2018 OBSERVATION PATIENT MANAGEMENT FORUM
Innovations in Observation Patient Management – Prevent Unnecessary Admissions, Maximize Reimbursements and Leverage Evidence-Based Triage Protocols to Improve Short-Term Care Quality
September 13-14, 2018 * Wyndham Grand Orlando Bonnet Creek * Orlando, FL

2018 Observation Patient Management Forum

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About the Conference

Faced with increasing patient volumes, declining reimbursements and overworked ED staff, hospitals must be prepared to leverage observation patient management. Well-structured observation units have resulted in financial gains, improved clinical outcomes and superior patient satisfaction ratings.

The 2018 Observation Patient Management Forum will highlight the pertinent challenges facing observation unit staff – ED physicians, hospitalists, case managers and billing and coding professionals. Additionally, the conference will highlight how and why hospitals that are not utilizing observation patient management are leaving money on the table.

The 2018 Observation Patient Management Forum will allow you to walk away with an understanding of current trends and market practices, and innovative strategies to prepare yourself for the challenges that lie ahead. Learn best practices in patient management and examine strategies to improve care, increase satisfaction and achieve organizational goals

Who Should Attend?

From Hospitals/Health Care Centers

VPs, Chief Medical Officers, Nursing Director, Managers and Senior Level Executives Responsible for:

  • Observation Medicine
  • Hospital Medicine
  • Clinical Decision Making
  • Emergency Nursing
  • Utilization Management
  • Reimbursement
  • Compliance
  • Medical Affairs
  • Emergency Medicine
  • Internal Medicine
  • Billing & Coding
  • Case Management
  • Patient Access
  • Denial Management
  • Quality Management
  • Discharge Planning
  • Patient Throughput
  • Physician Advisor
  • Admissions
  • Care Coordination

This conference will also benefit physician advisor firms, solution providers, healthcare consulting firms, and healthcare information technology firms.

Conference Agenda

Day One – Thursday, September 13, 2018

7:15 Conference Registration & Morning Breakfast

8:00 Chairperson’s Opening Remarks

8:15 Developing and Implementing an Effective Observation Case Management Program to Improve Efficiency and Flow

Hospitals have long struggled with managing patients efficiently who are placed in observation status. These patients are often viewed and treated as acute care patients by the patients, the providers, the caregivers, and the patients’ families. Case managers working on a dedicated observation unit have the ability to assess patients who will require transitional care services quickly. The case manager in conjunction with the patient and the interdisciplinary team will create a safe, effective, timely, and complete transitional care plan that allows for an efficient transition from the hospital to home or the most appropriate level of care. The transitional care plan is designed with a 24-hour transition timeline so that patients may be transitioned to the next level of care as soon as the patient is deemed safe and prepared to leave the unit. This rapid turnover in an observation unit requires the expertise of a case manager. The case manager facilitates every element of a safe transition for the patients that require this service.

Mary McLaughlin Davis, DNP, ACNS-BC, NEA-BC, CCM

Senior Director of Care Management

Cleveland Clinic, Euclid, Mednia and Akron Hospitals

President

Case Management Society of America

9:00 A Proven and Effective Blueprint for Implementing a Short Stay/Observation Unit at Your Hospital

This session will focus on the keys to a starting and maintaining an observation unit. The critical elements needed to succeed and the pitfalls to avoid will be described. Best practices for observation medicine will be defined. Examples of how can you use not just clinical protocols, but administrative protocols, policies, procedures, order sets, care paths/clinical pathways or algorithms for observation medicine will be given. Ways you can use observation to support your institution and do what you do best will be mentioned. What can observation accomplish in any location or setting, if it is done correctly, will be detailed.

Sharon E. Mace, MD, FACEP, FAAP

Professor of Medicine

Cleveland Clinic Lerner College of Medicine at Case Western Reserve University

Director, Observation Unit; Director, Research

Cleveland Clinic

9:45 Networking Break & Refreshments

10:15 Hesitation, Observation, Aspiration, Glorification

This session will highlight patient flow, patient satisfaction and productivity challenges that Wellington Regional Medical Center faced with the growing numbers of observation patients (managed care being the heaviest driver). The hospital was overwhelmed with patients holding in our ED, numerous complaints, tedious meetings 3 times daily for case management, nursing, supervisor and emergency department to discuss patient flow issues and next steps. Overwhelmed by the above factors, an observation team was formed consisting of physicians, nursing, and ancillary departments. Together this team revolutionized our processes through definitive planning and action steps. The specific components of our step-by-step process allowed us to:

- Decrease holding hours in the ED by 65%

- Provide a specific unit designated for observation patients with observation trained nurses who utilize disease specific order sets that allow efficiency in caring for the patient expeditiously

- Discharge observation patients with chest pain within 19 hours; and make significant progress with other diagnoses

- Increase overall patient satisfaction

- Increase appropriate patient placement which eliminated the log jams

- In addition, we now are using scribes to facilitate the documentation so that we are even more efficient.

