The ACO Journey, Legal Environment, & Peer Review Risks

2.0 CME Credits
2.0 CE Credits

ABQAURP sub-specialty credits: Managed Care 2.0, Physician Advisor 2.0, Patient Safety/Risk Management 2.0, Case Management 2.0, Transitions of Care .75

The formation of the Accountable Care Organization (ACO) fosters the concepts of providing quality, safe, financially secure care; as such fulfilling the ethical responsibility the AMA requires for practitioners.

Discuss the MSSP proposed rule on assignments, data sharing, financial benchmarks for ACO’s. Reduce your risks during an ACO Peer Review by preparing an internal audit. Improve your performance by following the dimensions of quality, accountable care goals and the four domains of care being considered. Explore Memorial Hermann’s journey to accountable care by building a high performance physician network.

At the conclusion of the activity, attendees will be able to:
  • Recognize challenges providers are facing as ACO roles are determined
  • Leverage the legal risks of shared savings programs and accountable care
  • Discuss provider responsibility and risk in the peer review process
  • Review the impact of economic profiling and credentialing in the evolution of the ACO
  • Discuss ACO success with population health and risk stratification tools
  • Review physician leadership and essential aspects of Medicare shared savings success
These sessions were recorded live at our 2016 Annual Health Care Quality & Patient Safety Conference and are a portion of the online course entitled: Quality Under the Affordable Care Act: Keys to Success.

This course is intended for Physicians of all specialties, Nurses, and Other Health Care Professionals with appropriate CME credit and nursing contact hours offered for each profession.

The American Board of Quality Assurance and Utilization Review Physicians, Inc. (ABQAURP) is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians.

ABQAURP designates this enduring material for a maximum of 2.0 AMA PRA Category 1 Credits™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

ABQAURP is an approved provider of continuing education for nurses. This activity is designated for 2.0 contact hours through the Florida Board of Nursing, Provider # 50-94.

This program is approved for Category 2 credit by the American Osteopathic Association.

All participants must achieve a final assessment score of at least seventy percent (70%) for recertification and continuing education credits. You have 60 days to complete the course after ordering. Please note: Exam candidates taking the Core Body of Knowledge and Diplomates renewing their certification may have less time to complete, as determined by deadlines imposed. This activity is valid from August 4, 2016 through March 15, 2019.

Please read the ABQAURP Privacy Policy and we suggest strongly that you read the System Requirements before continuing.

COURSE FEES: Diplomate $60.00      Professional Member $70.00      Non-Member $85.00

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About The Authors
Members of the CME Committee, Planners, and Faculty have disclosed to ABQAURP any relevant financial relationships. No relevant financial relationships or conflicts of interest exist in regard to the content of this activity.

Christopher J. Laney, JD, CHCQM

Chris Laney is Associate Attorney at Rogers and Associates, Attorneys and Counselors in Detroit, Michigan. Chris’ practice focuses primarily on representing health care providers in Medicare audits, business transactions, and reimbursement issues; he has significant experience representing providers in third party payer audits, professional licensing, federal agency investigations, and credentialing matters. A frequent author and presenter on compliance issues, Stark, and other fraud-and-abuse issues, Chris has been named Rising Star top young lawyer in Michigan multiple times. Chris has been an asset to ABQAURP as a frequent speaker and serving on our CME, Exam, and Item-Writing committees.

Richard Kaine, MD, CHCQM
Dr. Richard Kaine is the Director of Consulting Services for Quality Management Resources, a nationwide consulting firm and the Medical Director for Health Practice Management.  Dr. Kaine has been certified by the American Board of Pediatrics, the American Board of Family Practice, the American Board of Internal Medicine, and is a long-standing, valuable member of ABQAURP’s board of directors.  He is a former HMO Medical Director and Executive Director; building provider networks and credentialing thousands of physicians for national insurers. He lectures nationally about quality, utilization, credentialing, and compliance issues.

D. Keith Fernandez, MD
Dr. Keith Fernandez is President and Physician-in-Chief of MHMD, the Memorial Hermann Physician Network, the largest clinically integrated physician organization in Texas. Dr. Fernandez is the Memorial Hermann Health System Physician Champion for computerized physician order entry and has led prominent efforts in electronic ordering and evidence-based order sets for the Memorial Hermann System.

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