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April 7th, 2011

7:15 - 8:15 Continental Breakfast (Pre-Conference Attendees Only)
8:00 - 1:45 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
  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.
8:00 - 9:00 Pre-Con Workshop Session 1: Reducing Readmissions
- With growing concerns to cutting costs within the health system setting, readmission rates are under a high level of scrutiny and review. This session will take a closer look at the 30-day hospital readmission rate, an important marker of care management success. This session will also review variations in rates among providers and discover the financial implications of reducing readmissions. Attendees will take away applicable best practices in discharge planning.
9:15 - 10:15 Pre-Con Workshop Session 2: The Campaign for Better Care: Why We Need a Better Way
- Today's fragmented health care system fails to meet the fundamental needs of older adults and their family caregivers, especially the 20% of Medicare beneficiaries with five or more chronic conditions who account for about 68% of Medicare expenditures. These are the people who make the heaviest use of the current system, at the highest cost, but with the poorest outcomes. Launched in 2010, the Campaign for Better Care, is a consumer advocacy campaign pressing for high quality, comprehensive and coordinated care for vulnerable older adults with multiple chronic conditions and their families. This session will provide an overview of the Campaign and its elements, including strategies to organize the grassroots voice of older adults and their families as activists for better care.
10:30 - 11:30 Pre-Con Workshop Session 3: RAC 2011-Lessons Learned
- Recovery Audit Contractors (RACs) have imposed significant burdens on case management professionals in 2010. This panel session will review case management's most frequently asked questions related to RACs and discuss best practices associated with these concerns. Attendees will also discuss both positive and negative lessons learned in 2010.
11:45 - 1:00 Pre-Con Workshop Session 4: Transitions of Care
- The increased specialization of clinicians and sites of care has progressively fragmented patient care. The resulting gaps and numerous handoffs pose a threat to patient safety and continuity of care. This session presents the origins and magnitude of these problems. Additionally, the obstacles to smooth transfers will be discussed, as well as strategies to improve quality in the transition process. Further discussion will center on the opportunity for the case manager to play an even more vital role in this critical health care interaction.
1:00 - 2:30 ACMA Leadership Forum: 2011 ACMA Hospital Case Management Survey Results
- ACMA’s Leadership Forum will showcase findings from the 2011 ACMA National Hospital Case Management Survey.
  
  This survey produces comprehensive benchmarking data for the practice of Hospital/Health System Case Management with a 95% confidence interval. The 2011 Survey is the sixth conducted by ACMA since 2001, providing a picture of the evolution of the practice that is broad in scope, historically grounded, and statistically accurate.
  
  Key findings will be presented and their implication for the practice of Hospital/Health System Case Management will be discussed. The session will also include discussion of how to interpret the implications for your department from the data report, and how to use this valuable resource of improvement in your organization.
2:30 - 6:30 Welcome Reception with Sponsors & Exhibitors/Poster Session Presentation/Silent Auction
- To kickoff this year's conference, we celebrate your arrival with a Welcome Reception on Thursday, April 7, 2011 from 2:30-6:30 pm. This networking event is the official launch of the conference, and your first opportunity to connect with Sponsor/Exhibitors to explore an exciting marketplace of services, tools and new technology.
  
  The Welcome Reception will be attended by case management professionals from all over the United States, possibly making this event the single largest annual gathering of Hospital/Health System Case Management leaders. Do not hesitate to take advantage of this opportunity to build and expand your network, and converse with your fellow attendees in a fun, informal setting.
  
  Don't forget to use this as your first chance to complete your Networking Passport in a chance to win a NEW CAR! The Welcome Reception includes appetizers and wine and is included in the main conference registration fee; however, attendance to the Welcome Reception must be confirmed at time of registration.

