Board Meeting Items for Discussion

Mary McLaughlin-Davis
Advisory Board Chair

Membership: Mary McLaughlin Davis, Ron Hirsch, Jessica Gustafson, Cynthia Fleece, Sharon Easterling

Leadership succession issues: our next meeting is May 20, there may be new information regarding publications or Townhalls I can communicate on May 21.

What direction can I give this team about their role, if there is one within ACPA? They are committed members of ACPA, but as a small group are struggling to remain relevant.

Townhalls: We planned to present this past January, but the group decided to wait until after NPAC, due to their schedules and to discern what topics are most relevant to membership (hot topics).

Newsletters Publications: Ron is the only contributor at this time.

Special Projects: None on the horizon. Is there a project the Advisory Board can organize to assist ACPA?

Three of the five members of the Advisory Board met on May 20th. Their consensus is this board has outlived its purpose for ACPA. They are thrilled at the membership growth and the size and significance of the committees. They respectfully request to be dissolved as a committee and the existing members are willing to join other committees if there is a need and if it falls within their area of expertise. 

Adriane Martin
CDI Chair

Membership: Members added--Yes, Dr. Kucejko and Dr. Upchurch. 2 applicants under review.

Need to recruit? No

Leadership succession issues? No

Townhalls: Last one—May 15th . Topic/attendance—Pressure Ulcers. Next one, progress—Sept.25th, topic TBD. Needs—none at this time

Newsletter/Publications: Number, topics—3 to date: Expanding CDI Beyond Inpatient, Admit Type Demystified and Clarifying Confusion Around NSTEMI. Medical Necessity tips added to the CDI Resource page. Pneumonia tips coming soon to CDI Resource page.

Special Projects:

· Revamp of CDI Committee agenda to include time to allow for member discussions of wins/challenges at their intuitions

· Ongoing investigation into streamlining review/editing of CDI resource documents process. Testing Google docs as on-line platform.

· Need to connect with Clarissa on Advanced CDI Course for NPAC and potential creation of Quality subcommittee.

Ritu Prasad
GAC Chair

Membership: Members added?  Need to recruit? Leadership succession issues?  

1. N/A, accepting waitlist

Townhalls: Last one, topic/attendance.  Next one, progress.  Needs?

1. Summer 2025: 7/23, 12-1pm

2. “Dissecting 4208-F: Medicare Advantage Reform & Your Advisory Game Plan”

 Panel Agenda:

 Moderator: Stephanie Van Zandt

Chat Support: Anita Patel

 Panelists:

• Kendall Smith, MD
  “4208-F at a Glance with Key Highlights and What’s Changing”
  – Overview of the final rule, implementation timeline, and broad implications for Medicare Advantage Organizations & Key INPT areas to focus on.
• Carolyn Dutton, MD
  “Navigating the Expedited Appeals Process Under 4208-F”
  – Deep dive into the criteria for expedited appeal, timelines, and physician advisor role in expedited appeals for MA beneficiaries.
• Erin Boyd, MD vs. Bernie (still confirming with Bernie if he wants to do this)
  “ 4208-F and AORs & Member Appeals even Post-Discharge”
  –Appointment of Representative (AOR) process, member appeal rights, and how advisors can support MA appeals even after pt has been discharged.
• Maria Johar, MD
  “CMS complaints & positive results”
  – Presentation of data with regards to CMS complaint trends related to Medicare Advantage denials and delays, with insights for proactive advisor response.

 Newsletter/Publications: Number, topics?

--Introduced Marina to the team, will defer to Marina to share newsletter submissions

 Special Projects: Progress? Needs?

--Updated CMS complaint form added to ACPA website:  “CMS Medicare Advantage Complaint Form, Version 8.”

Anuja Mohla
OBS. Chair

Membership: Members added – 2. 1 more pending review. Leadership succession – In conversation with current vice chairs. 

Townhalls: 2/2025 Outpatient socials/surgicals.  Next one- Nov combined with GAC.

Newsletter/Publications: 1 Dr Ravitz

Special Projects: OBS rate, sent email to Clarissa/Ahmed for input.

Denise Goodman
PEDS Chair

 Membership: Members added?  Need to recruit? Leadership succession issues? Excellent meeting at NPAC. I believe we had about 30 people with good ideas for new projects. Alyssa became chair and Samantha Dallefeld and Sumana Narasimhan are vice chairs. Denise is immediate past chair.

Townhalls: Last one, topic/attendance.  Next one, progress.  Needs? Last one June 2024 with Observation Committee. Next one October 2025, provisional topic is NICU issues for the general Physician Advisor. Topics we’ve considered – level of care vs facility level designation; adding baby to the policy; changes in coverage over long stays (like months). Would welcome other topic ideas from Board members.

