophy of this program is embedded in the concept of an individual centered care management approach with an emphasis of being empathetic, non-judgmental and eliminating negative terms such as non-compliant, abusers, and frequent flyers.
  
  Presentation 2: The Emergency Department Team: Collaboration + Education = Success
  M. Motsko & M. Sawyer
  
  The interdisciplinary relationship between ED case managers, physicians and the ED staff is critical to success in preventing inappropriate admissions and readmissions to the Hospital. This session will demonstrate how Lehigh Valley Health Network utilizes the ED case manager as a facilitator, educator and link with community resources. The presentation will include data identifying avoidable admissions and utilization patterns, as well as practical applications that attendees will be able to incorporate into their own processes.
3:45 - 5:00Breakout Sessions B
1B: Improving Care in High-Risk Populations: Transition, Comm., and Continuity
- High-risk Medicare patients are particularly vulnerable during transitions in medical care. From an acute care setting to home and all the points in between - these are the times when coordination of care has been shown to be limited, at best. The MassGeneral Care Management Program (CMP) is a primary care-based care management model designed to improve overall care and reduce costs in a high-risk Medicare population. This session will present components of the CMP model that have been designed to improve the transition points.
2B: Utilization Review: To Centralize or Not to Centralize?
- Recent ACMA survey data reports that case management still owns the utilization review (UR) function in 99% of participating hospitals. However, 23% of those hospitals report that staff other than nurse or social work case managers is primarily responsible for the function. In this era, RACs, MACs, MICs have put UR under increased scrutiny. At the same time, progression of care and transition planning are at times diluted by the need to attend to UR responsibilities. Case management leaders need to consider the benefits and risks of centralizing the UR function. This presentation will outline the factors to consider in making the right decision regarding this issue for your facility. Strategies to maintain team collaboration and approaches to avoid the formation of "silos" will also be presented.
3B: 3 Hospitals - 30 Nursing Homes: The Success of a Patient Care Coalition
- The process of a patient transitioning from hospital to a nursing home can occur quite smoothly, while other transitions are challenging due to various factors including: communication, referral information, and family situations. In this session, you will learn about three hospitals that came together to form a Patient Care Coalition to ease transitions between hospitals and nursing homes. Through the coalition, both hospitals and nursing homes were able to identify strengths of the referral and transition process, along with the opportunities for improvement. As a result, the Coalition was able to set standards for required nursing home referral information, demonstrate a need for nursing homes to provide for bariatric needs, and collaboratively develop a nursing home guide brochure.
4B: Managing Care Utilizing the Progression Care Model
- Are you in need of a new case management model? The Progression Care Model redefines the roles in case management to eliminate unnecessary handoffs that cause discharge planning fragmentation. This model incorporates daily Progression Care Meetings that allow the Progression Coordinator and nurses to exchange information, and review for appropriate resource utilization and length of stay. We will share with you the outcomes that we experienced after implementing this model.
5B: Professional Navigator: A New Tool in the Tool Box of Case Management
- A new tool in the tool box of case management is the position of Patient Navigator. The profile of the uninsured is changing rapidly due to the addition of large numbers of unemployed workers due to the economic climate. These newly uninsured patients and their families have little if any experience in navigating the system of health care without insurance, resources or assistance. The addition of these patients to the already huge numbers of chronically uninsured creates stress on the health care system and hospital case management departments. The Patient Navigator provides a professional, knowledgeable and caring member of the case management team that benefits both uninsured patients and case management departments.
6B: Speed Learning
- Presentation 1: A Team-Based Approach to Managing High-Risk Patients
  S. Van Houten
  
  The BIMA Health Partnership program uses a team-based approach within an ambulatory care setting to support dual-diagnosis patients in an effort to improve chronic disease management and reduce repeat visits to the hospital Emergency Department (ED) and hospital admission. Intensive social work services, along with collaboration from primary care physicians and the Department of Psychiatry, are utilized to achieve these goals. The patients identified for this program face a number of social and financial barriers to improved health, and the program focuses on patient advocacy and empowerment along with health education, social support and assistance navigating the complex health system. This presentation will provide participants an opportunity to learn about this unique disease management program, how it has improved the health and well-being of patients involved, and how this model of care serves to meet individual as well as organizational goals.
  
  Presentation 2: The SWAT Program: Overcoming Intractable Barriers to Discharge
  S. McGaffigan
  
  Safe Ways for Alternative Treatment (SWAT) is one hospital's attempt at resolving intractable discharge barriers at Tampa General Hospital (TGH), a large metropolitan academic medical center. The program applies financial concepts such as cost avoidance and opportunity loss to determine whether or not to pay for a patient�s post-acute care services. On a daily basis, (TGH), the safety net hospital for the central west coast of Florida, is challenged in coordinating safe and appropriate discharge plans for patients that are either unfunded or under-funded. These patients frequently have high post-acute care needs and extended lengths of stay. This session will focus on the design and implementation of the SWAT program at TGH, and how this program benefits patients and the hospital.