April 8th, 2011

7:00 - 8:00 ACMA Member Orientation
- If you are new to the association, attend this member orientation to learn about how to utilize your member benefits, how ACMA serves and represents you, and how to get involved.
7:00 - 9:00 Networking Breakfast with Sponsors/Exhibitors (Continental Breakfast Provided)
9:15 - 9:45 Welcome & ACMA/Joint Commission 2011 Franklin Award of Distinction Announcement
- After opening comments, ACMA and Joint Commission will announce the 2011 Franklin Award of Distinction Winner.
9:45 - 11:00 Keynote Address: If Disney Ran Your Hospital...9 1/2 Things You Would Do Differently
- Customer service is the never-ending pursuit of excellence to keep employees and customers so satisfied that they tell others of the way they were treated in your organization. This session stresses the importance of patient satisfaction and how it affects employee satisfaction.
1:30 - 2:45 Breakout Sessions A
1A: If Disney Ran Your Hospital...9 1/2 Things You Would Do Differently: A Closer Look
- Join Fred Lee as he takes attendees into an depth look at customer satisfaction. This session will serve as a continuation from his keynote address.
2A: Front-End Case Management Strategies to Reduce Financial Risk
- This session summarizes one organization’s redesign of a case management model that applies front-end strategies aimed at financial risk reduction. The model is designed to optimize internal process flows in order to enhance patient quality and safety. The organizational changes necessary to implement this model required extensive planning and integration with the nursing department. Staff and physician education were also key components of the implementation process.
3A: Transitioning with Health Care Reform: Interdisciplinary Care Planning
- This presentation provides an overview of the development and implementation of evidence-based interdisciplinary care plans for a non-profit community hospital transitioning from paper medical records to electronic health records. This session will also examine barriers and improvement initiatives based on care plans and its impact on clinical transformations and outcomes including those for patients/families, providers and the healthcare system.
4A: Ethical Decision Making in Complex Cases
- This session reviews legal and ethical issues and how to apply them in an Ethical Decision Making Model to complex cases where client autonomy and client safety are in conflict. The session examines the case manager’s knowledge about the difference between legal and medical-model applications of these concepts. Additionally, a brief overview of how the Life Care Planning model of practice applies a more holistic view to client care.
5A: Measure What You Manage: Identify Opportunites and Apply Best Practice Solutions
- It is difficult to manage unless you can measure. This session will present key considerations for effectively measuring important case management metrics such as avoidable delays, readmissions, and denials. This session will present national trends in some of the most challenging barriers to safe and efficient care delivery, and the reasons that delay care delivery. Finally, the session will include some of the best practice case examples that have proven effective in managing some of these universal challenges.
6A: Designing and Implementing a Collaborative Case Management Model Using Six Sigma Tools
- Designing a comprehensive case management program that recognizes physician responsibilities, while also ensuring compliance is complex and time consuming. Additionally, management of documentation and billing of observation services can be challenging to case managers and business office personnel. This session examines the use of a “tool box” utilized in the Change Acceleration Process (CAP) and LEAN and Six Sigma methodologies. These processes help case managers create a shared vision for change and encourage buy-in from physicians, nursing and business office staff. Speakers will also discuss the importance of measuring and analyzing critical metrics and communicating this data to key stakeholders.
3:00 - 4:15 Breakout Sessions B
1B: Ethical Decision Making in Complex Cases
- This session reviews legal and ethical issues and how to apply them in an Ethical Decision Making Model to complex cases where client autonomy and client safety are in conflict. The session examines the case manager’s knowledge about the difference between legal and medical-model applications of these concepts. Additionally, a brief overview of how the Life Care Planning model of practice applies a more holistic view to client care.
2B: ACMA Social Work Fellowship Presentation
- ACMA's Social Work Case Management Fellowship program is a nine-month hospital-based program governed and bestowed by ACMA in partnership with the University of Southern California School of Social Work and Cedars-Sinai Medical Center in Los Angeles, Calif. The program provides a premiere educational experience for social work professionals desiring to expand their understanding of hospital social work and case management practice. During this session, the 2010 Fellowship Candidate will present her experience and lessons learned.
3B: Patient Navigation in a Complex Medical System
- The sickest, most frail patients account for the largest percent of our national health care costs. Using a team approach to assist patients in navigating complex care, case managers can prevent complications, avoid hospitalizations and improve quality of life. Care transitions between one level of care to another is a critical time for patients. This session helps identify multiple hidden barriers which are responsible for transition failure and recommends potential care strategies through multidisciplinary team collaboration.
4B: Show Me the Money: An Integrated Approach to Managing Third Party Audits
- Managing audits can protect hospital revenue. One health system took a strategic approach to these audits while supervising anticipated risk to its Integrated Care Delivery System. This session provides an overview of the implementation of a centralized process and outlines the true risk experienced by this delivery system.
5B: Delayed Discharges: A Nursing/Case Management Solution
- Using Lean Six Sigma concepts to uncover and address the root cause of delayed discharges, this integrated health system established a Collaborative Nursing-Case Management Care Coordination model. This session centralizes on the model’s infrastructure and collaboration tools, which helped to increase discharge prediction accuracy and decrease the observed to expected length of stay.
6B: Hospitalist-Care Coordinator Team: Dynamic Case Management Practice
- Hospitals, physicians and case managers must strategically align to face coming challenges related to provisions of the recently enacted health care reform legislation. This session examines an initiative in place at one organization, which has improved quality outcomes and patient progression. Through the initiative, hospitalists and case managers have joined together to lead deliberate change in facing these challenges. This presentation discusses how a hospitalist-case management team functions in daily practice, and how the team has improved both care coordination and patient and employee satisfaction.
4:30 - 6:30 Networking Reception with Sponsors & Exhibitors/Poster Presentation/WIN THE WHEELS! Car Gi...
6:30 - 9:30 Compare AD User Group Meeting and Event (Subscribers Only)
- If you are a Compare AD Subscriber, please make plans to attend this user group meeting. This meeting will be a forum for subscribers to discuss pending product changes and improvements. After the discussion, we will spend the remaining time in a subscribers' networking event, giving you a chance to relax and have fun after the first day of conference sessions.

