Conference Agenda
Rising Together for Excellence in Health Care Quality
September 24-25, 2026 | Sheraton Sand Key Resort, Clearwater Beach, FL

Health care is transforming rapidly, driven by regulatory change, emerging technologies such as AI, evolving reimbursement models, and increasing demands for coordinated, high-value care. Today’s interprofessional teams must collaborate more effectively than ever to ensure safe care transitions, optimize utilization, strengthen documentation, and improve population health outcomes.

Join us at ABQAURP’s 49th Annual Conference to explore innovative, evidence-based strategies that enhance communication, support compliance, leverage technology, and elevate performance across the continuum of care.

Together, we will rise to meet the challenges of a shifting health care landscape—bridging gaps between quality care delivery, reimbursement integrity, and patient satisfaction.

Upon conclusion of this live conference, members of the interprofessional team should be able to:

• Apply innovative, evidence-based strategies to strengthen collaboration across the health care team to improve care transitions.
• Assess the practical application of AI integration in health systems that manages risk and aligns with organizational strategy.
• Examine current regulatory and legislative changes to enhance value-based, high quality, coordinated health care.
• Explore innovative approaches to integrate technology and bridge gaps in patient care to improve care transitions, decrease acute care visits, and expand access to care.
• Evaluate how targeted, accurate documentation supports regulatory compliance while enhancing interprofessional communication and safer health outcomes.
• Determine how data-driven care management strategies and process improvement approaches can be used to optimize utilization and improve quality metrics.
• Describe how quality measures impact point-of-care decisions to improve performance and support population-based health outcomes.
• Identify crucial skills for today’s Physician Advisor to flourish such as medical necessity documentation, utilization management, coding, reporting metrics, denials management, and health team collaboration.

Wednesday, September 23, 2026
4:30pm-6:30pm   Early Registration

Thursday, September 24, 2026
6:45am-7:45am   Registration and Continental Breakfast Buffet

7:45am-8:00am   Welcome and Announcements

 

Joseph G. Vitolo, MD, FAPA, FASAM, CHCQM-PHYADV, FABQAURP 
ABQAURP Chairman of the Board

 

Sunil K. Sinha, MD, MBA, CHCQM, FACHE, FABQAURP 
ABQAURP Vice Chairman & Education Committee Chair

8:00am-9:00am    Operationalizing Clinical AI: Navigating Governance and Measuring Impact 
Kristin Preihs, MPH - Vice President, Health Research & Educational Trust - American Hospital Association

As artificial intelligence (AI) rapidly reshapes the health care landscape, executives face the dual challenge of embracing innovation while ensuring safety, efficacy, and fiscal responsibility. This session moves beyond theoretical discussions to present a practical roadmap for AI integration. Attendees will gain an inside look at how hospital and health care systems across the country establish robust AI oversight and governance to filter the noise and prioritize high-impact solutions. The presentation concludes with a "deep dive" into specific clinical AI deployments, offering a transparent look at the results, lessons learned, and measurable ROI that are driving the future of care delivery.

• Analyze the current clinical AI landscape to distinguish between market hype and scalable, high-value applications for health systems
• Evaluate governance frameworks and prioritization methodologies effectively used to manage risk and align AI investments with organizational strategy 
• Assess the clinical and financial return on investment of deployed AI solutions through a review of real-world case studies and performance data

9:00am-10:00am    Regulatory Policy – Current and Expected Changes
Alex Bardakh MPP, CAE, PLC - Vice President of Government Affairs and Policy - CareConnectMD

The session provides an overview of the current legislative and regulatory landscape shaping health care policy. It will describe the move away from fee-for-service toward value-based care models and how that will impact care coordination. Likewise, new payment changes are shaping reimbursement structure for the move toward value-based care and care coordination. Participants will learn about new coding structures that are supporting this movement.