April 10th, 2010

7:00 - 7:45 ACMA Medicare Important Message Forum
- Make plans now to join us for the ACMA Medicare Important Message Forum. The ACMA Public Policy committee will solicit major concerns surrounding the IM second notice during this session, which will be prioritized by the committee and the ACMA Board of Directors for CMS review.
  
  The forum is a breakfast event open to all conference attendees, and will be held April 10, 2010 from 7-7:45 a.m. Join us for this discussion, and offer your insight and recommendations. If you are unable to attend the conference this year, please submit your concerns/recommendations to Tyler Neese at tneese@acmaweb.org.
8:00 - 9:00 Med. Home, Community CM, & Telehealth: Progressing CM Beyond Inpt. Settings
- Healthcare reforms indicate increased priority on care transitions, and managing these properly are going to require inpatient case management to morph beyond historical models. Past forays into community case management have often encountered barriers due to reimbursement and outcome validation. However, with reforms indicating required management of patients in their home and community, new support for these models are materializing.
  
  The Connecticut VA Healthcare System has developed a model to manage patients through the full continuum, and has employed community and in-home methodologies to achieve low readmissions and higher quality of care for the patient population.
  
  This session will showcase a continuum-based model; remote monitoring technology, communications and data sources; as well as in-home assessments/treatments. The discussion will discuss the concept of "owning" the patient regardless of setting, and the related accountabilities and how these are measured. Specific strategies to avoid readmissions and leverage an electronic medical record (EMR) for improved transitions of care will be included.
9:15 - 10:30Breakout Sessions D
1D: Initiating Evidence-Based, Data-Driven Nursing Care
- This session presents a prevalence study model, results, and interventions produced from the study. Prevalence studies facilitate benchmarking by establishing a baseline to assist in managing clinical outcomes. An advantage of prevalence surveys is that useful data can be generated in a time- and cost- efficient manner to augment quality standards. This study asked, what is the level of evidence-based compliance? for eight high-volume, high-risk quality care indicators: Point-of-care blood glucose monitoring, central lines, peripheral intravenous (IV) access, Oral Care, Foley care/toileting, mobility, pain, and sequential compression devices (SCDs). The best practices survey is conducted utilizing chart review, patient observation and patient interview on 22 medical/surgical and critical care units using a convenience sample of adults admitted for greater than 24 hours. In addition to confirming that current nursing care is evidence-based, the data were used to develop interventions to improve outcomes. Results of the implemented programs are assessed periodically to identify practice concerns and sustain improvement.
2D: The IP Doc. Integrity Program: A Collaborative Partnership
- The Inpatient Documentation Integrity Program at Baylor University Medical Center is an innovative approach that accurately reflects clinical documentation through concurrent and retrospective physician queries. It promotes a collaborative partnership between the care coordinators, medical record coders and physicians to improve documentation for greater specificity to reflect accurate severity of illness (SOI) and risk of mortality (ROM). This session will focus on the inner workings of the program and creative strategies that were implemented to query physicians for clarification while maintaining the integrity of their documentation.
3D: Social Workers: Are They Health Care's Undocumented Citizens?
- Social workers are not the primary health care professionals in hospitals and other health care settings. This session will explore the issues that arise from this lack of primacy and its impact upon the practicing social worker. The discussion will include strategies for both individual social workers and case management leaders to manage this impact.
4D: Improving the Quality of Life for COPD Patients
- Care management staff, as well as other health care providers, play key roles in the implementation of evidence-based practices in both the hospital and community setting. This session will provide an overview of how UPMC St. Margaret Hospital, in collaboration with the Pittsburgh Regional Healthcare Initiative and a large community-based physician practice, successfully developed and implemented both innovative quality and educational practices to reduce the readmission of patients with Chronic Obstructive Pulmonary Disease (COPD). Key components of the discussion will include: Team development, community based care management, physician COPD guidelines, the role of respiratory therapy and other health care disciplines, patient education, data analysis and future state.
5D: Leveraging Shared Gov. in CM to Achieve Nat'l Recognition
- Presented by 2009 Franklin Award of Distinction winner
  This innovative organizational model gives case management staff members control over their practice, and can extend their influence into administrative areas previously controlled only by managers. Shared governance provides an organizational framework that offers staff members increased participation in decisions about their work and workplace. Participation in shared governance has enhanced worker performance, job satisfaction, patient satisfaction, and has decreased staff turnover rates. The development of shared governance councils has greatly increased the ability to improve processes.
6D: Speed Learning
- Presentation 1:Can You Hear Me Now? Engaging Case Managers to Address Staff Burnout and Satisfaction
  S. Thornton
  