April 9th, 2011

7:00 - 7:45 ACMA Public Policy Forum (Breakfast Provided)
- Make plans now to join us for the ACMA Public Policy Forum. The ACMA Public Policy committee will solicit major concerns surrounding current health care legislation during this session, which will be prioritized by the committee and the ACMA Board of Directors.
  
  The forum is a breakfast event open to all conference attendees, and will be held April 9, 2011 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 tneese@acmaweb.org
8:00 - 9:00 ACMA Annual Meeting
- The 2011 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.
  
  At this year's conference, ACMA has elected to raise funds for its advocacy and public policy efforts. Now in the implementation phase, the health care reform bill's provisions continue to impact the practice of case management. ACMA will pursue an active voice in legislation, and your support will aid our association in pursuing relevant policy initiatives and sending members to Capitol Hill to represent case management's interests and ACMA's legislative priorities.
  
  Note: The ACMA Annual Meeting is open to ACMA members only. A nonmember NICM Main Conference registration includes a one-year ACMA membership.
9:15 - 10:30 Breakout Sessions C
1C: Communities Working Together to Provide
- Two community groups partnered with a teaching hospital to implement evidence-based care transitions models to improve access and quality of health care to underserving seniors and individuals with disabilities. This session offers suggestions to break down silos, coordinate community efforts to enhance transitions of care, and create a ‘No Wrong Door’ system of resource access so that older adults and individuals with disabilities can be supported safely in their communities in the way they choose.
2C: Denial Management: Centralization to Maximize Reimbursement
- In response to the ever-increasing scrutiny and attention paid to accurate and appropriate documentation and billing, healthcare systems are focusing their efforts toward the denial management processes within their organizations. This presentation describes the Centralized Denial Management model at a particular health system, and reviews its benefits and barriers, and the outcomes achieved.
3C: The Business Case for P.A.C.U Case Management
- This presentation examines one hospital’s case management-driven initiative to maximize revenue and compliance within the operating room. The initiative utilizes a case manager in the P.A.C.U. in order to manage the process of placing patients in “Extended Recovery” status. The P.A.C.U. case management role helps to ensure compliance with Medicare-required recovery time and subsequent correct admission status. The case manager also identifies and captures inpatient only procedures, educates providers on regulatory requirements and serves as liaison between the P.A.C.U. and Patient Financial Services to ensure the coordination of payment and authorizations. Presenters will discuss this initiative in depth, as well as the positive outcomes achieved and the value of investing case management resources in the P.A.C.U.
4C: Improving the Discharge Process: Utilizing the Patient and Family Centered Care Methodology
- The Patient and Family Centered Care (PFCC) philosophy teaches care experiences by viewing them through the eyes of patients and families and not their providers. The PFCC Methodology is a six step process that drives and maintains transformational change to any identified care experience. This session outlines the numerous positive outcomes and processes that impacted the hospital’s HCHAPS scores, and also reviews the improvement of this hospital’s discharge experience.
5C: Decreasing Readmissions Rates: Getting Results
- Readmissions to acute care facilities are coming under more scrutiny by both governmental and non-governmental quality organizations as well as payors. There are proven interventions that decrease readmissions through targeting recipients. Targeting is necessary with scarce case management resources, and there are several tools available for identifying patients at risk. This hospital is initiating an improvement program that targets patients based on principle diagnosis.
6C: Speeding Learning
- Presentation C-1: Putting the Pieces Together with Complex Care Management
  J. West & L. Flood Jensen
  
  Early identification of complex patients, as well as dedication of resources, can contribute to patient resolution. This session examines how a rural hospital developed a tracking tool for early identification of complex patients along with strategies, resulting in positive outcome data and increased communication among interdisciplinary lines.
  
  Presentation C-2: It takes a Village...and a Risk Management Team
  P. Kramer & D. Lum
  
  This session uses a case review approach to evaluate the internal and community resources, state resources, health plan support and involvement, and the legal resources that are engaged to effectuate a safe and successful discharge plan to the appropriate level of care.
  
  Presentation C-3: Change Management: "Why Won't They Just Do What I Say"
  S. Lawrence & M. Sawyer
  
  Change Management is a necessary component in the healthcare realm. It is a transition that requires motivation of team members to embrace new processes or initiatives that will result in organizational success. Our presentation will address the evolution of the Case Manager’s Role; the barriers encountered, and impact on staff. We will review organizational techniques utilized to develop our plan of action and the resulting outcomes from our effects both intended and unintended.
10:45 - 12:00 Breakout Sessions D
1D: ACMA Franklin Award Winner Presentation
- Winning the Franklin Award of Distinction signifies excellence in Case Management practices on an organizational level – an organization that demonstrates commitment to a collaborative practice philosophy, processes for applying interdisciplinary and interdependent expertise in achieving patient outcomes, coordination of care along the continuum, and that their Case Management service is functionally comprehensive, outcome oriented, and influential within their organization.
  
