17 (Thursday) - 18 (Friday) CST
Las Colinas Country Club
4400 N O Connor Rd, Irving, TX 75062
HFMA Lone Star
View Summer Institute Agenda Brochure Is your company interested in Event Sponsorship? Please view the Sponsorship Prospectus Here
Is your company interested in Event Sponsorship? Please view the Sponsorship Prospectus Here
Special Thanks to our Breakfast sponsor
Course: 170801 | CPE: 1.0 | Level: Intermediate | Prerequisites: None
The push to reduce Medicaid spending has never been so great. For Texas, there is good reason to believe that this could play out as CMS and HHSC continue to negotiate terms of the 1115 Waiver renewal. Regardless of this federal push, the continued maturation of the 1115 Waiver program requires all participating organizations with DSRIP projects to determine the disposition of their projects and rethink their approach and structure to the DSRIP program. Further, the UC funding quagmire will require organizations receiving such funds to determine how they will finance the future cost of the Medicaid shortfall and the cost of caring for those who have no insurance coverage. Many uncertainties exist regarding UC funding levels and the impact of the UC disallowance appeal. This course will provide a current update to the dynamic realities of today’s Medicaid program and, in addition, review the new opportunities and complexities found in the Medicaid Uniform Hospital Rate Improvement Program (UHRIP). This will include discussion of the impact of the 8 newly approved Local Provider Participation Funds (LPPF) in Texas. This program will be of benefit to anyone who has to make decisions regarding the impact of Medicaid funding on operations and for those finance leaders who project, budget, and account for Medicaid uncompensated care funding.
This course is designed to provide a current update on the 1115 Waiver renewal, with emphasis on future UC funding levels and critical new DSRIP requirements, and to educate attendee’s on the new UHRIP Medicaid funding program in development in Texas.
Accountant, Reimbursement Director, Budget Director, Controller, and C-Level/CFO’s
David C. Salsberry is an advisor to several healthcare organizations seeking assistance with performance improvement, business process/system optimization, population health financial strategy, 1115 Waiver/Medicaid supplemental payments, and revenue cycle optimization. He has over 25 years of experience as a healthcare leader and CFO in several complex organizations including community not-for-profit, academic, and public hospital organizations. His consulting clients have included Texas Health Resources, Mount Sinai Health System, Dallas Children’s Health System, West Virginia United Health System, Baylor College of Medicine, MHMR of Tarrant County, and University of North Texas Health Science Center. He has provided strategic, financial and tactical assistance to organizations implementing the Texas, NY and Arizona 1115 Waivers and the UHRIP program
Course: 170802 | CPE: 1.0 | Level: Entry | Prerequisites: None
This course will provide a high-level summary of what the fair market value standards and commerical reasonableness concepts are, why they are imporant and then provide real world experiences and practical takeaways for hospital and health system management.
Help hospital and health system management better understand the compliance risks surrounding physician contracting and associated payments as well as provide practical takeaways through real world examples.
C-Level Finance, Compliance and Operations individuals involved in decision making process around physician contracting and compensation issues.
Neil is a member of BKD’s National Health Care Group and the firm’s Physician Services Center of Excellence. In his role as a Managing Consultant, he provides a variety of transaction and compliance consulting services to health care organizations including fair market value analyses, compensation consulting and hospital-physician alignment consulting.
Prior to joining BKD, Neil provided similar health care and physician related consulting services at a large regional CPA firm. His background and technical experience with health care arrangements include physician employment, professional services, medical directorship, physician management and on-call services agreements.
Neil is a member of the American Institute of CPAs (AICPA), Indiana CPA Society and Healthcare Financial Management Association. He holds the Accredited in Business Valuation (ABV) credential through the AICPA.
He serves as board president for the Domestic Violence Network of Greater Indianapolis. Neil is a graduate of the Krannert School of Management at Purdue University, West Lafayette, Indiana, with a B.S. degree in accounting.