  Case management leaders are often looked at to be the champions of change. With these high organizational expectations of performance, leaders must stay abreast of a department's climate, and sometimes find the methods they have relied upon have stalled and they struggle to make a direct connection with staff. Enhancing the relationship between management, employee, department climate, employee burnout and satisfaction while meeting organizational outcomes is challenging. Meeting this challenge can lead to the creation of solution-oriented strategies that respond to the organization's requirements while increasing job satisfaction and professional growth. This presentation offers a look into how the management team at Spartanburg Regional Medical Center evaluated their relationship with their staff. The discussion will include how a staff-driven plan was formulated to restructure both ownership and responsibility of work and identified areas of improvement, including a need to separate discharge planning responsibilities from utilization management. As a result of this re-evaluation, the burnout score improved by 24%, the department climate score increased by 4.0% (consultative range), and strategic variables score increased by 9.6%. A connection was made.
  
  Presentation 2: Mentoring Your Staff
  V. Bass
  
  Leaders - when out of the office for vacation, work-related or personal leave, what will you find when you return? Is there a leader(s) in your department that are ready to step up to the plate in your absence? Does your staff know how to carry on effectively in your absence? Most important, how do your boss and other departments react to your staff's ability to carry on while you are away? If you are uncertain, a mentoring program can help develop leaders to equip your department to run seamlessly in your absence. This presentation will discuss developing such a program, and how to examine your responsibilities and assess the capabilities of your staff.
  
  Presentation 3: Case Management Can Do It - They're in the Charts Anyway!
  F. Bellamy
  
  As the practice of hospital/health system case management continues to evolve, we continue to see various functions delegated to case management that might not require high levels of nursing and/or social work expertise. Similarly, there are numerous functions traditionally carried out by other areas in the organization that have a great deal of impact on the clinical, financial, and administrative outcomes that are tied to case management. To achieve the best outcomes, reporting relationships and allocation of resources must be reexamined, thinking outside of traditional silos. This presentation examines the trend and concept of other functions being absorbed under the case management umbrella. Data and insights from the experience of several hospitals will be presented.
10:45 - 12:00Breakout Sessions E
1E: Patient Care Plans: How to Cope with Challenging Patients
- This session will present an initiative to identify a subset of patients who are medically and often psychosocially complex and frequently utilize hospital services. These are often patients who present for admission several times per month, have high pain needs, and/or are generally noncompliant with prescribed care. In the past, these patients have proven to be challenging to all staff involved, taking time and resources and inadvertently adding to the length of stay as well as frequent readmission. A team was formed consisting of care management, physician advisors, emergency room physicians, general medicine physicians, and psychiatry. This team collectively identifies patients who are known for their high utilization of services, and works collaboratively to form a specific patient care plan. The goal is to reduce unnecessary admissions, attain better pain management, minimize secondary gain from hospital admission and decrease redundant diagnostic work-ups. The electronic medical record is also utilized to easily identify these patients.
2E: Leveraging Leadership to Decrease LOS through Mgt. of Avoidable Days
- This session will present a successful model that integrates tracking of avoidable day/delay (ADD) information with leadership support to reduce barriers to care delivery. Case management department staff is asked to document ADD information so that we are able to identify the barriers to a patient's smooth transition through their hospital stay. This data is captured in our electronic documentation system and is shared regularly with leadership. As a part of this process, the case management staff is asked to contact the person who is most likely able to address the delay in real time. Within our process we have leveraged leadership across the system in various ways to ensure appropriate changes are made. This presentation also discusses the various ways the executives at the facilities and at the system office have been engaged to ensure the appropriate emphasis is given to assessing the barriers and making decisions that address the quality of the patient experience and are fiscally responsible.
3E: Palliative Care as a Specialty Service in the Case Management Department
- The goals of hospital case managers and palliative care practitioners are aligned in multiple ways and initiating a palliative care program within a hospital's case management department can be very successful for everyone involved. Hospital case management departments are continuously challenged to decrease the utilization of hospital resources while maintaining high quality care. Recently released data indicates that an effective palliative care program can decrease the cost of hospitalization while improving the patient's experience. Palliative care focuses on achieving and maintaining a patient's comfort, establishing realistic goals and advocates for care in the most appropriate setting. Participants will receive information about palliative care, its benefits, its relationship to case management, and information on how to start a palliative care program.
4E: Clinical Resource Management: Aligning the Model with the Mission
- This presentation will provide an overview of how this hospital approached the need to change the existing case management model, including evaluation of effectiveness of current model and development of the new model of Clinical Resource Management. The discussion will cover the indicators that led to the decision to make a change, the approach used to evaluate the extent of the change, the implementation process, assisting staff through the change process and finally the results achieved and lessons learned.
5E: Part 1 - Utilization Mgt. - How to Marry Case Mgt. UR with Hospital Billing
- Do you ever get confused about the regulations surrounding utilization management (UM) and hospital billing? What is right for Medicare may be different for your commercial payors, and how are you supposed to keep it all straight with RAC and other auditors evaluating your hospital practices? This two-part session will discuss the marriage and integration between Care Management and Revenue Cycle Management including: Patient Access, Patient Financial Services, and Health Information Management. This integration includes aspects of compliance, individual payor requirements, and the delivery of quality patient care.
6E: Speed Learning
- Presentation 1: Are Perfunctory Tasks Bogging Down Your Staff?
  S. Eubanks
  