  This session summarizes Memorial Hermann’s ten year journey and evolution of a system-wide care management program. The program was designed to manage resource consumption, improve care coordination and improve managed care payer relationships. This program has achieved measurable success through Senior Leadership support.
2D: Hospital Case Management's Role in Health Care Reform
- Chosen as one of three national pilots for the Accountable Care Organization (ACO) movement, this presentation shares the process of planning, implementing and measuring the success of a case management program. With the goal of improving quality and decreasing health care costs, this session aligns a hospital with broader national goals of health care reform.
3D: Palliative Care in the Emergency Room
- This session examines a trigger tool developed by one organization’s Inpatient Palliative Care Team. By utilizing the tool, social workers are able to proactively identify patients in the Emergency Department who would benefit from a palliative plan of care. By the end of this session, participants will be prepared to utilize a trigger tool and detect patients that may benefit from palliative care interventions. Additionally, attendees will learn to apply their clinical expertise when responding to those patients who have been identified.
4D: Advanced Illness Management
- Advanced Illness Management (AIM) is a program providing care management, palliative care consultation and advanced care planning for patients, with late stage chronic illness who are at risk of dying in the next twelve months. The program is designed to reduce unnecessary, unwanted hospital admissions and emergency room visits, as well as improve quality of life. The AIM program bridges the gap between the hospital setting and the community physician’s office by utilizing a single interdisciplinary team, which specializes in care management for patients in the hospital, at home and in the physician’s office.
5D: Patient Flow Barriers at the End of Life: Health Care's Last Taboo
- Medically appropriate end-of-life care and its impact on health care costs remains a complex subject. This session addresses patient-flow barriers that discharge planners face and provides working solutions to aid cultural, trust, psychological and communication issues.
6D: Speed Learning
- Presentation D-1:Transitions of Care: A Geriatric Nutrition Case Example
  C. Man Ee
  
  An elderly person’s quality of life in the community can be enhanced through an effective nutrition preventive care plan. This session examines the multidisciplinary approach employed at one organization to develop and implement a nutrition education tool for the elderly. The speaker will also address the importance of adequate nutrition as preventive care to ensure positive quality of life among the elderly. Challenges related to the care of this patient population will also be discussed.
  
  Presentation D-2: Managing Short Stays: One Day Stay Review Process
  P. Kramer and T. Keesling
  