Tammy is a member of BKD’s National Health Care Group and the Physician Services Center of Excellence. She provides consulting services to provider groups and health care organizations related to physician compensation, hospital-physician alignment, revenue cycle, process improvement, budgeting and compliance.
Prior to joining BKD, Tammy provided financial leadership for a 900+ physician multi-specialty non-profit group as well as a small specialty for profit physician owned organization. Tammy has also provided CFO services in the managed care space for the top two payer entities in Texas.
Tammy has owned her own health care financial consulting services business and has provided financial consulting for an international accounting firm. Tammy is an adjunct professor teaching Masters of Healthcare Administration candidates courses in Healthcare Finance and Leadership. Tammy is a member of the Healthcare Financial Management Association and serves on the board of directors for the Lone Star Chapter.
Break Sponsorship Opportunity – $200 See Sponsorship Prospectus Here
Course 170803 | CPE: 1.5 | Level: Entry/Intermediate |Prerequisites: None
Industry analysts IDC predicts that 30 percent of providers will use cognitive analytics against patient data and real world evidence for personalized medicine by 2018. A leading think tank warns that 1 in 3 jobs in UK will be replaced by robots over the next 20 years. The Artificial Intelligence (AI) revolution is here and everywhere. Its impacts and implications are shaping up the future of healthcare. This interactive session will introduce the foundation of AI, Machine Learning, and Deep learning using easy-to-understand terms and relatable examples, with emphasis on their practical uses in healthcare and how they transform personalized medicine and population health. Legal, ethical, and moral concerns for AI will be addressed.
• Explain the concepts, trends and development in AI, Machine Learning and Deep Learning in an easy and relatable way
• Discuss the practical uses of many AI applications in healthcare and
• Describe how AI transforms the future of medicine and personalized patient care
Anyone interested in the future of healthcare.
Sam is a seasoned healthcare executive and faculty with 25+ years of experience in health IT, healthcare finance, big data analytics, and continuous quality improvement, including in the role of COO, CIO, VP of Analytics, Senior Director, Director of Medical/Healthcare Informatics. He is a faculty at UC Irvine and USC Price School of Public Policy.
Sam currently is the Chief Information and Innovation Officer for a healthcare startup. He is a long time HFMA volunteer serving in many national, region and chapter roles (including HFMA National Advisory Council, SoCal Chapter President-elect, National Board of Examiners, CHFP Exam Standard Setting Committee, Yerger judge, Region 11 Education Committee Co-Chair and Chair). Additionally, He served as President of HIMSS SoCal Chapter with over 2,400 members, Chair of the HIMSS National Chapters Task Force, and on HIMSS National Davies Committee on the use of HIT and EHRs. He received HFMA Bronze, Silver, Gold, and Medal of Honor, and several Yerger Special Recognition awards. He received the 2012 HIMSS National Chapter Leader of the Year Award. Under his presidency HIMSS SoCal chapter received HIMSS National Chapter of the Year award in 2011. He is a frequent speaker/moderator at national and professional conferences addressing health IT and healthcare finance challenge facing our society. He trains healthcare leaders in the US and internationally.
Course: 170804 | CPE: 1.0 | Level: Entry | Prerequisites: None
This course will teach how the metabolism reacts to its surroundings, how we change and manipulate the metabolism, and what exercise and nutrition helps benefit it.
Mickey is a Metabolic Specialist, Personal Trainer, and TEAM Instructor at LifeTime Fitness. He has worked as a personal trainer at the University of Arkansas and has interned with professional teams. Mickey has a Bachelors in Kinesiology from Southern Arkansas University and his Masters in Exercise Science, University of Arkansas. He is a NSCA Certified Strength and Conditioning Specialist, a Functional Movement Specialist, and USA Track and Field Level 1 certified.