Newsletter/Publications: Number, topics? Addressed this to our group at NPAC.  Sumana is the point person and was following up with volunteers.

Special Projects: Progress? Needs? We are still interested in somehow consolidating definitions of observation and inpatient on a state-by-state level for Medicaid. It’s kind of a ginormous project. Erik Madsen has agreed to take the lead but we haven’t added to our data since our NPAC presentation.

Scott Ceule, MD, FACP, FAAP
National Physician Advisor Conference Chair

Registration –  

Ben Kartchner
Certification Committee Chair

Mary McLaughlin-Davis
Advisory Board Chair

Membership: Members added? Need to recruit? Leadership succession issues?
The bi-laws state the Advisory Committee Chair serves two years and secedes to the vice chair. I need to let the Advisory Committee know what the plan is for 2025. Jessica Gustafson would like to chair the committee again, however, it doesn’t appear there will be a committee by the end of 2025.
Townhalls: Last one, topic/attendance. October 2024 on collaboration of CM and Physician Advisor. Next one, January 16 with a legal panel.
Progress. Needs? Jessica is recruiting legal colleagues, however, we have not completed the panel yet.
Newsletter/Publications: Number, topics? Ron requested and received answers from the expert October panel of questions submitted at the Town Hall. He compiled the Q&A and submitted it for the newsletter.
Special Projects: Progress? Needs? Answer for the Advisory Board on future leadership.

Erica Remer
CDI Committee Chair

Membership: Members added? No new members – we add on a quarterly basis. Need to recruit? We do not have recruitment needs. Leadership succession issues? Adriane is taking over in January. We will be having a planning meeting January 6. Waldo just had surgery but plans to come back as Vice-Chair. Penny Jefferson is going to be the other Vice-Chair (understanding at this point that she is not eligible to become Chair since she is not a physician).
Townhalls: Last one, topic/attendance. Our town hall was December 12 titled “CDI Physician Advisors in Critical Leadership Capacities: Lessons Learned” Next one, progress. Next topic likely to be CDI Validation Needs? None identified.
 Newsletter/Publications: Number, topics? We are planning on ending our collaboration with ACDIS as they seem to be overly aggressively trying to monopolize the CDI PA space. Adriane and team are discussing new focus beginning of January when she takes over as Chair.
 Special Projects: Progress? Needs? Working on medical necessity documentation materials. Revision/update of pneumonia finalized (anticipated – our meeting is 12/17/24). Other materials in the works.

Ritu Prasad
GAC Committee Chair

Membership: None, membership capped
 OBS-GAC town hall: 11/14/24  -- 2 MN Rule from local to national
105 attendees,  90 stayed till the end, Lots of questions in advance of town hall and q&a
 Newsletter/Publications: Number, topics?
3 newsletter articles Nov, Prior Auth and Infusion (Carolyn Dutton), MD to Payor Med Dir to phys Ad (Anita Patel), MA and P2P (Bernie Emkes)
 Special Projects: Progress? Needs?

1. Cleveland Clinic –ACPA Phys Adv Symposium feedback, successful event 200+
2. Adding CMS complaint form to GAC website and maybe resources
3. Clarissa to attend Jan GAC regarding policy paper
4. CMS 2026 Medicare Adv Proposed Rule comment: Richelle
5. CMS 4208-P: comments due 1.27.25—GAC working on a member template for comment

Anuja Mohla
OBS Chair

Membership: Members added- 3 
 Townhalls: Last one 11/2024 combined with GAC on 2 MN rule strategies for MA plan. Good attendance. Next one – Feb 2025 Outpatients in a bed : surgical vs socials. Working on outlining agenda and panelists.
 Newsletter/Publications: OBS newsletter questions each month. 
Special Projects: White Paper on OBS metrics. Looking for reviewers for most recent draft. 

Denise Goodman
PEDS Chair

Membership: Members added?  Need to recruit? Leadership succession issues?  Denise is stepping down as chair. We have 2 excellent co-chairs and initially one of them, Sumana Narasimhan, was going to step in. She instead is going to continue as NPAC vice chair and Alyssa Riley will be stepping into the chair role. My next steps are to notify the rest of the committee and work with Parthavi to set up an election for a second vice chair right after the new year. I’d like to have that person in place before we transition so we can have a full leadership handoff no later than NPAC.
Townhalls: Last one, topic/attendance.  Next one, progress.  Needs? Tentatively volunteered for October, but wanted to brainstorm with GAC regarding working together on topic(s) TBD related to Medicaid and the new administration
Newsletter/Publications: Number, topics?
-The Fast and the Furious: Pediatric Illness and Inpatient Statusing. Alyssa Riley, February
-What does language equity have to do with physician advisors? More than you think. Victoria A. Rodriguez and Denise M. Goodman, June
-Noncitizen children and pediatric physician advisors. Karthic Srinivasan, Deborah Hucaby, Kimberly Mulson, July/August
Special Projects: Progress? Needs?  Need help with the election and the Town Hall.
A couple of more updates:

1. Tracy compared my membership list to ACPA data. I’m cleaning it up and sending invites to pediatricians.
2. Alyssa, Sumana, and I are going to review/revise the charter in the next few weeks.