  Today in case management a multitude of tasks associated with utilization management and discharge planning are hampering our effectiveness to progress the patient in the continuum of care. Are those tasks more effectively managed by support staff rather than bogging down case managers? This could leave more time for these professionals to be the driving force towards discharge. This session will present a case management model that effectively and efficiently leverages clinical staff. Specific tools and outcome data will be presented.
  
  Presentation 2: Going Paperless: How to Do More with Less
  T. Rainwater
  
  Tough times call for new ways of doing more with less. Case management models that rely on paperwork and manual processes no longer fit the bill for today�s fast-paced work environment. Teams can work smarter by establishing an electronic archive of critical information surrounding patient benefits, eligibility and authorization. Documenting this information electronically, staff can locate records from any PC or workstation and forward to outside parties - all without paper. This session will demonstrate how Southeast Missouri Hospital has used a paperless approach to document faxed notification, online verification and even phone reviews. The discussion will consider the impact on case management workflow and outcomes.
  
  Presentation 3: Developing a Competency Evaluation Program: A Model for Staff Education
  D. Wright
  
  Case management is an evolving process. Effectively managing many of the current issues - such as Medicare Conditions of Participation (CoPs), avoidable delays and patient status - require that case management staff are knowledgeable of the most current information available. How do you ensure that you are providing education in these areas? This session will describe a Competency Fair Model that is researched, developed and presented entirely by a case management staff for their peers. The resulting educational tools offer an assessment for the entire staff in a three-day drop-in program that identifies areas for additional training and/or remedial sessions.
12:15 - 1:30Breakout Sessions F - Sponsor Lunch Sessions
3M - Denial Management: Track, Trend and Intervene
- If you are tired of hearing your CFO say, "Show me the money," and your physicians say, "Not on my watch," you won't want to miss learning how process changes combined with automation resulted in quantifiable improvements at Jefferson Regional Medical Center. Jefferson, a 375-bed acute care hospital located in Allegheny County, PA, has the second highest elderly population in the United States. Eighty percent of all admissions present to the Emergency Room and sixty percent of Medicare admissions are Medicare Managed admissions. During this session, you will learn how the case management team established a denial prevention, management, and recovery program that uses an established process of concurrent documentation and intervention to help prevent revenue loss and retrieve revenue for clinical services rendered
ACS MIDAS+ - Clinical Doc. Improvement: A Streamlined Approach to Data Collection
- Clinical Documentation Improvement (CDI) programs are springing up all across the country as a means to address the need for accurate and complete medical record documentation that has resulted from the transition to Medicare Severity DRGs. This session will focus on the tools needed to support both the efficient workflow and comprehensive reporting needs of a CDI program. The interrelationship between CDI and publically reported Quality Measures will also be discussed.
Allscripts - Innovating Case Management as Health Care Transforms
- Better coordination of care for Medicare patients at all levels of care has been identified as one of the best opportunities for reducing costs, improving quality outcomes, and preventing unnecessary readmissions. As reform becomes reality, and compliance scrutiny intensifies across all payors, how will care managers achieve outcomes in an "electronic-enabled" care delivery system? What effect will technology adoption have on how patient care is delivered cross continuum? Experiences of innovation "that work" in practice to improve care coordination between levels of care, with a focus on patient safety and efficiency will be explored.
Allsup - Understanding Social Security Disability Ins. & the Impact on Revenue Cycle
- This session will offer a primer on the federal Social Security Disability Insurance (SSDI) program. It will include a thorough description of the SSDI process and differentiate the process and requirements between filing for supplemental Security Income (SSI) in contrast to SSDI. The session will discuss qualifications, time lines associated with filing, impact of state employee furlough, appeal process, and importance of coordination with medical assistance programs to minimize impact on hospital revenue cycle. Also included is an overview of SSDI coordination with long and short term disability benefits and worker's compensation. This session will be of special interest to case managers and social workers who assist disabled adult patients with discharge planning and identification of financial resources when an individual is unable to return to work. Discussion will include impact of early intervention with chronic frequent admission patients and determination of who is likely to qualify for SSDI benefits.
EHR - Implementing Clinical & Admin. Processes that Minimize Compliance & Fin'l Risk
- The key to audit preparedness is developing a daily process for complying with the UR Standards of Medicare�s Conditions of Participation (CoPs). This session will provide you insight into building and optimizing your UR Committee and process, ensuring an effective observation status and 1-day stay certification and appeal process that leverages case management, medical staff, and physician advisement expertise, and defending against medical necessity denials and potential False Claims Act (FCA) exposures. A strong physician advisement program is also a key to ensuring the strong hospital and medical staff communication necessary to manage evolving regulatory requirements. This session will provide you insight into building and optimizing an internal compliance program that leverages Case Management expertise and Physician Advisement. It will examine how to create a UR process that proactively defends against medical necessity denials. Attendees will gain an in-depth understanding of the rules for RACs, MACs, MIPs, MICs, and the Administrative Law Judge appeal process.
McKesson
- Session information TBD
Mexcare - Closure of the Chronic Renal Dialysis Program
- This session describes the process of arriving at the decision to close the long standing Chronic Renal Dialysis Program at Grady Memorial Hospital in Atlanta, GA. Once the decision was made, speakers will demonstrate a step-by-step chronology of placement outcomes for affected patients.