Course: 170805 | CPE: 1.0 | Level: Intermediate | Prerequisites: None
This course will provide a high-level overview of Blue Cross and Blue Shield of Texas’ insights as a payor participating in the Affordable Care Act. This course will also discuss the necessary steps this customer-owned insurer is taking toward leading the industry in the fee-for-value evolution.
Shara McClure is divisional senior vice president (DSVP) of Texas Health Care Delivery at Blue Cross and Blue Shield of Texas (BCBSTX). She is responsible for Provider Network Management and Operations for BCBSTX’s group, government, and retail products. Based in Richardson, Shara leads the efforts across all product segments to develop and implement provider contracting and service strategies to ensure competitiveness, contain unit cost, improve member access, and add value through alternative payment systems.
Shara has been with BCBSTX since 2005. Prior to being named DSVP in 2017, Shara served as vice president of Network Management, overseeing provider relations, contracting, and value-based care programs statewide. Shara also serves as the enterprise chairperson of Women Improving the Strength of the Enterprise (WISE) business resource group throughout all five state plans.
Course: 170806 | CPE: 1.0 | Level: Entry | Prerequisites: None
This course is designed to guide service contract stakeholders (Executives, Business operations management, Subject Matter Experts, etc.) through the phases of the contracting process: award, negotiations, formation and oversight. It will present best practices and troubleshooting for common obstacles in the contracting process.
Provide stakeholders in a healthcare services contract with the tools to navigate
the contracting process, and to foresee (or troubleshoot) any obstacles.
C-Level, Business Off, Operations
Presented by Rachael Smiley, Attorney, Law Offices of Judith W. Ross
Rachael Smiley has advised businesses and public institutions in variety of transactions and disputes since 2008. Rachael currently practices commercial bankruptcy and business reorganization law at The Law Offices of Judith W. Ross in Dallas, Texas. From 2014-2017, she served as Manager of the Office of Contracts Management at UT Southwestern Medical Center, negotiating agreements on behalf of the University and its Hospitals. She received her J.D., cum laude, from Southern Methodist University in 2008, and her B.A., magna cum laude, from Texas Christian University in 1999.
Break Sponsorship Opportunity – $200 See Sponsorship Prospectus Here
Course: 170807 | CPE: 1.0 | Level: Entry | Prerequisites: None
In September 2013, Arkansas became the first state in the nation to receive approval from the federal government for a Section 1115 demonstration waiver to require most adults who are newly eligible for coverage through the Affordable Care Act’s (ACA) Medicaid expansion to enroll in Marketplace plans. As a result of this coverage, Arkansas has been able to drive down its uninsured rate and reduce uncompensated care costs.
Presented by Representative Charlie Collins, State Representative, Arkansas House of Representatives
Rep. Charlie Collins of Fayetteville is serving his fourth term in the Arkansas House of Representatives. He represents District 84, which includes part of Washington County.
For the 91st General Assembly, he serves as chair of the House Insurance and Commerce Committee. He also serves on the House Revenue and Taxation Committee and the Joint Budget Committee.
For the 90th General Assembly, he served as chair of the House Insurance and Commerce Committee, and was named Co-Chairman of the Health Reform Legislative Task Force. During the 89th General Assembly, he served as chair of the House Revenue and Taxation Committee.
Rep. Collins is a small business owner. He is a graduate of Franklin High School in Michigan. He is a veteran and received a bachelor’s degree from the U.S. Naval Academy. He earned a master’s degree in quantitative economics from George Washington University. He and his wife, Leeann, have four children: two sons, and two daughters.
Presented by Senator Jonathan Dismang, Senate President Pro Tempore, Arkansas Senate
Senator Jonathan Dismang represents Senate District 28, which is comprised of Prairie County and parts of Arkansas, Lonoke, Monroe, White and Woodruff Counties. Serving his third term in the Senate, he has been elected twice as President Pro Tempore for the General Assembly. At 36, he was the youngest Senate President in the state’s history. He is also the youngest in the United States to currently hold that post. He is a member or vice chairman of 19 legislative committees and subcommittees.
