2023 Observation Patient Management Forum

8:00am – 8:15am
Chairperson’s Opening Remarks 

8:15am – 9:00am
Thinking Outside of the Box: How to Make Your Obs Unit a Clinically Successful Enterprise 

Stefanie B. Porges MD
Medical Director, Hospital of the University
of Pennsylvania Emergency Department
Observation Unit
University of Pennsylvania

9:00am – 9:45am
Engaging A Multi-Disciplinary Team in Observation Management 

Lindsay McGann, MD
Assistant Professor of Clinical Medicine
Section of Hospital Medicine, Department of Internal Medicine
Lewis Katz School of Medicine at Temple University
Temple University Hospital 

9:45am – 10:15am
Networking & Refreshments Break 

10:15am – 11:00am
Observation: Tales from The Trenches, Common Mistakes And How To Avoid Them. ™
Observation services often present a challenge to the hospitals and doctors. This presentation will review the most common challenges and suggest solutions as to avoid failure in the correct implementation of Observation services

Tibian Abramovitz MD, HCQM
Medical Director of Utilization Management
Maimonides Midwood Community Hospital 

11:00am – 11:45am
Observation Care that Works: Improving ED Metrics, Hospital Capacity and Patient Satisfaction
A dedicated observation care unit forms an essential component of the integrated network of inpatient and outpatient services that combine to achieve the triple-aim: improved patient experiences, better outcomes and lowered costs. It also helps hospitals position themselves for the future. As a result of improved ability to manage growing patient populations, hospitals now face less pressure to devote resources to facilities expansion and managing overcrowding. Instead, it can focus on delivering quality and efficient care to their communities. This session will explore how to cut length of stay, lower readmissions and raise patient satisfaction with a dedicated observation unit.

Sharon E. Mace, MD, FACEP, FAAP
Professor of Medicine
Cleveland Clinic Lerner College of Medicine of Case Western Reserve University
Director, Research, Emergency Services Institute (ESI)
Former, Director, Observation Unit, ESI
Cleveland Clinic 

11:45am – 12:30pm
A Director of Quality/Hospitalist’s Approach to Observation Medicine
Looking at all things observation through the eyes of a provider who has worked in high and low functioning observation units.  Here to share the good, bad, and ugly! 

Kasey Schnebly, DNP, CRNP, CPHQ
Director of Quality
Adfinitas Health 

12:30pm – 1:30pm
Luncheon 

1:30pm – 2:15pm
Speeding ED Triage and Overall Patient Care
Emergency department triage is a critical step for the care of ED patients.  Timely triage can easily result in better patients outcomes, experience, increased revenue, and avoidance of later expense (i.e. medical malpractice).  Though standard triage approaches can be wedded to decades old processes with several non-value added steps.  We will be reviewing the benefits of timely triage, with the overall goal to speed care to patients.

Keith Grams MD, FACEP
Chair, Emergency Medicine
Rochester Regional Hospital 

2:15pm – 3:15pm
Panel: Way to Improve Patient Flow that Impact Efficiency
Moving patients within a healthcare facility involves medical care, resources, decision-making, and internal systems in place. Optimizing patient flow is critical for healthcare facilities for two main reasons, patient safety and quality of care. And if the pandemic taught us anything, it is within our power to create a health system that invites everyone to be part of an affordable, sustainable, accessible, high-quality system that keeps people healthy and improves our communities and society at large. We collectively have the power to address patient health and safety and address patient flow in hospitals. Improving your patient flow is a way to increase revenue and patient satisfaction. This session will explore strategies to improve patient flow, and how efficient patient flow will increase your healthcare facilities’ revenue and, more importantly, keep your patients satisfied and safer.

Sharon E. Mace, MD, FACEP, FAAP
Professor of Medicine
Cleveland Clinic Lerner College of Medicine of Case Western Reserve University
Director, Research, Emergency Services Institute (ESI)
Former, Director, Observation Unit, ESI
Cleveland Clinic 

Tibian Abramovitz MD, HCQM
Medical Director of Utilization Management
Maimonides Midwood Community Hospital 

3:15pm – 3:45pm
Networking & Refreshments Break

3:45pm – 4:30pm
How Observation Units Improve ED Efficiency
Patients who seek emergency department (ED) treatment are often found not well enough for immediate discharge yet are also not sick enough to warrant full inpatient admission. These patients are increasingly treated as outpatients using observation services. Observation units provide a potential solution by allowing protocol-driven care for patients who require longer observation, but don’t require admission. This strategy can help patients go home safer and faster, while saving hospitals money. An observation unit is a designated section of the emergency department where patients are monitored by a staff team for 6-24 hours. Patients who require observation or testing are moved to a separate area where they are monitored and treated according to disease-specific protocols. This session will explore the successful operation of an observation unit, including  of a CDU can be found in each of the following sections of this article:

• Principles of care
• Physical design
• Admission criteria
• Benefits and drawbacks of observation units