Milliman Care Guidelines - Facilitating Progression of Care Using Milliman Care Guidelines
- Historically, hospital-based Case Managers (HBCM) concentrated on one of two mandated activities: Utilization Review (UR) and Discharge Planning (DCP). Today, responding to the increasing demands from the healthcare marketplace, HBCMs are increasingly focused on a role that involves proactive care coordination. While there are many tools, resources and criteria sets to help with the UR and DCP expectations, most HPCMs have had to rely on clinical knowledge and prior experience to fulfill new proactive care coordination responsibilities. HBCMs are recognizing that the use of evidence-based Care Guidelines can enhance proactive care coordination by helping to identify key milestones and interventions along with anticipated time frames for recovery. This session will explore the role Milliman Care Guidelines plays in supporting proactive care coordination to improve the efficiency and quality care provided during an acute care hospitalization episode.
Morrisey Associates - The MCCM Adventure: Winning Through Automation
- This session will focus on how you can address the key problems facing case management using Morrisey Concurrent Care Manager� (MCCM�) integrated care management solution. The session focuses on using the latest in advanced technology to address all of the following:
  - Automating workflows using intelligent work listing
  - Configuring workflows to meet the needs of your department
  - Integrating technology to streamline workflow from pre-admission, acute care, and continuum
  - Utilizing MCCM to support concurrent medical record coding and to enable reviewers to send electronic physician queries and escalate cases to physician advisors
Trace / The White Stone Group - Prove it or Lose It: Document Pre-Auth. & Protect Revenue
- Pressure is mounting for hospitals to increase efficiency, improve margins, and support revenue-driving functions. This session will demonstrate strategies from Lenox Hill Hospital in Manhattan, NY, to document and centralize key revenue cycle activities. Lenox Hill created a pre-authorization unit composed of Nurse Case Managers and clerical staff to manage medical necessity review and insurance verification for all inpatient and operative procedures prior to admission. The hospital uses Trace technology to document and manage critical communication surrounding patient pre-authorization. Records are captured and indexed electronically for efficient processing, sorting and retrieval. Results include improved outcomes in quality, efficiency, compliance and reimbursement.
2:00 - 3:15Breakout Sessions G
1G: POA Indicator & HACs: The Legal, Financial, & Public Reporting Implications
- Present on Admission (POA) indicators and Hospital Acquired Conditions (HAC) are new regulatory requirements affecting hospitals, and many case management departments. This presentation will provide an overview of the POA indicators and HACs - what is required and the potential impacts. Barriers to appropriate documentation will be discussed, including physician issues and hospital issues (process or lack thereof). The presentation will then explore the legal, financial, and public reporting implications of POA indicators and HAC, and methods to minimize your organization's legal and financial risk, as well as specific scenarios that put a hospital at risk. Multi-system collaboration will be required for the process to be effective, including physicians, coders, case managers, clinical documentation specialists, etc.
2G: Revolutionizing a Care Management Program: Changing the Status Quo
- Today's healthcare environment is ever-changing, forcing hospitals to adapt in order to survive. Care management departments must consequently streamline workflow to keep up with competing demands of reimbursement, capacity management, patient throughput, and denial management. Leadership should assess and reassess the effectiveness of its processes and look to eliminate waste. Learn how a single hospital within a 20-hospital health system re-designed its care management department while balancing the competing demands of the hospital-wide 100-day initiatives lead by the executive management team. This presentation describes the process and methodology for Care Management to assess departmental performance, streamline workflow, and implement new programs to meet the overall goals of the organization.
3G: Waste Not-Want Not: LEAN Strategies to Improve Process & Performance
- Improving efficiencies, identifying and eliminating rework and waste, and increasing satisfaction for case managers are common goals in the rapidly changing healthcare environment. Decreasing length of stay, improving throughput, reducing process variability, and enhancing team work are results achieved using LEAN methodology. This presentation shares a system's implementation of LEAN methodology for process improvement and the positive outcomes achieved. Share the beginning of this journey to excellence.
4G: Justifying Dollars & Sense of Medical SW: Measuring Psychosocial Acuity
- Planning for capacity expansion in a large academic tertiary care center, case management/social work leadership was commissioned to develop a patient acuity scale using clinical indicators for social work on a unit/service level. As hospital capacity increases in size and beds, a business model need was identified to justify staffing needs for social work based on patient care characteristics and acuity. Clinical care indicators on a scale of 1 thru 5 were developed and tested by a social work subgroup. Staff buy-in and call to action was critical for the assignment, as well as the desire to measure patient care needs rather than productivity. Categories were based on time and tasks spent with individual patients and families. The presentation will describe the development, testing and house-wide implementation of the scale. Data and findings to date will be discussed, with applications for resource allocation of both actual and potential patient needs.
5G: Part 2 - Utilization Mgt. - How to Marry Case Mgt. UR with Hospital Billing
- Do you ever get confused about the regulations surrounding utilization management (UM) and hospital billing? What is right for Medicare may be different for your commercial payors, and how are you supposed to keep it all straight with RAC and other auditors evaluating your hospital practices? This two-part session will discuss the marriage and integration between Care Management and Revenue Cycle Management including: Patient Access, Patient Financial Services, and Health Information Management. This integration includes aspects of compliance, individual payor requirements, and the delivery of quality patient care.
6G: Speed Learning
- Presentation 1: System Approach for Successful Denial Management
  D. Caram & M. McCullock
  