• Implement changes based on legislative and regulatory landscape shaping health care policy
• Compare various value-based care models
• Synthesize new coding initiatives that drive reimbursement

10:00am-10:15am    Networking Break

10:15am-11:15am    Building Excellence and Quality Outcomes in Transitions of Care
Cheri Lattimer RN, BSN - Executive Director - National Transitions of Care Coalition (NTOCC)

Transitions of care represent high-risk periods that directly affect patient safety, care quality, and health care utilization. Gaps in communication, care coordination, and accountability across disciplines and settings contribute to preventable adverse events, readmissions, and inefficiencies. This educational session is designed for an interprofessional health care team and addresses transitions of care across the continuum, including micro-transitions within care settings. The session will examine evidence-based best practices, emerging interdisciplinary care models, and innovative strategies that promote effective collaboration among clinicians, care coordinators, pharmacists, and social services. The discussion will also include new CPT coding and payment models that support value-based care, as well as the use of health information technology to enhance communication, reduce fragmentation, and improve patient-centered outcomes.

• Identify key elements of high-quality, interdisciplinary transitions of care and common risk points that contribute to patient safety events and suboptimal outcomes across care settings
• Describe evidence-based best practices and innovative strategies to promote collaboration amongst clinicians, care coordinators, pharmacists, and social services
• Evaluate emerging care delivery and payment models, including value-based reimbursement and CPT coding, which support sustainable, high-quality transitions of care and improved clinical outcomes

11:15am-12:15pm   Elevating Surgical Outcomes Through CDI: Strengthening Medical Necessity Documentation Across the Care Continuum
Signa LaToya Perkins MD, MBS, CPHYADV - Chief, Department of Medicine - Signature Healthcare Brockton Hospital and Medical Director, Physician Advisory Services - Sound Physicians

This session explores the role clinical documentation integrity (CDI) serves as a powerful lever for improving surgical outcomes by strengthening medical necessity documentation across the entire care continuum. Common documentation gaps within the operative phases will be explored to demonstrate how targeted CDI strategies can address them. Participants will discover how robust and accurate documentation not only supports coding and regulatory compliance but also enhances interprofessional communication, reinforces quality metrics, and ultimately promotes safer, more efficient surgical pathways.

• Analyze gaps in current surgical medical necessity documentation by comparing real-world CDI cases across the operative phases
• Apply evidence-based CDI principles to revise documentation that accurately reflects surgical medical necessity allowing for alignment with coding, quality, and regulatory requirements
• Create an interdisciplinary documentation workflow that strengthens medical necessity support across the care continuum and improves downstream surgical, quality outcomes

12:15pm-1:15pm    Networking Lunch (Buffet Lunch Provided)

1:15pm-2:15pm    Delivering Quality Care & Data-Driven Gap Closure
Michael S. Barr MD, MBA, MACP, FRCP - President & Founder - MEDIS, LLC

This session explains why today’s quality measures frustrate health care leaders and fail to change care delivery. Attendees learn how accountability metrics differ from improvement measures and how digital quality measures can support decisions at the point of care. The presenter shows how responsible use of AI can reduce burden, improve performance, and support person-centered, population-based outcomes.

• Analyze the origins, types, and purposes of quality measures distinguishing how accountability measures differ from improvement-oriented measures within value-based care frameworks
• Evaluate the role of AI, need for proper data infrastructure, and streamlined clinical workflows to enhance gap closure and support person-centered, population-based care
• Design an actionable approach to integrating timely, clinically relevant data, including patient-reported outcomes, into routine practice to improve quality performance and support continuous improvement efforts

2:15pm-3:15pm    From Silos to Synergy: Standardizing Whole-Person Care Across the Continuum
Raine Arndt-Couch DSW, JD, LCSW, CCM, FCM - Founder & Principal Consultant - Responsive Advocacy & Consulting, LLC

Whole-person care is widely endorsed, but too often remains more aspiration than operational reality. Across the continuum, behavioral health, well-being, pharmacy-related needs, and community supports are frequently acknowledged yet insufficiently embedded into the standardized workflows that shape quality, utilization management, and population health efforts. This session will focus on practical solutions to reduce fragmentation, break down silos, and strengthen interdisciplinary collaboration in ways that support measurable improvement. Participants will explore how clearer role alignment, stronger teamwork, and more consistent processes can elevate the contribution of each care team member and better position organizations to deliver integrated, equitable, whole-person care that improves patient outcomes.