Asenath Cassel, RN, MN

Chief Nursing Officer

Wellington Regional Medical Center

11:00 Achieving Success in Clinical Decision Making and Management of the Observation Unit

This session will review key concepts and strategies for successful observation management. It will reveal the lessons learned in key areas of practice, including staffing, leadership, documentation, and oversight. It will feature new and innovative methods in use embedding clinical decision support and evidenced-based guidelines within the EMR to facilitate best practice and streamlined operations. This session will also share the knowledge of how to leverage resources in the hospital to prioritize observation patients and their care, in order to maximize the efficiency of emergency medicine throughput in a variety of observation unit settings. During this session, the audience will be given pearls of running a successful observation unit. This will include a review of the best practices, owning and hard-wiring the mission of the unit among staff, patient selection, coordination of ancillary services and benefits of case management. In addition, the strategies for unit management will be detailed with recommendations for metrics, accountability, and feedback to staff.

Stephanie Figueroa, MPAS, DFAAPA, PA-C

Director of Observation Medicine, PA Manager, and Epic Physician Champion

Johns Hopkins Department of Emergency Medicine

11:45 Achieving Success in Observation Unit Development and Management

During this session the audience will be given pearls of running a successful observation unit. This will include a review of the best practices, owning and hard-wiring the mission of the unit among staff, patient selection, coordination of ancillary services and benefits of case management. In addition, the strategies for unit management will be detailed with recommendations for metrics, accountability and feedback to staff.

J. Jeremy Thomas, MD, MBA, FACEP, FAAEM

Professor, Department of Emergency Medicine

Director of Emergency Services

Director of Observation Medicine

UAB Medicine

12:30 Luncheon for All Attendees & Speakers

1:30 Observation: Tales from the Trenches, Common Mistakes and How to Avoid Them

This session will review the growing pains of an observation unit, pitfalls and challenges of providing efficient and expeditious observation services. Examine the role of consultant in an observation unit. Interactively examine real cases to determine correct placement, observation versus inpatient. Explore how staff should engage with patients during the observation stay from arrival to discharge.

Tibian Abramovitz, MD

Director, Case Management and Denials

Brookdale University Hospital and Medical Center

2:15 Management of Patients with Cancer in the Observation Setting

Hospitals' use of observation status for patients with cancer presenting to the emergency department (ED) is not well understood. A recent review of SEER Medicare data suggested that observation status is used proportionately less for beneficiaries with cancer that for those without. At our own institution, an NCCN site, which only treats patients with cancer, we observed decreased rates of hospital admission and inpatient bed utilization following implementation of an observation unit 4 years ago. We have defined a number of discrete clinical conditions related to cancer symptomatology and treatment that can be successfully managed in the observation setting. Adoption of this approach for this patient population has the potential to reduce hospital use, which is of interest to hospitals, payers, and patients.

Adam D. Klotz, MD

Associate Member, Urgent Care Service

Associate Professor, Weill Cornell Medical College

Co-Chair, Institutional Patient Flow Committee

Director, Urgent Care Clinical Decision Unit

Memorial Sloan Kettering Cancer Center

3:00 Networking Break & Refreshments

3:30 Observation Optimization

This lecture will dive deep into the world of observation and provide tips/tools to help your observation unit become successful. Optimize your unit and go for the triple AIM. Real life experiences from an Observation Director will be provided and take home techniques will be shared.

Kasey Schnebly, DNP, CRNP

LEAD Hospitalist Certified Nurse Practitioner

Director of Observation

Meritus Medical Center

4:15 Nuts and Bolts for Observation Services:  Making the Business Case for Creating an Observation Unit

This presentation will discuss rapid admission strategies from triage to the ED Clinical Decision Unit (CDU) through coordination with ED nursing/MDs and consulting services. Additional uses of the CDU will be discussed to assist in providing capacity within the ED such as utilization of the CDU for patients waiting for procedures. Quality metrics will be examined along with ways to hardwire necessary change to meet the quality metrics. Lastly, is time to expand your CDU? This presentation will include an example of a business case to justify the cost of expansion.