  INTEGRIS Health has developed a culture and process in denial management that is a collaborative effort of case management and revenue cycle consortiums. Denial Management is centrally located and works with each hospital to provide the support for negotiating contracts, denials, and all issues identified. INTEGRIS Health took a proactive approach and incorporated the RAC process into its denial management processes. INTEGRIS Health leaders supported this effort and in a very short time frame worked collaboratively with all stakeholders to help eliminate duplication and identify best practices while maintaining the identity of each entity involved.
  
  Presentation 2: Denial Management - Collaboration and Prevention
  K. Littell
  
  This session will present a multidisciplinary approach to decrease denials and increase recovery rates. Improving in these key areas starts with improved data collection, resulting in reports that can be useful to prevent future denials, improve contractual agreements with payors and improve customer satisfaction. This discussion will examine how utilization management (UM) and case management collaborating with finance, contracting, admitting, physicians offices and clinical staff can avoid denied claims, improve reporting and reduce appeal efforts resulting in a low denial rate.
3:30 - 4:45Breakout Sessions H
1H: Finding a Home - An Innovative Self Care Model for the Uninsured
- An exciting and new endeavor at Memorial Hermann Healthcare System is underway to impact the uninsured population of the greater Houston area. With the use of Community Navigators and social work case managers, uninsured patients are linked to community resources and empowered to take control of their healthcare needs. This pilot program has produced measurable improvement in patient care management and reduced cost throughout the system. This session will explore the development and implementation of this program and the benefits to the greater community, the hospital system and the individual patient.
2H: Advancing Clinical Transformation (ACT)
- Comprehensive Care Management is a value-based, person-centered system that promotes efficient and effective care. It is a critical component of the ACT (Advancing Clinical Transformation) initiative at Catholic Health East. Implementing a new care model across a large health system is a complex endeavor; Phase I involves the transformation of hospital case management over a fifteen month timeframe. The methodology incorporates principles from six domains: Governance and Leadership, Process Improvement, Clinician Adoption, Change Management, Technology Enablement and Benefits Realization. The model, supported by an electronic care management system, will help make a quantum leap forward in the provision of efficient health care. Using electronic tools, the case manager identifies appropriate levels of care and considers alternative resource usage. As part of the ACT initiative, three initial metrics will be tracked against system wide targets: Medicare length of stay, clinical denials, and 30-day readmissions to acute care hospitals.
3H: Cultural Revolution: An Integrated Care Coordination Model
- Does your organization require cultural revolution to create high performing, successful care coordination service? This session will provide you with an approach to create a revolution using your existing structures to create high performance processes and team functioning. UCLA created cultural change by developing a project called, Advancing the Care Plan. The goal was to create cultural revolution embedded in the existing care coordination structure - simultaneously introducing new concepts and creating new accountabilities. New concepts and language, cornerstones of cultural revolution, became the vision that supported practice improvements. A multidisciplinary design team was formed whose initial focus was to identify core cultural issues that impeded desired integration. Roles and accountabilities were defined, coupled with new processes which shifted practice changes in the desired direction. Cultural revolutions begin with good ideas, fueled by strong concepts, new language and commitment to improving care.
4H: Continuity of Care Networks: Better Quality, Communication and Outcomes
- The Continuity of Care Department was founded to improve the quality and safety of Transitional Care by developing formal relationships with selected post-acute care providers based on quality and shared commitment to patients. Three programs will be described: a SNF Network, a population-based LTAC affiliation, and Hospital to Home, a hospital community agency partnership to reduce readmissions. The presentation will describe our journey from discharge planning in the traditional acute care mindset to transitional care designed from the patient's perspective, and the positive outcomes achieved.
5H: Insight Into Distinction: 2010 Franklin Award Winner Presentation
- Winning the Franklin Award of Distinction signifies excellence in case management practices on an organizational level. The winning organization must demonstrate:
  1. Commitment to a collaborative practice philosophy
  2. Processes for applying interdisciplinary and interdependent expertise in achieving patient outcomes
  3. Coordination of care along the continuum
  4. That their Case Management service is functionally comprehensive, outcome oriented, and influential within their organization
  This session will allow the 2010 winning organization - which will be announced at the opening of the Conference on April 9, 2010 - to present their successful model and processes. The session will include an overview of structural and organizational elements and discussion of the unique elements that have proven highly successful for the winning organization. This session is an excellent opportunity to gain insight into one of the country's most effective case management departments, and will offer an opportunity to engage the department's leaders in
  audience Q & A.
6H: Speed Learning
- Presentation 1: Achieving Quality in Case Management
  E. Kahn & T. Greely
  