Senator Dismang was elected to the Arkansas House of Representatives in 2008 to serve House District 49. He was elected vice chairman of the Freshman Caucus and recognized by his peers for his outstanding leadership ability. He was elected to the senate in 2010. In January 2014, Governing Magazine recognized him as one of 12 “Heavy Hitters” in legislatures across the nation. His legislative work has focused on Arkansas’s business climate and economic development, health care reform, and child advocacy.
Regionally and nationally, Senator Dismang is active with several key organizations including the Southern Legislative Conference, the National Conference of State Legislatures, the American Legislative Exchange Council, and the Council of State Governments. He serves as vice chairman of the Fiscal Affairs & Government Operations Committee and on the Executive Committee for SLC.
A native of Maynard, Arkansas, Senator Dismang graduated from Beebe High School, and is an honor graduate of Harding University with degrees in accounting and economics. Professionally, Senator Dismang provides financial oversight services with an emphasis in real estate. He is married to the former Mandy Staggs and together they have two children, Cade and Sawyer. They are members of the Church of Christ.
Course: 170808 | CPE: 1.0 | Level: Intermediate | Prerequisites: None
The passage of SB 1107 may open the floodgates for virtual healthcare in Texas. Physicians and health systems now have the freedom to explore exciting new ways of delivering better quality outcomes for their patients. This course will describe the new
legislation in Texas and discuss the potential it has unlocked for providers.
Mike is Management Consultant with Texas Care Alliance (TCA). He serves the organization’s 12 member healthcare systems and aligned physicians in their collective pursuit of The Triple Aim. In his role, Mike spearheads several initiatives aimed at expanding access to care, improving patient outcomes and decreasing the per capita costs of delivering care. Before joining TCA, Mike completed an administrative residency with Tenet Health in Dallas. Mike earned an M.B.A. in Healthcare Administration from Baylor University in Waco, TX. He also holds an M.A. from The Ohio State University and a B.B.A. from Emory University.
Great Opportunity for Fun Networking
Sponsorship Opportunity available – $500 See Sponsorship Prospectus Here
If interested in Speed Mentoring visit the event page: HERE
Course: 170809 | CPE: 1.0 | Level: Intermediate | Prerequisites: None
This presentation will focus on our new Charge Capture program and how we have re-structured our process to reduce the quantity, gross dollars and post-discharge days with Late Charges. A large focus on reporting and building outside vendor relationships will also be discussed.
Course Objectives: Reducing Late Charges, Charge Reconciliation, and Executive Reporting
Presented by Lena Tisten, Director-Revenue Integrity & Compliance, CHRISTUS Health
Lena Tisten is the Director of Revenue Integrity and Compliance at CHRISTUS Health, providing support with ChargeMaster and Charge Capture programs. Her passion for improving charge capture has resulted in a range of success through financial reporting, leadership support and enhanced vendor relationships.
Lena received a Bachelor’s of Science degree from Indiana University with a focus in Healthcare Administration and Economics. Throughout her 15 year career in the Healthcare industry, Lena has worked in various aspects of the Revenue Cycle including Patient Access, Patient Financial Services and HIM. She also serves on the Leadership Development Team to help develop other healthcare leaders.
Course: 170810 | CPE: 1.0 | Level: Intermediate | Prerequisites: None
The Charge Description Master (CDM) is a critical component of the Hospital Revenue Cycle. Not only does the CDM link directly to all patient revenue, it provides key information for utilization, management reporting, cost accounting and compliant billing. This webinar is designed for individuals wishing to gain an understanding of CDM basics or for individuals new to the CDM.
Bonnie Morris’s career in the healthcare industry spans more than 20 years and includes clinical pediatric services, medical auditing and revenue cycle consulting. Bonnie has earned recognition as a subject-matter expert for Charge Description Master Management and Charge Capture. Throughout her career, she has guided many projects to facilitate compliance, revenue cycle management and accurate claims submissions. Ms. Morris is a Registered Nurse with a Bachelor’s degree in Nursing from Baylor University. She also received a Master of Business Administration degree in Health Care Management from the University of Dallas.
