Quality Under the Affordable Care Act: Keys to Success 

8 CME Credit

8 CE Credit

ABQAURP sub-specialty credits: Managed Care 6.75, Physician Advisor 8.0, Patient Safety/Risk Management 6.5, Case Management 8.0, Transitions of Care 5.75


Be in the forefront of medical practice as it changes under the Affordable Care Act (ACA). Protect your practice and improve the health of both your patients and community in this new environment.

Now is the time to gain an in-depth understanding of what is required to be a successful practitioner under the ACA.

Understand what is being measured and how to demonstrate improved patient outcomes and health care practice value. Be among the leaders who have a winning Affordable Care Act-era practice.

At the conclusion of the activity, attendees will be able to:

  • Identify quality measures to accurately reflect practitioner outcomes
  • Realize coding and documentation challenges for optimal reimbursement
  • Evaluate various evolving payment methodologies for the reimbursement of quality metrics, patient experience, and efficiency
  • Define areas of risk from the delivery of care, billing, and documentation perspectives in a changing medical-legal environment
  • Demonstrate how Physician Advisors are playing a significant leadership role in the drive for cost-effective health care
  • Recognize the role of the Accountable Care Organization in improving care quality for both inpatient and ambulatory settings
  • Describe emerging roles and opportunities for physician leaders and practical steps to prepare for leading change
  • Categorize new steps to improve population health, one patient and one community at a time
  • Demonstrate the value of the patient-centered medical home
  • Analyze the impact of inadequate and fragmented behavioral health care services
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 online enduring material for a maximum of 8 AMA PRA Category 1 Credit™. Physicians should only claim 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 8 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 May 1, 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 $230.00      Member $270.00      Non-Member $330.00

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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.

Full speaker biographies are contained within the course syllabus, found in the Resources tab of the course modules.    

Ronald J. Rejzer, MD, CHCQM-PHYADV - Parkland Health & Hospital System / American College of Physician Advisors
Dr. Ron Rejzer is Senior Vice President and Chief Physician Advisor for Parkland Health and Hospital System in Dallas. He is Board Certified in both Family Medicine and Emergency Medicine and has held various Physician Executive roles with several prominent healthcare organizations. He has served as a consultant for Hospitalist programs, in Utilization Management development and has participated in Physician Advisor roles for over twelve years. As a founding member of ACPA, Dr. Rejzer has served as the President of the American College of Physician Advisors since 2014.

Howard Stein, DO, MHA, CHCQM-PHYADV - CentraState Medical Center / American College of Physician Advisors
Dr. Howard Stein currently serves as the Associate Director of Medical Affairs of CentraState Medical Center in New Jersey. He has been a full time Physician Advisor for Care Management since 2003. He is also the President of CentraState Medical Associates and is board certified as a family physician. Additionally, Dr. Stein has served on the Executive Board of the American College of Physician Advisors since its inception.  He served in the U.S. Air Force as a Physician in 1987.

Kenneth P. Anderson, DO, MS, CPE - Health Research & Educational Trust (HRET)
Dr. Kenneth Anderson is the Chief Operating Officer of the American Hospital Association's Health Research & Educational Trust. He is responsible for management of the day-to-day operations and serves as the internal leader of HRET, assisting in the development and integration of the organizational strategic plan across finance, operations and research. Dr. Anderson serves as a Baldrige National Quality Award Alumni Examiner and is a judge for the state of Pennsylvania Hospital & Health System Improvement Awards. He helped establish the first provider-owned Accountable Health Plan in the state of Iowa, changing legislation regulating the insurance industry.

Marie Cleary-Fishman, BSN, MS, MBA, CPHQ, CPPS, CHCQM - Health Research & Educational Trust (HRET)
Marie Cleary-Fishman has been with HRET since March of 2014 and previously spent four years at the Illinois Hospital Association (IHA) as Vice President of Performance Improvement. In her position at IHA, she led the state/national collaborative focused on decreasing central line-associated bloodstream infections and catheter-associated urinary tract infections. Marie also oversaw IHA’s participation in the initial AHA/HRET HEN and jointly led the Midwest Alliance for Patient Safety, a joint venture patient safety organization. Ms. Cleary-Fishman also served as the Senior Vice President for Performance Distinction at Resurrection Health Care, a responsibility that included system wide performance improvement, patient safety and case management activities for five acute care facilities, a long-term acute care facility, a variety of nursing homes, retirement centers, ambulatory and home care services.