  Achieving quality in case management is a comprehensive approach to patient care from pre-admission to post-discharge. This program will review and share strategies, outcomes, and tools utilized to achieve our success in case management patient excellence. The discussion will include multidisciplinary initiatives undertaken at two hospitals to improve the quality of the case management process, focusing on current challenges facing hospital case management departments. These projects have resulted in improvement in LOS, patient and staff satisfaction, ability to place high-risk patients in SNF, and a reduction in readmission rates. The discussion will also include implementation and success with admit to case management protocol to improve medical staff satisfaction with the case management admission process.
  
  Presentation 2: A Multidisciplinary Approach to Improve Inpatient Documentation
  J. Kim & D. Levin
  
  Inpatient clinical documentation is a crucial aspect of daily hospitalist activity. Complete and accurate documentation impacts a broad range of issues, including patient care, communication between caregivers, quality and safety outcomes, and assignment of the most appropriate Diagnosis Related Group (DRG) for the given admission. This can be challenging since most physicians document to communicate to the healthcare team as opposed to coding guidelines. In January 2006, after applying various approaches to clinical documentation improvement (CDMP) with varying levels of success, Rush University Medical Center opted for a new strategy involving an interdisciplinary team approach. Members included physician liaisons, coding auditors and nurse documentation specialists who shared a goal of combining their efforts to overcome challenges facing the ever-changing nature of inpatient clinical documentation. The program increased physician awareness of the impact of documentation, with noted improvements to accurately reflect the intensity of services provided. During this session, experiences, data, and tools will be shared, but more important, we will educate participants on methods to implement this process at their institution.

April 11th, 2010

8:00 - 11:00Post-Conference
1: Patient/Family Centered D/P - Moving from Provider to Patient Centeredness
- Managing the continuum of care needs in an environment that increasingly values timeliness and cost-cutting, is a challenge for Case Managers and Social Workers. Utilizing the principles of Patient and Family Centered Care, this session will review opportunities to put the patient in the driver's seat. This practice is most effectively driven by Case Managers and Social Workers that are expert in developing relationships, managing expectations, and coordinating the care of the team.
2: Readmissions on the Horizon - Case Management Strategies
- Readmissions or re-hospitalizations have become a hot topic among lawmakers, insurance companies and hospitals. Preventable readmissions are on everyone�s radar. The potential impact to a hospital's financial outcome has been a focus of many institutions related to the threat of decreased reimbursement and potential denial of payment for preventable re-hospitalizations.
  
  Being able to understand the causes of the readmissions is an area that Case Management has been thrust into. By being the gatekeeper in analyzing "criteria" for admission, it is a natural step to look to Case Management for answers on how to prevent a re-hospitalization. Case managers possess information about discharge and the readiness for a patient to leave the walls of the hospital at the most appropriate time. Additionally, data on readmission rates often resides with Case Management.
  
  Leaders need to be able to present information to their administrators that will shed light on why and how a readmission occurred, as well as how to prevent them in the future
  
  This workshop on readmissions will provide participants with an ability to analyze their data and become proficient in reporting findings and creating action plans to reduce readmissions.
  