Break Sponsorship Available – $200. See Sponsorship Prospectus Here
Course: 170811 | CPE: 1.0 | Level: Advanced | Prerequisites: None
A look at current cybersecurity and their risk to healthcare operations. Discussions around what you can do both individually and to support your company.
Clayton Darnell is the Security Operations Manager for Baylor Scott & White Health. He holds a Bachelor of Science in Information Security and Assurance, is a CISSP and Certified Ethical Hacker. Clayton holds over 10 years of experience and a lifetime of passion for security and technology. He transitioned into the healthcare 2 years ago, bringing with him experience from the defense, restaurant, and private consulting industries.
Course: 170812 | CPE: 1.0 | Level: Intermediate | Prerequisites: None
The session will present Mercy Healthcare’s story of the evolution of their traditional reimbursement service model. As the industry continues to change, it was necessary for Mercy to adjust and change many of their business practices, including their reimbursement process.
Trent leads DHG Healthcare’s Reimbursement Practice which is comprised of over 50 professionals working with clients across the country. Trent has over 25 years of experience and is a nationally recognized expert on third party reimbursement matters. Trent works with clients to interpret the ever changing regulatory environment.
Ms. Mounts serves as the Chief Reimbursement Officer for Mercy Health in Cincinnati, Ohio. In this role Ms. Mounts is responsible the oversight of all of the regulatory reporting functions for both federal as well as state specific requirements in the states where Mercy Operates. Mercy Health is a Catholic healthcare ministry serving Ohio and Kentucky. With more than 34,000 employees in eight regions, it is one of the largest healthcare systems in the country. At each one of the more than 450 points of care, Mercy deliver high-quality, compassionate care with one united purpose: to help our patients be well in mind, body and spirit.
Course: 170813 | CPE: 1.0 | Level: Entry/Intermediate | Prerequisites: None
The Course will look at two ethical issues: mergers, acquisitions and affiliations, and Chargemasters. Financial managers will see how MHA Programs prepare their students to consider these issues and may therefore anticipate how new hires and recent graduates might influence organizations in the future.
Martin Ostensen is an accomplished business leader with multi-faceted expertise in strategic, legal, fiscal, service and administrative leadership. His core competencies include adult education, business acumen, strategic planning, strategic leadership, leadership, and stakeholder relations.
Martin was the inaugural leader of Legal Aid Alberta’s (LAA) Legal Services Centres, and successfully directed the change in LAA’S business model. He led a 128-member business unit to provide high quality first point of contact service.
Presently, Martin holds faculty appointments with the School of Public Health (SPH) and Texas College of Osteopathic Medicine at the University of North Texas Health Science Center (UNTHSC), Fort Worth, and in the Neeley School of Business at Texas Christian University. Currently, he is the Director of the Master of Health Administration Program, and an Assistant Professor in the Department of Health Behavior and Health Systems.
14 (Thursday) - 15 (Friday) CST
Dallas Marriott Las Colinas
223 West Las Colinas Boulevard, Irving, TX 75039
HFMA Lone Star & DHG Healthcare
DHG Healthcare and HFMA’s Lone Star Chapter come together to lead an interactive workshop on revenue transformation, the expansion of healthcare payment [...]
DHG Healthcare and HFMA’s Lone Star Chapter come together to lead an interactive workshop on revenue transformation, the expansion of healthcare payment approaches, and Risk Capable models that help organizations effectively navigate the transition from Fee-For-Service (FFS) to risk-based payments. During this working session, a team of national thought leaders will lead participants through a series of presentations designed to assess organizational capabilities related to the design and implementation of alternative payment models. Participants will leave with a personalized workbook of action steps to support their organization in the next phase of their transition toward becoming Risk Capable. Each presentation will be led by DHG Healthcare’s national thought leaders who will share a state and local perspective on healthcare reform and dynamic responses to revenue transformation.