• Analyze how fragmented systems, inconsistent processes, and professional silos impede integration of behavioral health, well-being, pharmacy, and community supports into population health and quality efforts across care settings 
• Differentiate between aspirational concepts such as integrated care, health equity, and social drivers of health and the standardized interdisciplinary workflows essential for supporting whole-person care and improving performance
• Develop practical, interdisciplinary strategies to break down silos, address operational barriers, and strengthen collaboration across roles, with the goal of leveraging the unique contributions of each care team member to advance whole-person care and improve outcomes 

3:15pm-3:30pm    Networking Break

3:30pm-4:30pm    Reducing Preventable Utilization: The Physician Advisor’s Role in Improving Medicaid Outcomes
Allison Raines DO, MBA, MPH, FACEP, CHCQM, CPHYADV - Senior Medical Director and Chief Medical Officer Medicaid - Sentara Health Plans
Tiffany Kitts Thymius DO - Medical Director of Advisory Services - Sound Physicians

This session explores the evolving role of the Physician Advisor as a clinical and strategic leader in improving patient outcomes. In an environment where health care organizations must simultaneously enhance quality performance and manage cost and utilization, the Physician Advisor plays a pivotal role in driving measurable, sustainable change for the Medicaid population. The discussion will highlight practical strategies to reduce preventable, avoidable, and medically unnecessary utilization through strengthened interdisciplinary collaboration, physician engagement, and proactive care management. Attendees will examine how aligning clinical leadership with care coordination efforts fosters accountability, improves cross-setting communication, and supports success in value-based care models. Through a review of targeted process improvements and optimized care pathways, participants will learn how data-driven cohort identification, risk stratification, and advanced patient segmentation can be used to focus interventions, promote appropriate utilization, and deliver timely, patient-centered care. Real-world applications will illustrate the impact of these strategies on reducing emergency department visits and hospital readmissions while enhancing overall system performance. Participants will leave with actionable insights and practical approaches to support quality improvement, utilization management, and care transformation initiatives within their organizations.

• Analyze the evolving role of the Physician Advisor as a clinical and strategic leader in reducing preventable, avoidable, and medically unnecessary utilization within the Medicaid population
• Apply data-driven strategies, including risk stratification, cohort identification, and patient segmentation, to target interventions and optimize appropriate utilization of healthcare services
• Evaluate interdisciplinary process improvements and care pathway strategies for their impact on quality outcomes, emergency department utilization, and hospital readmission rates

4:30pm-5:30pm    Leveraging Tele-Oncology to Improve Rural Access, Transitions of Care, and Quality Outcomes
Robert Rice MD, PhD, MMM - Physician Hematology and Oncology - Intermountain Health

This session examines innovative approaches to tele-oncology in rural environments, emphasizing the integration of technology to bridge gaps in patient care. Attendees will engage in discussions about implementing transitions of care frameworks through telemedicine and examine best practices for leveraging telehealth to decrease acute care visits. The presentation will also highlight practical strategies, real-world examples, and opportunities for interdisciplinary collaboration, empowering participants to enhance health care delivery and patient outcomes within their organizations. 

• Describe tele-oncology models in rural settings
• Apply transitions of care frameworks using telemedicine
• Identify telehealth strategies that reduce acute care utilization

5:30pm    Closing Remarks and Adjournment

5:30pm-7:30pm     Networking Reception
Relax and network! Reception is open to Thursday, Friday, and two-day attendees. Reception is ages 21 and over only, please.