Scott Ceule
NPAC Chair

Planning update: Doing regular updates with Ronnie and Frontline.  Early bird pricing until Jan 17th.  
-Speaker update: Agenda is set – Release around Dec 18th.  Key points – E&F runs concurrently on Monday with NPAC, Keynote on Tuesday morning, Presidents address on Wednesday morning.  Have three tracks running concurrently on Mon, Tues, and Wed.  Invites for inaugural poster seesions sent out – some replies and shooting for more more than 10.   
-Marketing: Once agenda is out will push out promo for agenda and content.  Keynote will also come after contract is signed.  Keynote is Dr. Chris Windham – CMO of Lumeris.  Chris Boyle knows him and works with him on pop health and has really driven this process.  
-Registration: As of Wed Dec 11th – 60 for NPAC, 13 for NPAC and E&F, and 2 for E&F.  Totals of 67 in person and 8 virutal. Speakers just got codes so only have 2 registered so far, that will be another 60 or so.  At about 15% of budget goal right now – still very early.  Exhibitors – have $52,000 which over half already.  Still have one Titan opening(highest level 3 of the 4 taken already)  
-Needs/asks: Watch social media and re-post and like the promo stuff put out.  Will be gathering track hosts in next couple of weeks so also let me know if willing to help host a track.  Promo info about early bird will follow the agenda release as well – please promote that as well.   

Mary McLaughlin-Davis
Advisory Board Chair Advisory Board Mary McLaughlin-Davis Advisory Board Chair Advisory Board Well attended and successful Town Hall on October 28th entitled, The optimal collaborations between physician advisors and case managers in promoting excellent care throughout the continuum. The panel included ACPA members as well as content experts from Phoenix Medical Management and Well Star. The questions not answered will be addressed in written form in the ACPA Newsletter and perhaps other publications. The next Advisory Board Town Hall is planned for January or February 2025. The topic is compliance mandates and regulations. Jessica Gustafson will lead the panel.

Erica Remer
CDI Chair Membership: Members added? We added 2 more members. We do so on a quarterly basis. Need to recruit? We do not have recruitment needs. Leadership succession issues? We are in the process of identifying a new Vice-Chair to replace Adriane when she becomes Chair in January. Townhalls: Last one, topic/attendance. Next one, progress. Our next Town Hall is December 12. It will address the PA’s role as regards CDI. Needs? No needs identified. Newsletter/Publications: Number, topics? Our committee tries to submit at least one article per newsletter. Special Projects: Progress? Needs? Materials: We finalized CDI for the ED materials and submitted them for publication. Pediatric Respiratory Failure Whitepaper is out: https://www.acpadvisors.org/assets/docs/white-papers/ACPA-ACDIS_White-Paper_Pediatrics_Respiratory%20Failure%20Definitions.pdf

Ritu Prasad
GAC Chair Joanna Kipnes is now the 2nd vice chair for GAC, GAC-OBS town hall on Thursday Nov 14, Cleveland clinic symposium on Nov 20

Anuja Mohla
OBS. Chair Obs – report by Bart and Amit Membership: 1 New Members added. 3 new members in the pipeline for interview. Townhalls: Nov 14th GAC-OBS combined townhall on successful implementation of 2 MN rule. Next townhall in prep stages March 2025 on outpatient status. Newsletter/Publications: none Special Projects: White paper on observation metrics, could use help with reviewing draft.

Denise Goodman
PEDS Chair

Scott Ceule, MD, FACP, FAAP
National Physician Advisor Conference Chair Planning update: Met with Ronni and having great conversations with her and working and reviewing her releases. Still need exhibitor final plan from Jeannie. Speaker update: Had 90 submissions for presentations. Thanks to all that did abstract review. The NPAC team is now compiling the reviews, making decisions, and then will put together first draft of agenda. Will be like last year with E&F all day on Monday. Then will have 3 tracks running concurrently on Mon, Tues, and Wed with main stage to open and close every day. Presentations that do not make the cut for presentations but felt to have good content will be asked to be a part of the first ever poster presentation/session. We will be looking for around 10-15 posters if possible. Marketing: Registration opening soon – so get on LinkedIn and re-post, like, etc. so can get it out there to increase exposure. Registration: Will Open to Early Bird and E&F Nov 1st or beginning of following week. Needs/asks: None right now

