Curriculum Vitae

July 1998-Present

Medical Director, Sports Medicine and Rehabilitation

International Inc. LLC

Parrish and Bradenton, Florida

January 1994-June 1998

Corporate Medical Director, Olympus Healthcare Group,

Westborough, Massachusetts

•  As Chief Clinical Operating Officer/Corporate Medical Director at Olympus Healthcare Group, Inc., held fiscal responsibility for $184M Annualized Net Revenues ($95M from Skilled Nursing Home Operation, $80M from Long-Term Hospitals and Hospital Units, and $9M from Contract Ancillary Therapy Services [PT, OT, SLP, Psych and Respiratory]).  Primary role was to develop, implement and monitor the fiscal effectiveness of quality clinical operations within various reimbursement models including capitation, PPS, managed care and federal and state funding.  Expertise included clinical resource management model development, implementation and monitoring for both inpatient and outpatient post-acute/subacute settings.  Responsible for predictive budgeting, designing staffing models within a framework of appropriate quality and utilization management.

• Designed and implemented Olympus’ Progressive Care System, innovative clinical pathways that covered over 240 various medical, surgical and rehabilitative diagnoses by which all patient care is planned, implemented, monitored and evaluated against consumer goals and expectations.  This Progressive Care System serves as a model for post-acute care delivery within all of Olympus’ inpatient and outpatient programs.  Additionally, assisted in the designed and integrated effective clinical resource models within the post-acute care delivery system for ancillary services (PT, OT, SLP, Psych, and Respiratory Therapy).

• Reported all clinical services including Senior VP’s of Managed Care Contracting, Marketing, Program Development/Outcome Systems and Clinical Information Systems.

• The managed health care delivery experience included development and negotiation of managed care contracts such as Tufts, Harvard Pilgrim, United Healthcare, Blue Cross Blue Shield, as well as physician-hospital HMO capitated contracts.  Operational systems were designed and monitored to ensure effective clinical and efficient fiscal outcomes while assuring that all beneficiaries received quality and cost effective care.  Parallel automated clinical information systems were created that allowed for as close to as real time fiscal, clinical and outcome monitoring.  Alternative purchasing arrangements were also created for these health services which enabled clinical operations to improve quality and utilization.

• Collaborated with large multi-specialty physician groups to align clinical systems and operations which allowed best practices in Medicare Risk products.  Designed and implemented a nationally recognized risk stratification tool, applied to over 100,000 enrollees.

• Developed model physician profiling and staffing system through organizational restructuring.  Provided direct oversight of physician practice, resource utilization, formulary development and compliance and quality outcome monitoring.  Physician profiling included physician utilization, clinical outcomes, complication types and rates, pharmacy/formulary usage, length of stay to diagnosis comparisons and readmission rates.

• Provided provider network for community health care continuum including experience in contract negotiation with over forty hospital, sixty skilled nursing facilities and transitional units, twenty outpatient centers, three home health companies, contract psychological services, contract respiratory services, specialized parenteral nutritional services as well as specialized programs of neurological, neuromuscular, dementia and behavior conditions.

• Designed automated systems for quality monitoring, utilization review, nursing and therapy staffing models in response to PPS.  Created automated monthly reporting of clinical and fiscal outcomes across the post-acute continuum, which facilitated more effective utilization of corporate and regional resources.

• Provided clinical and operation support for patient relations, claims adjudication, benefit definition as well as consumer--patient and payer satisfaction.

• Worked closely with Federal and State Codes as Co-Chair to the committee for Revision of the Long-Term Care Public Codes for the State of Connecticut.  Additionally represented the subacute industry in its concerns regarding reimbursement changes in SNF’s at HCFA in Baltimore.  Co-authored an analysis of resource utilization in a medically complex subactue SNF facility to the House Ways and Means Committee at the request of the National Subacute Care Association (NSCA) in March 1998.

• Presented for the NSCA Institute, educating administrators, physicians and clinicians in PPS reimbursement and clinical realignment.  Additionally, Co-Chair of the NSCA Institute and member of the Education Committee.

BOARD CERTIFICATION:

 American Board of Physical Medicine and Rehabilitation—Fellow  May 1990

LICENSURE:

            Florida #ME0061947

          Georgia #003616

          Illinois #036-078809

CLOSE WINDOW