This session introduces the concept of Risk Capability and describes the foundational elements necessary for an organization to prepare, accept and manage risk-based payment models. We will present an overview of an effective governance structure for managing risk-based models, focusing specifically on bundled payment and episode-based models. Participants will be led through an exercise to begin evaluating their current governance structure.
As a Principal with DHG Healthcare, Bill currently serves as the Partner in Charge forthe Healthcare practice in the Southwest. His professional career spans over 30 years in the healthcare industry and he has held leadership roles with various firms and clients. Prior to joining DHG Healthcare, Bill served as a partner in the healthcare practice of an international professional services firm and served as the CFO for a fully integrated cardiovascular physician practice employing over 135 cardiologists.
At DHG Healthcare, he led the development of the Revenue Cycle and Compliance practice and was instrumental in developing the firm’s thought leadership and approach related to revenue transformation. Bill regularly assists his clients in navigating the challenging and difficult transition to alternative payment models and is a highly regarded and sought-after speaker on topics such as: “Revenue Portfolio Design for Healthcare Providers”; “Transparency in Healthcare Pricing”; “Operationalizing the Proposed MACRA Regulations”; as well as other topics related to the ongoing transformation in the industry. Through his expertise and industry experience, Bill continues to be actively engaged in leadership initiatives at DHG Healthcare.
During this session participants will hear a brief history of the evolution of bundled payments and gain an understanding of how CMS establishes bundled target pricing. We will share a case study example of how one health system is actively developing bundled products for the commercial market. We will also present and identify various clinical process levers to be considered as an organization considers whether to participate in a voluntary bundle. Additionally, participants will conduct a self-evaluation of their organization’s readiness to implement bundles.
Since joining the firm in 2010, Michael has become one of the firm’s go-to authorities on bundled/episodic payments, hospital merger transactions, physician-hospital alignment agreements, and health system strategic planning. These efforts have all been focused on helping physicians and hospitals develop win-win strategies and successful business models. During Michael’s tenure with DHG Healthcare, he has served as the Director of Bundled Payments (2012-2014) for a Bundled Payments for Care Improvement (BPCI) awardee. This position included leading care redesign efforts, aligning physician and hospital initiatives, creating economic win-win opportunities, and validating data to build the BPCI value proposition.
Michael’s other project work includes facilitating hospital-physician alignment relationships in orthopedics, radiology, spine services, sports medicine, oncology, cardiothoracic surgery, and general surgery. His experience in these hospital services includes co-management agreements, professional services arrangements, recruitment assistance contracts, bundled payments, and comprehensive clinical institutes. Client results from Michael’s work include increased physician engagement, decreased hospital costs for surgical implants, streamlined operating room efficiency, increased patient satisfaction, and stronger hospital-physician relationships. He has experience with acute-care hospital mergers, health insurance exchanges, and issues relating to academic medical centers. Michael has been sought for podium opportunities relating to bundled payments, hospital M&A, and healthcare strategic planning.
Dr. Kiskaddon, CMO of DHG Healthcare, will present new models for clinical collaboration between physicians and hospitals. The presentation will dive into important considerations for new collaboration models that are essential for the success of episode-based payments. Participants will be led through an exercise to evaluate their current physician and hospital partnership structure and identify opportunities for enhanced alignment.