  It is now evident that short stays will be scrutinized closely by the Recovery Audit Contractors (RACs). Establishing an efficient process for reviewing short stays is critical to controlling an organization’s financial risk. This presentation outlines and describes the review process utilized at a community hospital. Speakers will present data (including PEPPER reports and observation rates) that support the integrity of the process and demonstrate its outcomes at or below national and jurisdictional benchmarks.
12:15 - 1:30 Breakout Sessions E: (Platinum Sponsor Presentations) | Lunch Provided
1E: 3M Health Information Systems: Manage your Outcomes by Managing Preventables
- The Centers for Medicare and Medicaid Services (CMS) estimates that 75 percent of readmissions in US hospitals are potentially preventable, totaling $12 billion annually. Penalties for failing to control these issues are looming. Are you able to accurately pinpoint the root cause of readmissions and complications within your hospital? In this session, we will discuss potential starting points to help you understand the scope of potentially preventable readmissions and complications before CMS starts to levy penalties in 2012. You will learn how to identify and prioritize the best opportunities for improvement using software tools and methodologies developed by 3M.
2E: ACS Midas+: Real-time Clinical Surveillance
- Are you tired of spending valuable time searching for the information you need in your hospital’s electronic medical record or worse yet, disparate information systems? Using Midas+, case managers, discharge planners and quality analysts are able to access a clinical information portal that delivers all relevant information in one consolidated, customizable view. Midas+ provides a real-time clinical surveillance system designed to alert clinicians to emerging complications. Our embedded clinical intelligence engine programmatically performs real-time surveillance of laboratory results, medication administrations, and a variety of other clinical data. Using complex evidence-based algorithms, case managers are proactively alerted to initiate interventions designed to avoid hospital acquired conditions and deliver quality patient outcomes. Reminders specific to interventions needed to meet Core Measure compliance and Meaningful Use Quality Reporting requirements are delivered concurrently to ensure all clinically relevant actions take place during the patient’s hospital stay. Come learn about how Midas+ can help you find more time in your day to spend interacting with patients instead of hunting for information.
3E: Air Ambulance by Air Trek: Principles of Air Medical Transport
- Air Trek, a Priority Sponsor for this year’s Win The Wheels giveaway, will take attendees on a virtual tour of air ambulance transportation. This session demonstrates real-life situations where case management professionals have had to respond to an immediate need for specific patients. Air Trek will answer questions and challenge attendees to think on their feet when crisis strikes. This presentation includes education on key factors such as cost containment, licensure, flight physiology and commercial airline assisted flights.
4E: Allscripts: Reform 2011: Leveraging Technology for Patient Continuity of Care
- In the rapid change environment of health care reform, new performance expectations are emerging. What clinical outcomes of care can occur for patients across care settings in your community? How will “meaningful use” expansion support the expectations for care coordination across the inpatient and outpatient settings ? How will preventable readmissions be reduced? What efficiencies for transitions of care will occur as Medicare and Medicaid reimbursements decrease and A.C.O models are created ? The National Quality Forum stated in 2010 that “All patients, but especially the growing number of Americans who suffer from multiple chronic conditions, can benefit from care coordination. Care coordination is an information-rich, patient-centric endeavor that seeks to deliver the right care (and only the right care) to the right patient at the right time.” Discussions will focus on the innovative ways that Allscript’s technology is integrated for continuity , and critical decisionmaking about the patient’s plan of care.
5E: Executive Health Resources: Expert Panel: Case Management’s Role in Building a Rapid Audit Response Team
- Throughout the past few years, the government has identified billions of dollars improperly paid through Medicare and Medicaid programs. As a result, hospitals now face a new era of health care audit accountability. This era is full of a variety of Program Integrity Contractor initiatives focused on identifying improper payments and issuing denials. Hospitals must be prepared to appeal those denials that are worthy of appeal. As many appeals management processes are complex and involve many steps, departments, documents, and deadlines, organization and preparedness are the first steps to success. In this session, EHR experts and case management directors from two client hospitals will provide participants with a blueprint for developing a team approach and effective processes for rapid audit response through a panel discussion.
6E: McKesson: Seeing is Believing-Visual Cues in Healthcare
- This session will demonstrate how Oakwood Hospital and Medical Center in Dearborn, Mich., is utilizing technology to transform Case Managers to the next level in providing optimal facilitated care for their patients. The power of McKesson’s Horizon Enterprise Visibility enterprise tracking board enables Case Managers to work more efficiently utilizing at-a-glance technology. Some of the streamlined areas for Case Manager which will be discussed include: identifying observation patients, isolating patients so expected length of stay is not exceeded, improving workflow around ambulance transports and communicating to Bed Management when ED patient admits meet InterQual guidelines for a bed to be assigned. Learn how Oakwood is continuously able to meet its goal of discharging a patient within three hours of a physician signing a discharge order and identifying and broadcasting by 9 am over 85% of the day’s potential discharges. You will walk away from this session with a wealth of creative ideas and best practices on how to optimize Case Management operations.
7E: MexCare: Management of the Unfunded Foreign National
- Learn successful strategies for the management of unfunded foreign nationals from seasoned case managers. Let them share their strategies and best practices for successful, safe and timely discharge. The conference member will participate in an open question and answer forum with our distinguished panel members and key members of the MexCare management team. Conference members attending the question and answer forum will leave with a comprehensive understanding of actual case studies and the strategies to ensure safe, effective and timely discharge.
8E: Milliman Care Guidelines: Evidence-based Clinical Guidelines and Software to Drive Quality Patient Care
- Hundreds of hospitals are switching to the Milliman Care Guidelines®, due in part to the rigorous evidence-based development and the ease of access to evidence. Integrated, diagnosis-specific references, abstracts, and evidence summaries are all accessible within a user's workflow, providing the tools needed to drive higher-quality care and efficient use of medical resources. The Care Guidelines are now used by more than 1,800 clients, including seven of the eight largest US health plans and 25 CMS audit contractors. A recent contract gives all Fiscal Intermediaries (FIs), Medicare Administrative Contractors (MACs) and Quality Improvement Organizations (QIOs) Care Guidelines access for CMS healthcare audits.
9E: Morrisey Associates: "Readmission: Was that the Plan?"
- Perhaps the single biggest topic of 2010 was health care reform, and there's no doubt it will continue in 2011 and beyond. Reducing the rate of unplanned hospital readmissions is a key component of the agenda to reform health care. Consider the facts: one in five Medicare beneficiaries discharged today will re-enter the hospital in 30 days or less; 90% of those readmissions are unplanned. Hospital readmission rates are another category of data used to judge the quality of hospital care and such rates are now made available by CMS. Many payors have begun to tie reimbursement to a hospital’s readmission rate and soon will impose penalties on those facilities that have readmission rates felt to be excessive. This session will focus on identifying and tracking key metrics related to unplanned readmission rates and present strategies for reducing such via MCCM architected solutions.
10E: Proficient Health: Simplify the RAC Attack
- The presentation reviews a high level overview of Secure AO showing the ease of use of the new ACMA product to provide an electronic solution for the secure file transfer of patient records to the myriad of hospital auditors.
11E: Accretive PAS ™: Push Back the RAC
- The RAC demonstration project resulted in millions in take backs from hospitals in three states. It was so successful that it has gone national… and it’s here to stay. Much of the revenue was reclaimed when the RAC determined that patients admitted as inpatients should have been treated in an outpatient setting. This continues to be a focus of RAC audits. This session will review the reasons so many hospital admissions were declared “not medically necessary.” Knowledge of the requirements for admission will enable hospitals to avoid and successfully appeal RAC take backs. Advanced appeal strategies beyond the medical necessity arguments will also be explored.
12E Fresenius Medical Care: Living Life to the Fullest with Dialysis
- Shad Ireland was the first dialysis patient to compete in, and complete, the physically challenging Ironman Triathlon competition on July 25, 2004. A 27-year dialysis patient, Shad has campaigned nationwide to raise dialysis awareness while encouraging chronically ill people to take a positive, proactive approach to their challenges and achieve their life goals. He is an individual who is passionate about life, who is motivated by challenges, and who is committed to the inspiration of his fellow patients. He is an individual who is beating the odds by turning obstacles into achievements and celebrating every breath along the way. And he is an individual who has accepted, and is successfully living with kidney disease and all of the experiences that go along with this diagnosis.