Friday, September 25, 2026
6:45am-7:45am   Registration and Continental Breakfast Buffet

7:45am-8:00am   Welcome and Announcements 

 

Sunil K. Sinha, MD, MBA, CHCQM, FACHE, FABQAURP 
ABQAURP Vice Chairman & Education Committee Chair

8:00am-9:00am    AI Ethics and Healthcare
James B. Trumble MD, MBA - Assistant Chief Medical Officer, Vice President Clinical Integration - TidalHealth

This session provides a focused overview of how artificial intelligence (AI) is being applied in health care, with attention on compliance, risk, and ethical responsibility. Participants will recall common health care Al applications including clinical decision support, health analytics, revenue cycle management, and operational optimization, alongside key compliance considerations such as HIPAA, patient consent, and regulatory oversight. The session will describe and analyze adversarial attacks on Al systems such as prompt injection, model manipulation, and deepfakes-and the consequences these threats pose in health care, including clinical safety risks, compromised data integrity, financial loss, and erosion of patient trust. Finally, the session addresses the foundational issues of trust, responsibility, and transparency in Al, emphasizing explainability, bias detection, human-in-the-loop oversight, and accountability for attendees to evaluate and apply these principles. Attendees will gain insight into why responsible Al is essential and create a responsible mindset for safe, equitable, and effective health care delivery and how strong governance helps ensure Al supports, rather than undermines, patient care. 

• Highlight key AI compliance principles and practical clinical applications supporting safe, ethical, and effective care
• Explain adversarial attacks and their consequences
• Explain how trust, responsibility, and transparency shape the safe and ethical use of AI in health care delivery

9:00am-10:00am    Winning at Denials: A Strong Offense is the Best Defense
Catherine Pesek Bird DO, MBA, CHCQM-PHYADV, ACPA-C - Physician Advisor - Lakeland Regional Health Medical Center

Think of two hospitals: one is focused on queries and AI-generated software to determine coding and billing; the other is focused on a team approach to UM, CDI, and quality.  How do these approaches differ? Which approach would be better for your hospital? How can you build your team to best reduce query burden, denial management, and still achieve your desired outcome? In this session, we will review current views on how to best utilize a Physician Advisor, how to ideally develop an in-house team, and how to provide physician education to reduce denials.

• Evaluate the types of denials based on patient status and medical necessity
• Compare results based on different approaches to clinical documentation
• Examine the potential value of AI-related software to hospital metrics

10:00am-10:15am    Networking Break

10:15am-11:15am    Using Medicare Regulations to Hold Medicare Advantage Plans Accountable
Timothy Brundage, MD, CCDS - CEO and Physician Advisor - Brundage Group

CMS’ 2024 update formally applied the Medicare Two‑Midnight Rule to Medicare Advantage (MA) plans, yet many plans still fail to comply, keeping patients in observation longer and increasing payer friction. This session reviews CMS’ regulatory clarifications designed to curb MA tactics that delay or reduce hospital reimbursement, including misconceptions about physician expectation, the two‑midnight threshold, and presumption. It also addresses CMS’ 2026 clarification distinguishing coverage determinations from payment determinations and explores how some payers, such as through Aetna’s Severity Payment Policy, are revising payment practices to further limit hospital revenue.

• Explain CMS’ application of the Medicare Two‑Midnight rule to Medicare Advantage (MA) plans
• Distinguish key elements of the Two‑Midnight rule, physician expectation, threshold, and presumption, and their implications for medical necessity decisions
• Identify patterns of payer behavior contributing to increased observation stays and hospital revenue loss
• Analyze CMS’ clarification on coverage vs. payment determinations and its impact on inpatient medical necessity denials and hospital reimbursement

11:15am-12:15pm    Optimizing Technology and Teaching for Optimal Patient Care and Long-Term Financial Sustainability
Timothy P. Connelly MD, MBA, FACP, CHCQM-PHYADV - Associate Program Director Internal Medicine Residency - HCA Healthcare