Presented by Dr. Robert Kiskaddon, Chief Medical Officer, DHG Healthcare
As the Chief Medical Officer for DHG Healthcare, Dr. Kiskaddon brings over 20 years of clinical medical practice experience and over 30 years of combined healthcare administrative and medical staff leadership to Dixon Hughes Goodman’s national healthcare practice. He has worked with academic medical centers, integrated health systems, employed and private physician practices and has had key positions in strategic planning, quality/compliance, financial management, utilization review, recovery audit, information technology/clinical informatics, healthcare reform and clinical integration. He has guided clients through successful engagements to improve operational design, practice management, compensation models, clinical documentation, and economic alignment. In addition, he has served as medical school faculty focusing on residency development and clinical education at Stanford University Medical Center, Yale University School of Medicine and University of Illinois College of Medicine. Dr. Kiskaddon is a recognized expert in multidisciplinary collaboration, team building and communication.
A seasoned clinician, administrator, consultant and educator, his role as DHG Healthcare’s Chief Medical Officer involves helping to bridge the various gaps between clinical and non-clinical stakeholders, bringing common focus to the significant issues challenging medical practitioners and healthcare organizations, and further enhancing technical perspectives and solution sets related to the industry’s journey to risk capability
This sessions describes the importance of meaningful connections between physicians, hospitals, and other non-acute providers in a value based model of payment. We will present actionable strategies for designing clinical care processes to manage care under a bundled payment structure. Participants will learn the importance of linking risk stratification and care management design and will complete an evaluation of their organization’s clinical care management readiness.
Lisa is a Principal with DHG Healthcare and works with hospitals, health systems and post-acute care providers to develop and implement strategies to succeed as healthcare delivery evolves from fee-for-service (volume) to risk- and performance-based payment models (value). Lisa has more than 17 years of experience in the healthcare and senior living industry, providing strategic planning, operations assessment and performance improvement, market research, marketing, and other advisory services. Lisa has been involved in the development of numerous start-up communities, as well as expansion and repositioning projects. She is experienced in the preparation of market demand analyses for proposed and existing senior living and long-term care providers, including CCRCs, assisted living facilities, skilled nursing facilities and other retirement housing projects.
Session participants will gain an understanding that “correct” MS-DRG reimbursement does not have an impact on VBP/APM performance but that optimal performance depends on overall patient acuity mechanisms (Risk Adjustment, Hierarchical Condition Categories). We will present concepts that will allow participants to better understand that the appropriate portrayal of patient acuity requires a “purposeful” focus beyond CC/MCC capture and traditional financial performance metrics. Each participant will be led through an exercise to evaluate their organization’s CDI structure and the role it plays in value-based care models.
Wayne is a part of the DHG Healthcare CFO Advisory team with over 23 years of experience in healthcare finance assisting clients in such areas as revenue cycle financial and operational performance improvement, and reimbursement and compliance services. He has worked with large health systems, academic medical centers, regional hospitals, physician practices, post-acute care settings, home infusion and DME providers through the course of his career. He has focused on both financial improvement and clinical documentation improvement initiatives, fraudulent claims defenses and self-disclosures, representing clients in the capacity of the Independent Review Organization (IRO), identifying and quantifying impacts of billing edits and denials and assisting with managing broader operational improvement projects.
Prior to joining DHG in 2014, Wayne has served in leadership roles devoted to the healthcare industry with a Big Four professional services firm and another nationally recognized healthcare consulting firm. He began his career in public accounting performing financial statement audits and preparing Medicare and Medicaid cost reports for hospital and healthcare system clients.
Wayne is a CPA licensed in the State of Georgia and is currently engaged in various financial, reimbursement, and revenue cycle performance improvement initiatives leads the firm’s ICD-10 readiness assistance activities. Wayne is also a guest speaker/presenter for numerous healthcare industry forums and webcasts covering topics including ICD-10 preparedness, Revenue Cycle performance improvement, Bundled Payment initiatives, fraud and abuse and other compliance topics.
Value Based Payments and Commercial Contracting – This session allows participants to learn about concepts and see examples of value-based models for inclusion in commercial contracts. We will also present successful strategies for designing a future state revenue portfolio that includes more value-based and episode-based payment models.. We will also discuss suggestions for realizing the value-based bonuses available in your current commercial contracts. Participants will have the opportunity to develop a plan evaluating their readiness to transition to value-based contracts.