13E: Trace/The White Stone Group: Strategies to Ensure Effective & Efficient Communication
- Today’s complex health care environment involves countless interactions with physicians, patients and payers. Documentation strategies that rely on paper-driven, manual processes no longer fit the bill for today’s fast-paced work environment. This session will present the concept of a communication management system to document critical activities surrounding payer authorization, internal communication and discharge planning. Attendees will hear how Lenox Hill Hospital has used Trace to capture and centralize communication for improved outcomes in efficiency, compliance and reimbursement. When errors such as denials occur, records are leveraged as objective data to facilitate contract compliance and ensure accurate payment.
14E: Conifer Health Solutions: How to Implement an Effective Clinical Denials Strategy
- Each year billions of claims go unpaid due to the lack of clinical precertification, proper medical necessity screening, and inappropriate medical coding. Ensuring that your health system is properly reimbursed for its services is vital for an effective revenue management cycle. Using a multi-hospital health system as a case study, this session will provide effective approaches for establishing denial prevention and recovery processes that lead to enhanced profitability and reduction of case management workload and a decrease of insurance denials. Conifer will share their best resources available to support a hospital case management team and how they can impact your bottom-line revenue cycle management efforts.
2:00 - 3:15 Breakout Sessions F
1F: Breaking Through Barriers: Advancing an Emergency Department Case Management Focus Beyond Financial to Clinical
- With an ever increasing demand in the number of patients seeking treatment in Emergency Departments across the country, careful screening of patients for admission is essential. As experts in medical necessity and community resources, case managers are in a position to provide valuable assistance to Emergency Room physicians. This presentation discusses how the case management department in a metropolitan, academic medical center tailored a 24/7 case management model that navigates patient assignment, assists with optimizing patient flow, assigns appropriate admissions status and refers appropriate patients.
2F: Crisis Emotional Response Team: A Model for Employee and Community Crisis Intervention
- The Crisis Emotional Response Team (CERT) responds to internal and external hospital crisis situations such as employee suicides, employee accidental deaths, multiple patient deaths in a short period of time, difficulty adjusting to change, prolonged uncertainty and other crisis situations. CERT has taken a proactive approach and sponsored educational opportunities covering topics such as unemployment, financial strain, conflict resolution and others. CERT also serves as part of the hospital’s disaster response plan, which provides behavioral interventions for patients and families in the event of an external disaster.
3F: CMS Demostration Project for the Care Management Tool: Participant Perspective
- The Payment Reform Demonstration (PRD) is a testing Care Assessment Tool – the pre-cursor for defining and managing an ‘episode’ of care across all care environments and is thought to be the foundation for future Accountable Care Organizations and Payment Bundling. In this session, two organizations that were invited and accepted to participate in the PRD will share their perspectives; obstacles, challenges and barriers encountered with the proposed payment reform plan; and implications to health care organizations secondary to this PRD project.
4F: Managing the Operating Room Scheduling Process: The 72-Hour Deadline
- This presentation centers on the initiatives developed at a teaching hospital to ensure positive revenue management of the operating room (OR) process. The implementation process involved a multidisciplinary team from case management, nursing, finance and a physician. This session focuses on specific actions including scheduling, level of care assignment, pre-authorization, clinical requirements, OR utilization and the utilization review post procedure process.
5F: Disabilities, Addiction and Health Care: A Tangled Web
- This session explores the relationships among disabilities, addiction, health and counseling issues, health care, and treatment options. Motivational interviewing and its implications in a health setting, including increased compliance, will be examined. In addition, a video will be shown interviewing individuals facing the challenges of both addiction and disabilities. Also, a personal prospective will be shared by a social worker.
6F: Case Management and Compliance
- In recent years, case management has been flooded with numerous state and federal regulatory issues that impact our daily operations and delivery of services. The risk and financial impact of misunderstanding or failing to meet regulatory requirements is great, and many “urban myths” surrounding compliance issues are being perpetuated. This session is aimed at clearing up the myths and clarifying the real expectations of Conditions of Participation, the OIG work plan, and other relevant documents and directives. A systematic approach to development and implementation of an efficient and effective compliance work plan for case management will be presented, along with tips for success in the day-to-day environment.
3:30 - 4:45 Breakout Sessions G
1G: Developing and Implementing Online Yearly Competencies for Care Management
- With ever-changing rules, regulations, payment cuts and changes in plans of care, how does a care management department develop a plan to ensure their staff is qualified to meet the multiple financial and discharge needs of their patients for quality cost effective care? This presentation provides the necessary tools to develop an online yearly mandatory competency tool to evaluate case management staff that can build consistency, apply knowledge and meet patients’ needs.
2G: High Intensity Escalation: The Right Solution at the Right Time
- Is the changing health care environment leaving a bottle-neck in your Emergency Room or on your inpatient units? You need new and different strategies to remediate the barriers that surround these patients. High Intensity Escalation is an advanced case management strategy that can assist in achieving quick resolutions to complex problems. This presentation examines who these patients are, the barriers at hand and provides established methods to progress patients through the complexities of the care plan.
3G: Improving Patient Outcomes by Using Collaborative Team Research
- This session shares accomplishments of a multidisciplinary team consisting of care management staff, outpatient pharmacy staff, physicians and senior leadership from two organizations separated by 100 miles. Their program’s design and research, based on Dr. Eric Coleman’s Care Transition Model, showcases methods to produce better patient and organizational outcomes.
4G: WIN/WIN: University and Case Management Partnerships
- This session examines a collaborative partnership between university schools of social work and community health care providers. The program provides students with opportunities to work with the geriatric population through a grant from the John A. Hartford foundation. Speakers will provide attendees with a framework for implementing a similar partnership within their organization.The session outlines the process of establishing, developing and maintaining a relationship between a university and a healthcare provider in such a partnership.
5G: Front Door Screening: An Emergency Department Case Management Approach
- The “Front Door” is the best place to initiate screening for criteria, documentation and discharge planning. Millions of dollars can be saved when you have an effective Emergency Department (ED) case management program. One hospital’s ED Program was eliminated due to budget cuts; however, it was reinstated one year later when the impact of the lost value was realized by members of both the ED and administration.
6G: Achieving Optimal Care and Outcomes with Collaborative Interdisciplinary Rounds
- Collaborative and consistent coordination of care can be optimized by interdisciplinary rounds, a process in which case managers play a vital role. This presentation discusses the expansion and improvement of interdisciplinary rounds in a non-profit community-based hospital. Speakers will share the processes and tools developed and implemented as well as the patient, family and health system goals that were achieved as a result of the initiative. The session also addresses the importance of case management in this program, specifically in regards to the improved transfer of knowledge, care delivery and outcomes produced.
5:00 - 6:30 Closing Party & ACMA Live Auction & 50/50 Raffle
- As the biggest social event of the conference, we invite you to join us for our Closing Party. As a final toast to the conference, attendees look forward to this annual event with excitement and enthusiasm. Relax and socialize with new friends and Sponsors/Exhibitors while enjoying hors d'oeuvres, cocktails, games, dancing, music, and more! True to tradition, we unveil the location of the 2012 National Conference and announce the winner of the cash-prize raffle. Our live auction, which is always an attendee favorite, boasts several one-of-a-kind or wait-listed items. Thanks to the overwhelming generosity of our Sponsors/Exhibitors and donors, we have an incredible selection on which to bid. The live auction makes for a fun and fiercely competitive night complete with great company and prizes. Due to the popularity of the Closing Party, we offer guest passes for purchase. The Closing Party is included in the main conference registration fee; however, attendance must be confirmed at time of registration.