Patrice Callagy, RN, MPA, MSN, CEN

Director, Emergency Services

Stanford Health Care

5:00 End of Day 1

Day Two – Friday, September 14, 2018

7:15 Morning Breakfast

8:00 Chairperson’s Recap of Day One

8:15 Reducing Unnecessary Hospital Admissions Through Observation and Evidence-Based Clinical Decision Making

Hospitalizations account for nearly one-third of the total dollars spent on health care in the United States. Nearly a quarter of hospital readmissions are preventable. This presentation will focus on a hospital’s experience regarding (1) Predictive modeling – predicting discharges from observation using readily available metrics; (2) Discuss best practice protocols for management of the observation patient, aimed at minimizing the need for inpatient admission, and (3) Describe care transition strategies to ensure continuity of care and reduction in return visits/admissions for the observation patient. Learning objectives:

- Identify the “ideal” observation patient

- Predict discharge from observation using readily available metrics

- Discuss leading protocols for observation management that are aimed at minimizing the need for inpatient admission

- Describe care transition strategies to ensure continuity of care and reduction in return visits/admissions for the observation patient

Peg Keshock, MSN, RN, ACM 

Director, Care Coordination and Population Health

Metro Health System

9:00 Speeding Triage and Clinical Decision Making for Patients Presenting Chest Pain Conditions

Emergency departments continue to be faced with multiple challenges for the patient that arrives with chest pain as their chief complaint. The clinical presentation seldom follows the classic pathway leading to a definitive diagnosis or concrete plan of care. The uncertainty of sending home this patient population is viewed with potential risks and reservation. This presentation will discuss how to streamline the flow of this patient from triage to discharge. Collaboration between emergency physicians and cardiologists can drive a criteria-based - protocol driven observation unit to minimize risk for the healthcare providers while providing confidence and empowerment to the patient to ensure their well-being.

Genean Grant, MHA, BSN, RN, NE-BC

Emergency Services Manager

Methodist Charlton Medical Center

9:45 Networking Break & Refreshments

10:15 Emergency room overcrowding continues to be a challenge difficult to overcome. There are service and quality operational challenges to consider, moreover, the safety factor in caring for a boarder patient in a busy emergency room holds risk to become compromised. The boarding practice has led to ED staff confusion and dissatisfaction, cyclical and increased ED overcrowding and the potential of adding onto the patient length of stay. As UPMC McKeesport continues to play an important role in meeting the healthcare needs of 200,000 residents of McKeesport and its surrounding communities, most of which are elderly residents, strategies created to discharge patients and continue outpatient services have provided successful outcomes in ED and inpatient capacity management./p>

Kelly Heatherington, DNP, RN, NEA-BC

Director, Capacity Management & Support Services

University of Pittsburgh Medical Center, UPMC McKeesport and UPMC East

11:00 Psychiatric Observation: Is it Time to Expand Your Product Line

The number of psychiatric patients presenting to emergency departments has been increasing for the past few years. Many of these patients will board in the ED because inpatient beds are not available. Psychiatric observation provides not only the opportunity to unload these patients to a better care environment but also may improve care and reduce the need for admissions. This presentation will provide the ground work for establishing and maintaining a psychiatric observation unit.

Leslie S. Zun, MD, MBA

System Chair of the Department of Emergency Medicine

Chair and Professor in the Departments of Emergency Medicine and Psychiatry

Rosalind Franklin University of Medicine and Science at Chicago Medical School

11:45 Creation of Virtual Capacity by LOS Reduction

St. John’s Medical Center was frequently on transfer divert and had a high number of patient holds in the Emergency Department related to being at capacity. Knowing that building beds would be very costly, St. John’s decided to pursue the creation of virtual capacity by decreasing length of stay. St. John’s did an extensive analysis of bed day opportunities specific to:

- DC Location

- DRG

- Service Line

- Dirty bed availability

Gap analysis showed a bed day opportunities with surgical DRG’s, DC to LTAC, and dirty bed response times. The Process Improvement team began a series at projects targeting these identified opportunities and observed a reduction in ALOS. This reduction created virtual capacity and allowed St. John’s to reduce the number of divert hours and increase the number of transfers. This increase resulted in significant increased net revenue.

Katherine Barkat, RN, CCRN, BSN

Performance Improvement Advisor

St. John Health System

12:30 Conference Concludes

Workshop – Day 1 – Thursday, September 13, 2018

5:15pm – 7:15pm How to Approach and Implement Changes to Your Observation Program

In this workshop we will discuss learnings from the day’s sessions and thoughts on how to take what you’ve heard and implement it back home. We will discuss the 4 approaches to observation care, with the pros and cons of each, including a case study. Potential approaches to dashboards will be presented with the discussion of leading and lagging metrics and subsequent reporting. Payor considerations and the role of utilization management will be discussed. Finally, success factors will be presented based upon best practice regardless of the approach taken at your organization. Process performance tools will be presented to help participants facilitated changes in their hospitals and systems

Learning objectives:

  • 1. Understand the 4 types of observation care with pros and cons of each.
  • 2. Identify leading and lagging metrics for observation care.
  • 3. Take home tools that they can use to facilitate change in their own organization.
  • 4. Articulate the role of utilization management in monitoring on-going patient status

Wanda Pell, FACHE, MHA, RN

Manager

GE Healthcare Partners

Ms. Pell is a manager at GE Healthcare Partners with more than three decades of experience in areas of healthcare, including revenue cycle, compliance, care management and patient throughput. Ms. Pell recently successfully facilitated the design and expansion of a closed observation unit at a quaternary care hospital. She has worked with many hospitals to implement compliant approaches to management of observation care. In addition, she has worked with a children’s hospital to design processes to move utilization management into the revenue cycle product line. She has managed billing and compliance audits including Corporate Integrity Agreement audits. Ms. Pell earned her Bachelor of Science in Nursing at the University of North Carolina, Greensboro, and her Masters of Health Administration at Duke University.