This session starts with the importance of capturing CCs, MCCs and HCCs not only as it pertains to the hospital or clinic finances but how failing to do so affects the patient and the care and resources they may or may not receive. The session incorporates potential unintended consequences of using AI note writers exclusively in practice and how they often fail to adequately capture specific codifiable diagnoses in producing a note. The best opportunity is introducing AI in the correct way from the very start. Faculty will provide some documentation templates and discuss how to optimally use them to improve hospital throughput and optimize patient placement when they are transitioning care from one phase of care to another. Lastly, the session explores other aspects of AI and other technologies and how they can help with care efficiencies to improve long-term sustainability. The session concludes with some cautionary tales and lessons learned with technology and AI implementation mistakes that are easy to repeat if you are not aware of them.

• Identify CDI opportunities and methods to incorporate into your electronic health record for better CC, MCC, and HCC capture
• Incorporate documentation templates to support medical necessity on the front end prior to sending an authorization request to an MA plan
• Appraise artificial intelligence applications as they pertain to health care quality and utilization review and determine which ones you should consider implementing in your workflows

12:15pm-1:15pm    Networking Lunch (Buffet Lunch Provided)

1:15pm-2:15pm    Utilizing AI and Automation to Streamline Utilization Review and Protect Hospital Revenue
Sri Suravarapu MD, MPH, CPE, CHCQM-PHYADV - Medical Director, Utilization Review/Clinical Appeals - Stormont Vail Health
Chad Yeager RN, MSN - Vice President, Quality and Population Health - Stormont Vail Health

This session explores how Stormont Vail Health tackled inefficiencies in utilization review (UR) by implementing AI and automation to support timely and accurate hospital admission and appeal processes. The manual approach to searching EHRs for clinical documentation often led to delays and errors, impacting financial performance and increasing denial risks. By integrating AI-driven tools including an automated workflow for generating appeal letters, the UR team improved claim accuracy, reduced chart review time, and enhanced staff productivity. These solutions also enabled early identification of admission needs and streamlined documentation for continued stays, ultimately protecting hospital revenue and improving patient outcomes.

• Describe how using AI technology for utilization review improves financial performance by protecting hospitals from unnecessary denials and increasing staff productivity
• Assess the sources of EHR data that would be beneficial in determining medical necessity and priority for patient admissions
• Identify opportunities to improve existing medical necessity documentation workflows within the EHR 

2:15pm-3:15pm    Expanding Role of the Physician Advisor and Impact on Health System Performance
Miral Patel MD - System Lead Physician Advisor - CommonSpirit Health

The role of the Physician Advisor continues to evolve beyond traditional utilization management and varies significantly across organizations based on structure and strategy. This session explores how Physician Advisors add value across a range of responsibilities including utilization management, regulatory performance, denials management, as well as clinical operations and care progression.

• Discuss expanding roles of Physician Advisors within health systems
• Explain how Physician Advisors support organizational goals
• Evaluate the impact of Physician Advisors on measurable outcomes

3:15pm-3:30pm    Networking Break

3:30pm-4:30pm    Physician Advisor and Care Team Trivia
Melissa Buchner-Mehling, MD, CHCQM, CPHYADV, FABQAURP - Associate Chief Medical Officer - Sound Advisory
Natasha L. Chen, MD, CHCQM, CPHYADV, FABQAURP - Physician Advisor - Natasha L. Chen, M.D. PLLC

This interactive session examines the role of the physician advisor and opportunities for the health care team to collaborate in not only providing but documenting patient care. Important topics include utilization, documentation, appeals and denials management, and more. This session also serves as a review for those preparing for the Advanced Physician Advisor or Health Care Quality and Management board certifications. Attendees can play along using the Grupio conference app and see how their answers compare to their peers. Don’t miss this fun way of wrapping up our annual conference!

• Describe Medicare beneficiary notices and when to issue
• Assess the appropriate level of inpatient or outpatient care and best practices for documenting and billing patient services
• Identify physician advisor roles and responsibilities within the health care team

4:30pm    Closing Remarks and Adjournment

*Schedule, faculty, and content are subject to change.