April 10th, 2011

7:00 - 8:00 Continental Breakfast (Post-Conference Attendees Only)
8:00 - 9:00 Post Conference Workshop Session 1: Cultural Competency
- At times cultural and linguistic differences can create a barrier between the case manager and the patient and or the family. Being aware of cultural differences is essential when working with patients from multicultural backgrounds. This presentation provides the participant an opportunity to gain knowledge that will enhance and facilitate postive patient care and health care system outcomes
9:15 - 10:30 Post Conference Workshop Session 2
For Staff: Health Care Reform
- Health Care Policies are constantly changing, and it can be difficult to keep up. This session will identify and discuss the most current changes in health care and how this will affect the daily work of case management.
For Leadership: Lead from your Strengths
- Case Management Leaders need to be aware of their own personal strengths, as well as the strength of their staff members. This session will provide the opportunity to discover those strengths and how to use such knowledge in the workplace.
10:45 - 12:00 Post Conference Breakout Sessions 3
For Staff: Communicating with Style
- The art of communicating…is it lost? Can it be recovered? Absolutely! Communication is simply the process by which people create and share information. This session helps participants understand why communication breaks down and learn how to appreciate the benefits of effective communication. Active listening, tone of voice, body language and other interactive skills will be examined and discussed.
For Leadership: Supervision and Alternate Methods
- In order to be cost effective and to provide quality care to complex patients, many health care administrators have developed managerial structures in which traditional profession-based clinical supervision has been replaced by interprofessional supervision.