Shereen Shojaat, MS - Health Research & Educational Trust (HRET)
Shereen Shojaat currently holds the position of program specialist for the Health Research and Educational Trust (HRET), an affiliate of the American Hospital Association (AHA). She has been with HRET since March of 2015 and was previously with the Boys and Girls Clubs of America as a Youth Development Professional as well as working in the Global Education Programs at the World Food Prize Foundation. Shereen received her BS in Kinesiology and Health Pre-Medical Studies with a minor in Health Promotion from Iowa State University in 2013 and an MS in Global Health from the University of Notre Dame in 2014. Her master’s thesis project was conducted in Port-au-Prince, Haiti and facilitated increasing healthcare access to school children through a comprehensive health needs assessment.

Frank D. Byrne, MD, MMM, FACHE, FACPE, FACP, FCCP - Formerly St. Mary's Hospital, Wisconsin
Dr. Frank Byrne was named president emeritus of St. Mary’s Hospital in Madison, Wisconsin, in January 2015, after serving as president for the prior eleven years. During his tenure, St. Mary’s completed a multi-million dollar expansion, transitioned to a HIMSS Stage 7 electronic health record, and opened a free-standing satellite emergency center. A widely celebrated organization, St. Mary’s is part of SSM Health, the first health care organization to earn the Malcolm Baldrige National Quality Award.  Dr. Byrne has been active in a number of professional organizations, serving on the board of the American College of Physician Executives and the Board of Governors of the American College of Healthcare Executives.  Dr. Byrne has significant corporate governance experience, as well as not-for-profit hospitals and health systems, health plans, multi-specialty physician practices, foundations and other not-for-profit organizations.

Craig P. Tanio, MD - Maryland Health Care Commission
Dr. Craig Tanio is Chairman of the Maryland Health Care Commission, a regulatory body focused on improving health care quality, information, and access. Previously, he was Chief Medical Officer of JenCare, a joint venture between ChenMed and Humana that created a high intensity primary care model for low to moderate income seniors with multiple chronic conditions. He developed multiple clinical innovations including robust physician and physician leadership training programs, redesign of shared care management capabilities between payor and provider, interdisciplinary care coordination models, and integrated transitions of care programs. Craig formerly was a partner at McKinsey and Company for 12 years, where he helped multiple payors, providers, and international health systems develop and implement strategies to better manage health care costs and improve quality.  In addition to practicing medicine, he holds appointments at the Johns Hopkins University School of Medicine, Jefferson Medical College and the Florida Atlantic University Charles Schmidt College of Medicine.

Christopher J. Laney, JD, CHCQM - Baptist Health
Christopher Laney is Corporate Counsel for Baptist Health in Louisville, Kentucky, a full-spectrum health system consisting of eight hospitals, more than 170 outpatient facilities, and a network of 450 employed physicians and more than 1,600 independent physicians.  Mr. Laney advises the Population Health Department on the development of an ACO and participation in the Medicare Shared Savings Program, the development and implementation of a statewide clinical integration program, and other value-based purchasing initiatives.  He also advises all business units on HIPAA security and privacy issues.

Sam Antonios, MD, FACP, FHM, CCDS - Via Christi Clinic
Dr. Sam Antonios is the Medical Director of Information Systems and Utilization Management and Clinical Documentation Improvement at Via Christi Clinic in Kansas. Sam is a board certified internist and practices as a hospitalist at Via Christi. He oversees the implementation of electronic records, redesign of operations along with management of core informatics projects. He also is responsible for clinical documentation improvement efforts, denial reviews, and utilization management reviews. He was involved in the leadership of Via Christi through preparation, testing, and conversion to ICD-10 from documentation, clinical, IT, HIM, and process perspective last October. He works closely with the quality department in leading quality improvement projects.  