  At the end of the workshop the participants will have gained knowledge on the following topics and will be able to analyze readmissions and create an action plan to minimize the impact of readmissions at their respective facilities.
  1. Review current literature
  2. Define Readmissions
  3. Review Causes for Readmission
  4. Analyze data on readmissions
  5. Formalize an action plan
  6. Create a method to track efficiency of the action plan
  7. Future state for preventing readmissions
  Attendees should bring their organization's PEPPER reports and 30-day readmissions data for Quarter 1 of 2010.
1:00 - 4:00 ACM Certification Examination
- ACMA's certification examination for Hospital Case Managers will be offered at the conclusion of Post Conference.

Download Session Handouts Now

2011 Call for Presentations

April 8th, 2010

1: RAC - Tracking the Impact at Small, Med. & Large Hospitals

2: CMS & Legis. Update - Looking to the Horizon of Healthcare

3: CMS Demonstration - Operational Experience in the Care Transitions Demo.

NICM ACM Certification Review Workshop

ACMA Leadership Forum: Change Mgt. Plans for CM Process Improvement

Poster Presentation Session

April 9th, 2010

ACMA New Member Orientation

Keynote Address

ACMA Annual Meeting

Compare AD™ Informational Presentation

1A: Positioning CM to Transform Care under Payment Reform

2A: Hospital Based Child Abuse & Neglect Teams: Best Practice Model

3A: Engaging Physicians in Cost Effective Care

4A: Managing Care Utilizing the Integrated CM Model

5A: Creating a Continuum of Care for Older Adults - Seniors Emergency Center

6A: Speed Learning

1B: Improving Care in High-Risk Populations: Transition, Comm., and Continuity

2B: Utilization Review: To Centralize or Not to Centralize?

3B: 3 Hospitals - 30 Nursing Homes: The Success of a Patient Care Coalition

4B: Managing Care Utilizing the Progression Care Model

5B: Professional Navigator: A New Tool in the Tool Box of Case Management

6B: Speed Learning

April 10th, 2010

ACMA Medicare Important Message Forum

Med. Home, Community CM, & Telehealth: Progressing CM Beyond Inpt. Settings

1D: Initiating Evidence-Based, Data-Driven Nursing Care

2D: The IP Doc. Integrity Program: A Collaborative Partnership

3D: Social Workers: Are They Health Care's Undocumented Citizens?

4D: Improving the Quality of Life for COPD Patients

5D: Leveraging Shared Gov. in CM to Achieve Nat'l Recognition

6D: Speed Learning

1E: Patient Care Plans: How to Cope with Challenging Patients

2E: Leveraging Leadership to Decrease LOS through Mgt. of Avoidable Days

3E: Palliative Care as a Specialty Service in the Case Management Department

4E: Clinical Resource Management: Aligning the Model with the Mission

5E: Part 1 - Utilization Mgt. - How to Marry Case Mgt. UR with Hospital Billing

6E: Speed Learning

3M - Denial Management: Track, Trend and Intervene

ACS MIDAS+ - Clinical Doc. Improvement: A Streamlined Approach to Data Collection

Allscripts - Innovating Case Management as Health Care Transforms

Allsup - Understanding Social Security Disability Ins. & the Impact on Revenue Cycle

EHR - Implementing Clinical & Admin. Processes that Minimize Compliance & Fin'l Risk

McKesson

Mexcare - Closure of the Chronic Renal Dialysis Program

Milliman Care Guidelines - Facilitating Progression of Care Using Milliman Care Guidelines

Morrisey Associates - The MCCM Adventure: Winning Through Automation

Trace / The White Stone Group - Prove it or Lose It: Document Pre-Auth. & Protect Revenue

1G: POA Indicator & HACs: The Legal, Financial, & Public Reporting Implications

2G: Revolutionizing a Care Management Program: Changing the Status Quo

3G: Waste Not-Want Not: LEAN Strategies to Improve Process & Performance

4G: Justifying Dollars & Sense of Medical SW: Measuring Psychosocial Acuity

5G: Part 2 - Utilization Mgt. - How to Marry Case Mgt. UR with Hospital Billing

6G: Speed Learning

1H: Finding a Home - An Innovative Self Care Model for the Uninsured

2H: Advancing Clinical Transformation (ACT)

3H: Cultural Revolution: An Integrated Care Coordination Model

4H: Continuity of Care Networks: Better Quality, Communication and Outcomes

5H: Insight Into Distinction: 2010 Franklin Award Winner Presentation

6H: Speed Learning

April 11th, 2010

1: Patient/Family Centered D/P - Moving from Provider to Patient Centeredness

2: Readmissions on the Horizon - Case Management Strategies

ACM Certification Examination