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April 7th, 2011

Continental Breakfast (Pre-Conference Attendees Only)

ACM Certification Review Workshop

Pre-Con Workshop Session 1: Reducing Readmissions

Pre-Con Workshop Session 2: The Campaign for Better Care: Why We Need a Better Way

Pre-Con Workshop Session 3: RAC 2011-Lessons Learned

Pre-Con Workshop Session 4: Transitions of Care

ACMA Leadership Forum: 2011 ACMA Hospital Case Management Survey Results

Welcome Reception with Sponsors & Exhibitors/Poster Session Presentation/Silent Auction

April 8th, 2011

ACMA Member Orientation

Networking Breakfast with Sponsors/Exhibitors (Continental Breakfast Provided)

Welcome & ACMA/Joint Commission 2011 Franklin Award of Distinction Announcement

Keynote Address: If Disney Ran Your Hospital...9 1/2 Things You Would Do Differently

1A: If Disney Ran Your Hospital...9 1/2 Things You Would Do Differently: A Closer Look

2A: Front-End Case Management Strategies to Reduce Financial Risk

3A: Transitioning with Health Care Reform: Interdisciplinary Care Planning

4A: Ethical Decision Making in Complex Cases

5A: Measure What You Manage: Identify Opportunites and Apply Best Practice Solutions

6A: Designing and Implementing a Collaborative Case Management Model Using Six Sigma Tools

1B: Ethical Decision Making in Complex Cases

2B: ACMA Social Work Fellowship Presentation

3B: Patient Navigation in a Complex Medical System

4B: Show Me the Money: An Integrated Approach to Managing Third Party Audits

5B: Delayed Discharges: A Nursing/Case Management Solution

6B: Hospitalist-Care Coordinator Team: Dynamic Case Management Practice

Networking Reception with Sponsors & Exhibitors/Poster Presentation/WIN THE WHEELS! Car Giveaway

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April 9th, 2011

ACMA Public Policy Forum (Breakfast Provided)

ACMA Annual Meeting

1C: Communities Working Together to Provide

2C: Denial Management: Centralization to Maximize Reimbursement

3C: The Business Case for P.A.C.U Case Management

4C: Improving the Discharge Process: Utilizing the Patient and Family Centered Care Methodology

5C: Decreasing Readmissions Rates: Getting Results

6C: Speeding Learning

1D: ACMA Franklin Award Winner Presentation

2D: Hospital Case Management's Role in Health Care Reform

3D: Palliative Care in the Emergency Room

4D: Advanced Illness Management

5D: Patient Flow Barriers at the End of Life: Health Care's Last Taboo

6D: Speed Learning

1E: 3M Health Information Systems: Manage your Outcomes by Managing Preventables

2E: ACS Midas+: Real-time Clinical Surveillance

3E: Air Ambulance by Air Trek: Principles of Air Medical Transport

4E: Allscripts: Reform 2011: Leveraging Technology for Patient Continuity of Care

5E: Executive Health Resources: Expert Panel: Case Management’s Role in Building a Rapid Audit Response Team

6E: McKesson: Seeing is Believing-Visual Cues in Healthcare

7E: MexCare: Management of the Unfunded Foreign National

8E: Milliman Care Guidelines: Evidence-based Clinical Guidelines and Software to Drive Quality Patient Care

9E: Morrisey Associates: "Readmission: Was that the Plan?"

10E: Proficient Health: Simplify the RAC Attack

11E: Accretive PAS ™: Push Back the RAC

12E Fresenius Medical Care: Living Life to the Fullest with Dialysis

13E: Trace/The White Stone Group: Strategies to Ensure Effective & Efficient Communication

14E: Conifer Health Solutions: How to Implement an Effective Clinical Denials Strategy

1F: Breaking Through Barriers: Advancing an Emergency Department Case Management Focus Beyond Financial to Clinical

2F: Crisis Emotional Response Team: A Model for Employee and Community Crisis Intervention

3F: CMS Demostration Project for the Care Management Tool: Participant Perspective

4F: Managing the Operating Room Scheduling Process: The 72-Hour Deadline

5F: Disabilities, Addiction and Health Care: A Tangled Web

6F: Case Management and Compliance

1G: Developing and Implementing Online Yearly Competencies for Care Management

2G: High Intensity Escalation: The Right Solution at the Right Time

3G: Improving Patient Outcomes by Using Collaborative Team Research

4G: WIN/WIN: University and Case Management Partnerships

5G: Front Door Screening: An Emergency Department Case Management Approach

6G: Achieving Optimal Care and Outcomes with Collaborative Interdisciplinary Rounds

Closing Party & ACMA Live Auction & 50/50 Raffle

April 10th, 2011

Continental Breakfast (Post-Conference Attendees Only)

Post Conference Workshop Session 1: Cultural Competency

For Staff: Health Care Reform

For Leadership: Lead from your Strengths

For Staff: Communicating with Style

For Leadership: Supervision and Alternate Methods