D. Keith Fernandez, MD - Privia Health
Dr. Keith Fernandez is Senior Physician Executive at Privia Health in Houston. Prior to joining Privia, Dr. Fernandez served as President and Physician-in-Chief of the Memorial Hermann Physician Network, Chief Medical Officer of the Memorial Hermann Accountable Care Organization, and chairman of MHMD’s Clinical Programs Committee. In those roles, he developed a robust clinic integration program with over 2000 physicians and over 50 physician-led committees providing quality, safety and vendor governance for Memorial Hermann. He spearheaded the development of Memorial Hermann’s Patient Centered Medical Homes and Care Management program that formed the bedrock of the most financially successful Medicare Shared Savings Program for 3 years running with over 180 million dollars in shared savings, as well as multiple high performance commercial ACO, Medicare Advantage and risk based contracts.

Gary Kay, PhD - Georgetown University / Cognitive Research Corporation
Dr. Gary Kay is an Associate Professor of Neurology at Georgetown University School of Medicine and the President of the Cognitive Research Corporation.  He is the author and publisher of the CogScreen-Aeromedical test battery.   Dr. Kay has a clinical practice focusing on aviation neuropsychology. He teaches and conducts research on the effects of medications on brain functioning.  He is a senior neuropsychology consultant to the U.S. Federal Aviation Administration and also serves as a consultant to airline medical departments, military medical organizations, other governmental agencies and to the pharmaceutical industry.  He is the co-editor of the recently published book, Aeromedical Psychology.  Widely published, he has been an invited speaker at professional meetings across the globe.  

Melinda Hancock, CPA, FHFMA - Dixon Hughes Goodman LLP / Healthcare Financial Management Association

Melinda Hancock is a Partner at Dixon Hughes Goodman, one of the top 20 largest accounting firms in the U.S. She also currently serves as National Chair for the Healthcare Financial Management Association.  Melinda’s executive leadership at DHG Healthcare includes responsibility for development of services pointed to the mandatory elements of payment reform: value-based purchasing, readmissions, hospital-acquired conditions, shared savings models, governmental and commercial bundled payments, and the Medicare innovation model.

Kenneth Davis, MD, MSc. HP&M, FACP - Formerly San Antonio Methodist Healthcare System / Baldrige Performance Excellence Program
Dr. Kenneth Davis is the former Chief Medical Officer of San Antonio Methodist Healthcare System, having filled that role since 2008. Methodist Healthcare System serves San Antonio as an eight-hospital system with over 2000 beds and 3000 physicians on staff.  During his tenure, Methodist was honored with the Texas Gold Quality Award, the Bill Aston Award for Quality, and the Texas Award for Performance Excellence Texas Baldrige Award. Prior to working with Methodist, he served for sixteen years as the Chief Medical Officer at North Mississippi Health Services, a six-hospital health system in Northeast Mississippi.  The flagship hospital, North Mississippi Medical Center, was a recipient of the Malcolm Baldrige National Quality Award in 2006 and again in 2012 for the entire health system.  Well-versed in quality, Ken is a Fellow in the American College of Physicians and a Six Sigma Black belt. He was appointed by the US Secretary of Commerce to serve on the Judges Panel of the Malcolm Baldrige National Quality Award in 2015.

Paul Westbrook - Independent Consultant / Formerly Inova Health System
Mr. Paul Westbrook is an Independent Consultant. He previously served at Inova Health System from 2012 to 2015 as Vice President of Patient Experience where he was responsible for the creation, implementation and maintenance of systems that deliver excellent patient experiences.  Prior to joining Inova, Paul began his service delivery consulting company, Westbrook Consulting, with the mission of transferring his 35 years of hospitality service in branding, strategic deployment, and operations to other service industries, to give back to his community and make a meaningful difference in peoples’ lives. Paul’s previous career with The Ritz-Carlton and Marriott International spanned more than 26 years. He now serves on the Boards of the Malcolm Baldrige National Quality Awards and the Beryl Institute.



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