Featured Speakers

Mary McLaughlin Davis, DNP, ACNS-BC, NEA-BC, CCM

Mary McLaughlin Davis, DNP, ACNS-BC, NEA-BC, CCM

Senior Director of Care Management
Cleveland Clinic, Euclid, Mednia and Akron Hospitals
President
Case Management Society of America

Sharon Mace, MD, FACEP, FAAP

Sharon Mace, MD, FACEP, FAAP

Director, Observation Unit
Cleveland Clinic

Asenath Cassel, RN, MN

Asenath Cassel, RN, MN

Chief Nursing Officer
Wellington Regional Medical Center

Kasey Schnebly

Kasey Schnebly

LEAD Hospitalist Certified Nurse Practitioner
Director of Observation
Meritus Medical Center

J. Jeremy Thomas, MD, FACEP, FAAEM

J. Jeremy Thomas, MD, FACEP, FAAEM

Professor Department of Emergency Medicine
Director of Emergency Services
Director of Observation Medicine
University of Alabama at Birmingham

Tibian Abramovitz, MD

Tibian Abramovitz, MD

Director, Case Management and Denials
Brookdale University Hospital and Medical Center

Genean Grant, MHA, BSN, RN, CNRN

Genean Grant, MHA, BSN, RN, CNRN

Manager, Emergency Services
Methodist Charlton Medical Center

Adam D. Klotz, MD

Adam D. Klotz, MD

Associate Member, Urgent Care Service
Associate Professor, Weill Cornell Medical College
Co-Chair, Institutional Patient Flow Committee
Director, Urgent Care Clinical Decision Unit
Memorial Sloan Kettering Cancer Center

Leslie S. Zun, MD, MBA

Leslie S. Zun, MD, MBA

System Chair of the Department of Emergency Medicine
Chair and Professor in the Departments of Emergency Medicine and Psychiatry
Rosalind Franklin University of Medicine and Science at Chicago Medical School

Kelly Heatherington, DNP, RN, NEA-BC

Kelly Heatherington, DNP, RN, NEA-BC

Director, Capacity Management & Support Services
University of Pittsburgh Medical Center
UPMC McKeesport and UPMC East

Stephanie Figueroa, MPAS, DFAAPA, PA-C

Stephanie Figueroa, MPAS, DFAAPA, PA-C

Director of Observation Medicine
PA Manager, and Epic Physician Champion
Johns Hopkins Department of Emergency Medicine

Patrice Callagy, RN, MPA, MSN, CEN

Patrice Callagy, RN, MPA, MSN, CEN

Director, Emergency Services
Stanford Health Care

Peg Keshock, MSN, RN, ACM

Peg Keshock, MSN, RN, ACM

Director, Care Coordination and Population Health
Metro Health System

Katherine Barkat

Katherine Barkat

Performance Improvement Advisor
St. John Health System

Wanda Pell, FACHE, MHA, RN

Wanda Pell, FACHE, MHA, RN

Manager

GE Healthcare Partners

Venue

Wyndham Grand Orlando Resort Bonnet Creek
14651 Chelonia Parkway
Orlando, FL 32821
407-390-2300

Mention BRI Network to get the discounted rate of $179/night

Sponsors and Exhibitors

TBA

FAQ

Are there group discounts available?

  • Yes – Register a group of 3 or more at the same time and receive an additional 10% off the registration fee

Are there discounts for Non-Profit/Government Organizations?

  • Yes – please call us at 800-743-8490 for special pricing

What is the cancellation policy?

  • Cancellations received 3 weeks prior to the event will receive a refund minus the administration fee of $185. Cancellation received less than 3 weeks prior to the event will receive a credit to a future event valid for one year.

Can the registration be transferred to a colleague?

  • Yes – please email us in writing at info@brinetwork.com with the colleague’s name and title

Where can I find information on the venue/accommodations?

  • Along with your registration receipt you will receive information on how to make your hotel reservations. You can also visit individual event page for specific hotel information. The conference fee does not include the cost of accommodations.

What is the suggested dress code?

  • Business casual. Meeting rooms can sometimes be cold so we recommend a sweater or light jacket
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