Ben Kartchner
Certification Committee Chair  

Mary McLaughlin-Davis
Advisory Board Chair Advisory Board No members added. My two-year term as chair ends this year, Jennifer Gustafson is interested in chairing again, however, no recruiting efforts are in progress. Town Hall is scheduled on Monday October 28th titled, the optimal collaborations between physician advisors and case managers in promoting excellent care throughout the continuum. Presenters are, Christopher A. Boyle, MD, System VP, Stewardship and Physician Advisor Services Diane Shifley AVP for post-acute services and population health. Both represent Endeavor Health Services. Sara Williams, MSN, ACM-RN, VP Clinical Strategy Phoenix Medical Management We are waiting for one additional organization to respond about their availability to present. We hope to have an interactive session with some formal presentation and lots of discussion.

Erica Remer
CDI Chair Membership: No new members. I will be stepping down at end of December and Waldo or Adriane will be chair (Waldo has right of first refusal).  Townhalls: Last one, July 11, sepsis. Next one, December 12. No topic selected yet. Newsletter/Publications: At least 1 newsletter article/month. ACDIS journal quarterly.  Special Projects: Working on materials for CDI in ED at this time. Next up, medical necessity. We are continuing to update and revise already published materials to ensure current.

Ritu Prasad
GAC Chair Membership: Members added?  Need to recruit? Leadership succession issues?
     - Membership currently capped, noted on website, waitlist  Townhalls: Last one, topic/attendance.  Next one, progress.  Needs?     - Early stages of planning OBS-GAC town hall for Nov  Newsletter/Publications: Number, topics?  Special Projects: Progress? Needs?
     - Email to membership and social media post in progress on CMS complaint process now centralized (rather than a unique process for each region) 

Anuja Mohla
OBS. Chair Obs – report by Bart and Amit We have two members under consideration for addition to the committee (we just got their requests in July)  No leadership issues at present.  We had a recent joint town hall with pediatrics in the spring (after NPAC). It was very weel received and an overall success.  We recently created a learning module on observation unit best practices.  We continue to submit monthly cases to the newsletter and are exploring ways to increase in engagement in reader response.  Neither Bart nor I are aware of any special projects.  

Denise Goodman
PEDS Chair Membership: Members added?  Need to recruit? Leadership succession issues?  - No new members since last time; active new members since NPAC.  Townhalls: Last one, topic/attendance.  Next one, progress.  Needs? – With observation committee in June. Appears well received. Parthavi hopefully has numbers attended and any evaluations (I’ve note seen any).  Newsletter/Publications: Number, topics? Two, one on language other than English. One coming up on non-citizen children.  Special Projects: Progress? Needs? Still working through a project on variability in state Medicaid rules/approaches to status.

Scott Ceule, MD, FACP, FAAP
National Physician Advisor Conference Chair Planning update: Updating the Welcome page, budget prep, poster session. Site visit at BOD retreat. Speaker update: Call for Abstracts going out soon – Due date Sept 30th ( 4-6 weeks to submit)Goal is to have agenda finalized before end of the year to allow 2-3 weeks of Early bird pricing with agenda published.  Marketing: Need update – need to have team reach out to all previous exhibitors – price increase? Waiting on prospectus from team. Watch for the call for abstracts and comment and re-post on social media.  Registration: Not open yet – need pricing(budget work) and then can open.  Needs/asks: E&F – will be a part of NPAC planning committee this year. Need confirmation about who will be able to do present lectures for E&F for NPAC 2025.

Ben Kartchner
Certification Committee Chair  Passed:
CV/Alternative Certification Pathway - 28, 1 failed and passed 2^nd time
Preparation Course Modules - 38, 2 failed and passed 2^nd time
E&F - 13, All passed first try  Failed:
CV/Alternative Cert Pathway - 5 have made a first attempt, 1 of these failed second attempt (the others have not made a second attempt), 0 have made a third attempt
Preparation Course Modules - 12 have failed a first attempt, 1 of these failed a 2^nd attempt (the others have not made a second attempt), 0 have made a third attempt
E&F - 4 have failed first attempt, 0 have made a 2^nd or 3^rd attempt Approved/paid for test but have not taken it:
CV/Alternative Cert Pathway - 15 (March-2, April-1, May-2, June-6, July-2, Aug-2)
Preparation Course Modules - 36 finished modules (March-2, April-5, May-5, June-9, July-7, Aug-7)
E&F - 19 (April-6, May-5, June-7, July-1)

Working on Modules but not finished (date in () is date purchased)
100 (Feb-5, Mar-18, Apr-14, May-25, June-11, July-15, Aug-12) Of 84 people who went to E&F:
13 took test and passed
4 took test and failed but did not take it again
19 purchased the test but did not attempt it TLC Revenue Dashboard
Certification Revenue Dashboard