Beth Mullins is a Principal with DHG Healthcare, the national healthcare practice of Dixon Hughes Goodman, LLP. Beth has over 20 years of healthcare experience in various roles, including managed care contracting, pricing transparency, clinically integrated networks, and business development. Beth joined DHG Healthcare in January of 2017 to lead the managed care business consulting segment of DHG Healthcare’s National Strategy Practice. Beth’s experience includes international and domestic consulting experience with health systems, an in-depth knowledge of health plan and other payer systems, results-oriented managed care/provider pricing negotiations, strategic planning and product line analyses as well as building and broadening physician relationships.
Additionally, Beth works with hospitals and physician group clients in the development of networks (PHOs and IPAs) as a first step in the process of moving toward a clinically integrated network (CIN). This helps clients prepare for clinical integration, develop shared savings reimbursement models of payment, and identify quality metrics to drive changes in the delivery of healthcare. This continued focus on the strategic plan and its implementation has earned her recognition in the industry as a top performer.
This session will evaluate the various types of information and analytic capability required to manage bundled payment contracts. We will share case study examples of data informed program management and results. We will also discuss the expected CMS BPCI Open Enrollment and the typical data intelligence needed to make decisions on bundling, episodes and risk tracks. We will also share an example of ACO analytics – the “bundler on steroids.”
Chris serves as a Principal in our Enterprise Intelligence practice based out of Greenville, SC. He currently leads our Accountable Care Organization (ACO) analytics team, system and market access studies, product development and various dash-boarding initiatives. Chris previously spent 5 years as part of DHG Healthcare’s National Strategy Practice where he provided strategic planning and service line optimization in addition to leading extensive physician alignment initiatives such as clinical integration, co-management agreements, real estate joint ventures, employment strategies and directorships. Prior to joining Dixon Hughes Goodman, Chris served in various roles including Investments and Partnerships Specialist, Director of Physician Alignment and National Business Development Sales Manager. Chris has also served as past President for American College of Healthcare Executives (ACHE) of Northern Ohio.
Edward combines 25 years of healthcare consulting experience with seven years of corporate experience to provide realistic business thinking for our healthcare clients. Edward has acquired significant experience in the areas of enterprise analytics and business intelligence, strategic business planning, health system planning, growth strategies, service line feasibility, and market strategies. He has particular experience serving national accounts with custom strategic solutions. His business experience, coupled with his healthcare focus and years of hands on planning experience, ensures practical and manageable strategic solutions for our healthcare clients.
Edward currently serves as leader of the DHG Healthcare Analytic Solutions group, the enterprise intelligence practice area of the DHG Healthcare practice, with a specific emphasis in developing analytic solutions for risk capable organizations. In the past five years, Edward and his teams have conducted more than 500 planning engagements across a wide range of clients including for profit multi-location systems, not-for-profit systems, community hospitals, rural hospitals, specialty hospitals and health related companies. Edward is a frequent speaker on analytics and strategic planning.
Entering into value based payment arrangements, including payment bundles, creates significant risk for organizations. This risk often manifests itself in significant financial statement risk. This session will present the latest accounting guidance related to value-based payment models and will examine financial reporting implications.
Marie Castro, CPA, CHFP, is a partner with DHG Healthcare. With over 18 years of experience in public accounting, her background includes providing assurance and advisory services to clients within the healthcare industry and adding value throughout the audit process, specifically relating to complex accounting transactions, financial reporting, and internal controls.
Marie has spent her entire career working exclusively in health care. Her extensive healthcare experience includes auditing a wide range of not-for-profit and for-profit entities including health systems, hospitals, nursing homes, CCRC’s, academic practice plans, and physician practices. Marie is an active member of the Texas Society of Certified Public Accountants, Healthcare Financial Management Association, and the Texas Association of Healthcare Financial Administrators. Marie regularly makes presentations to board of directors and professional groups.