Washington DC-Baltimore Area
I am an accomplished physician executive, with 20+ years in Data-Driven Quality Improvement (QI), Clinical Documentation Integrity (CDI) and Population Health, advancing Value-Based Care across the US--- and I have done so as board-certified in Health Care Quality Management (CHCQM), with a Master’s in Public Policy (MPP). As a caring and committed team leader and team member, I have specialized in Medical Staff Engagement, to advance major CDI, Quality and other transformative initiatives in hospitals and academic medical centers. I have also leveraged my graduate certificate training in Health Information Technology (HIT) and in Health Services Research, to advance Health Care Data Analytics in Population Health management. For the last decade, I have excelled in advancing CDI in over 100 hospitals across the US, sharing this CDI expertise with audiences in over 10 national/regional presentations. REVENUE CYCLE & REGULATORY COMPLIANCE • Experienced in supporting CFO/CEO optimization of documentation programs to capture Medical Necessity & Severity-Of-Illness, with ICD-10 coding, to meet utilization review goals as well as Medicaid, Medicare & Managed Care medical necessity, medical coverage policy. CLINICAL INFORMATICS & DATABASE ANALYSIS: • Experienced in supporting Chief Informatics Officers (CIOs) & Chief Medical Informatics Officers (CMIOs) in the integration of Clinical Documentation Integrity (CDI) into hospital Electronic Medical Record/Electronic Health Record (EMR/EHR) ICD-10 environments; • Experienced in algorithm optimization for a machine learning and natural language processing (NLP) functionality behind an artificial intelligence system, called Computer-Assisted Physician Documentation (CAPD). • Experienced in supporting implementation of cutting edge Electronic Medical Record (EMR) technologies, Regulatory Compliance, Quality Reporting & Performance Analytics and Social Determinants of Health (SDOH) tracking; • Experienced in supporting Health Information Exchange (HIE): Electronic Medical Record (EMR) Connectivity, Public Health Data Reporting, Community Physician/Clinic Engagement, Privacy/Security Issues, Population Health Management, Quality Improvement; SPEAKER: Clinical Validation, Denials Management, Clinical Documentation Integrity (CDI), Value-Based Care, Quality Improvement, Patient Safety/Medication Safety, Health Equity. SUMMARY Finally, I am a LOVING husband and PROUD father of a wonderful, elementary school kid--- delighting in every moment that my wife and I get, to help him flourish and explore the world...!
After 10 years of honing my Clinical Documentation Integrity (CDI) skills and expertise in engaging hospital/providers, I am now fully immersing myself in the nuances of the DRG "clinical validation" criteria, Grievance/Appeals/Denial Management processes of major managed care plans. And in doing so, I am expanding the depth of my understanding of CDI, from the perspective of Medicare, Medicaid and private managed care payers. As a Physician Reviewer, I am partnered with a highly trained team of physician/nurse reviewers and certified DRG coding specialists, for this 40-year-old Payment Integrity Solution organization--- which saved it clients over $350 million in the last year.
(VOLUNTEER) Mayoral-Appointed Member of the committee that provides policy advice on outpatient prescription medication for DC Medicaid
(VOLUNTEER) Mayoral- Appointed member of the Oversight Board to support implementation of Health Information Exchange for the District of Columbia.
Consistent with my past leadership in consulting, I led a systemwide operational effectiveness assessment of the current state of Medstar’s CDI program, in order to design and implement system resources designed to optimize the clinical documentation that supported quality, patient safety and clinical performance profiling. As the Medical Director, I successfully organized the system’s physician advisors to support the development and implementation of of both written and webinar-based provider CDI education. I also partnered with the Quality Data Team IT analysts to implement provider level CDI performance reports. And finally, I led the system-wide deployment of a Nutrition Status – Computer-Assisted Physician Documentation (CAPD) effort that dramatically increased clinically validated capture of Malnutrition and also drove provider-dietitian diagnosis/treatment plan congruence from <30% to >75%, in six months. Based in the Medstar Quality & Safety Department, I was partnered with system leaders in Medstar Compliance and in Medstar Finance, in support of the hospital-based CDI and Quality Teams across the system. Together, we developed Medstar’s first (systemwide) CDI program performance dashboard, revealing the need for greater system coordination and resource support. I then prepared a formal CDI consulting firm proposal that would enhance Medstar’s CDI system leadership, training and operational oversight, in ways that would help the system take its CDI program to the highest performance level.
As National Medical Director for Clinical Documentation Improvement (CDI), I led a Physician Consultant team, specializing in training in hospital medical staffs and outpatient physician groups in optimizing accurate clinical documentation for ICD-10 Coding, DRG Billing Patient Acuity Capture for Risk Adjustment in Quality Reporting. I also served as a company-wide resource for medical staff / physician behavior "change management", focused on CDI, to help physicians effectively capture the "medical necessity" and "severity-of-illness" that is used in Physician Performance Profiling, Hospital Patient Safety & Quality Reporting and Hospital Revenue Cycle Improvement. And I also provided content expertise in Medical/Surgical, Pediatric, Cancer/Mental Health/Disabilities CD, as one of only a handful of US physicians to pursue and maintain an AHIMA-Approved ICD-10 Trainer status. Finally, I was a popular client CDI presenter, especially for addressing CD-resistant physicians and physician groups. I also had a special role in providing CDI expertise for algorithm optimization of the machine learning and natural language processing (NLP) functionality behind Nuance artificial intelligence system, called Computer-Assisted Physician Documentation. And finally, I have been an invited national speaker on CDI, Physician Engagement and HIM roles in Health Information Exchange.
- Consultant: Medical Staff/Leader Engagement in Clinical Documentation Improvement (CDI) and ICD-10 Preparation - Physician Educator: Documentation in ICD-9/ICD-10 Coding to capture Medical Necessity & Severity of Illness, to support regulatory compliance; - CMO/Medical Director Support: Documentation of Present on Admission (POA) vs. Healthcare Acquired Conditions (HAC) to support compliance and quality reporting; - Health IT Advisor: Computer Assisted Coding & Other Computer Assisted Technologies to support documentation, compliance and ICD-10 preparation; - Recognized Speaker: Health Care Reform, ICD-10, Medicare/Medicaid. Managed Care, Values-Based Purchasing in Healthcare, Clinical Documentation & Its Revenue Cycle Impact
Member of the Clinical Committee that reviews and approves "Use Cases" and "Clinical Projects" for the Maryland State-recognized Health Information Exchange (HIE) provider--- CRISP Chesapeake Regional Information System for our Patients.