Hao Nguyen, MD
Medical Director of Observation Services
UPMC Pinnacle Emergency Department Observation Units 

4:30pm – 5:15pm
Observation Medicine: Quality, Performance and Financial Improvement

• Learn how to achieve optimal quality and performance with your observation unit
• Understand why the ‘common metrics’ are so misunderstood
• Learn how to accelerate growth and how to avoid pitfalls in expansion
• Have fun, learn a lot, try to stump the speaker with your hardest question…

Christopher Caspers, MD, FACEP
Vice Chair
Department of Emergency Medicine
NYU Langone Hospital – Long Island
Associate Professor
NYU Long Island School of Medicine 

5:15pm
End of Day One

7:15am – 8:00am
Networking Breakfast 

8:00am – 8:15am
Chairperson’s Recap 

8:15am – 9:00am
Financial Impacts of ED Observation Units
The emergency department observation unit is a specialized unit designed for efficient, ongoing medical treatment, assessment, and reassessment of patients before the appropriate decision can be made to either discharge or admit. Observation units been increasingly utilized to avoid unnecessary admissions, optimize inpatient bed capacity, improve emergency department throughput, and overall deliver more efficient care; all resulting in significant national and hospital cost savings. However, since observation services are billed as outpatient services, observation unit expansion may increase out-of-pocket costs for patients, particularly Medicare beneficiaries. As there is significant speculation, controversy and media attention surrounding these issues, this session will explore financial impacts of observation units at the hospital and patient levels. 

9:00am – 9:45am
Post-Acute Transition Care for Observation Patients
Enhanced discharge planning and coordinating post-acute continuity of care can be very helpful in decreasing readmission rates, re-observations and revisits to your facility.  In the ongoing perpetuation of hospital department silos, implementing transitional care processes are critical in attempts to better bridge post-acute care coordination with the observation patient.

In this presentation, concepts to be shared:

• Align existing Quality resources to enhance front end care coordination and discharge planning
• Initiate and optimize Transitional Care Management and Chronic Care Management

Ron Martinson, MD, MSM-HCA, CPE, FAAFP
Community Medicine Officer
Knox Community Hospital 

9:45am – 10:15am
Networking & Refreshments Break 

10:15am – 11:00am
Implementing Observation Care Pathways for Behavioral Health Patients in Northwell Emergency Departments

Rachel Bruce, MD
Vice Chair 
Lenox Health Greenwich Village Emergency Department
Northwell Health

Jonathan Merson MD
Medical Director 
Behavioral Health Service Line
Northwell Health

Kayla Perro LMSW
Senior Manager
Behavioral Health Service Line
Northwell Health

11:00am – 11:45am
Reducing Unnecessary Hospital Admissions Through Observation and Evidence-Based Clinical Decision Making
Emergency Department (ED) Observation Units have been shown to provide high-quality care, reduce length of stay as compared to other observation areas in the hospital,  and overall reduce hospital costs.  Some of these efficiency gains have been linked to increased usage of well-established clinical pathways.  This talk will describe Stanford’s operational environment and processes to improve the quality and usage of an ED observation unit.  Specifically, an evidence-based approach for choosing appropriate short-stay patients, developing clinical care pathways, measuring factors associated with length of stay, and improving care transition strategies will be discussed.

Jennifer Hunter
Lead APP Clinical Decision Unit (CDU) Observation
Stanford Health Care

Michael Losak, MD
Medical Director Clinical Decision Unit (CDU) Observation
Stanford Health Care 

11:45am – 12:30pm
How to Approach and Implement Changes to Your Observation Program
This session will explore approaches to observation care, including pros and cons, including a case study. Potential approaches to dashboards will be presented with discussion of leading and lagging metrics and subsequent reporting. Payor considerations and the role of utilization management will be discussed. Success factors and performance tools will be presented to help participants facilitate changes in their hospitals and systems. 

Matthew A. Wheatley MD, FACEP
Associate Medical Director – Emergency Care Center
Medical Director – Clinical Decision Unit
Medical Director – Urgent Care
Grady Health Systems 

12:30pm
Main Conference Concludes 

Workshop: The Path to Better Observation Patient Management

Hospital care in the U.S. is a complex dance of coordination and communication. The hospital is altogether the most complex organization ever devised. With today’s payment and reimbursement policies, you could argue that hospital healthcare is even more complex today than it was years ago. Deciding on what to improve within this world can be daunting. There are so many options, and so many groups involved in each. The use of observation status when admitting patients today is extremely widespread. Originally intended as a short-term period of lightweight care before admission or discharge, Medicare has seen a huge increase in observation spending, and it continues to grow. Hospitals are reimbursed at lower rates for what’s essentially the same as inpatient care, to the point that most observation visits represent financial losses to the hospital. On the other side, patients (especially Medicare and Medicaid recipients) are also subject to a different payment structure and sometimes end up paying more for an observation stay. This session will explore how hospitals can improve how they work with observation patients.