December 7, 2016

Honoring Hirsch’s Healthcare Heroes

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With the end of the year comes the announcement of this year’s Hirsch’s Heroes (you can find a rundown of the 2015 Heroes at this link), individuals I annually cite for their contributions to the world of healthcare and compliance.

My first hero of 2016 is Ian Mattis, the Comprehensive Error Rate Testing (CERT) supervisor for Novitas, one of the Medicare Administrative Contractors (MACs).

I first encountered Ian several years ago, when I sent in a question to Novitas about a Centers for Medicare & Medicaid Services (CMS) publication. Ian responded to me quickly with a thorough and understandable answer. And of course, when you encounter someone like that, you keep their contact information. So when Novitas published a series of CERT audit results and several appeared to be incomplete or inaccurate, I contacted Ian again. And not only did he get back to me quickly again, but he set up a conference call with several of his audit staff, including nurses and coders, and we went through each case in depth. Then, when a hospital contacted me about what they felt was an inappropriate pacemaker denial, I once again contacted Ian and worked with the hospital to arrange a conference call to review the denial and the application of the NCD requirements to that particular case and in general. Ian’s willingness to help me and help providers makes him one of my heroes.

My next hero is Dr. Juliet Ugarte Hopkins. She is the system physician advisor for ProHealth in Wisconsin. She is unique in a couple of ways; she practiced as a pediatric hospitalist, which is an unusual specialty to lead into becoming a physician advisor, and she left the hospital in Illinois where she was in practice to become the physician advisor at a system where she had never practiced prior. But she devoted herself to learning about becoming a great physician advisor by joining the American College of Physician Advisors, attending multiple conferences, and becoming certified as a physician advisor through the American Board of Quality Assurance and Utilization Review Physicians.

She also became a board member of the Wisconsin chapter of the American Case Management Association and received rave reviews for her talk at the Accretive Physician Advisor symposium on how she learned to love the role of physician advisor. For setting an example after which all physician advisors can model themselves, I name Dr. Ugarte Hopkins as one of my heroes. 

And last but not least is my third hero, Dr. Michael Salvatore. He is the physician advisor at Beebee Medical Center in Lewes, Del. Dr. Salvatore practiced for many years as a pulmonologist and critical care physician, where he never saw an orifice into which he could not order a tube to be placed.

But like many physicians, as he gained experience and wisdom, he saw that more is not always better, and he became a specialist in palliative care. So as a physician advisor he could use his training in critical care and palliative care to really put things in perspective for patients, families, and especially for other doctors, many of whom never learned how to say “no” to a request to do something more.  

But the main reason he is named as one of my heroes is his mastery of the English language and his ability to provide levity at the times when frustration is at its worst. Dr. Salvatore is a constant presence on RAC Relief, where he has posted such statements as this: “I think what CMS is saying is that the ignorance of their ignorant interpretation of regulation is the only ignorance they are interested in. But this begs the question of whether ignorance of ignorance is ignorance. Using the double negative rule, either grammatically or mathematically, ignorance of ignorance is understanding, which is why we all understand what is going on here.“

When discussing the many ways that physician advisors and case managers help hospitals to reduce costs, he stated, with (I hope) no intent to offend me, “one of the problems is getting our C­suite to appreciate money saved, which is difficult due to the obsession and fascination with money spent, except when it is spent on consultants.”

So, thank you to Ian Mattis, Dr. Juliet Ugarte Hopkins, and Dr. Michael Salvatore for being my 2016 heroes.

EDITOR’S NOTE: Listen to Monitor Mondays on Dec. 12, 10-10:30 a.m. ET for coverage of the annual Hirsch’s Healthcare Heroes.

 

Ronald Hirsch, MD, FACP, CHCQM

Ronald Hirsch, MD, FACP, CHCQM is vice president of the Regulations and Education Group at R1 Physician Advisory Services. Dr. Hirsch’s career in medicine includes many clinical leadership roles at healthcare organizations ranging from acute-care hospitals and home health agencies to long-term care facilities and group medical practices. In addition to serving as a medical director of case management and medical necessity reviewer throughout his career, Dr. Hirsch has delivered numerous peer lectures on case management best practices and is a published author on the topic. He is a member of the Advisory Board of the American College of Physician Advisors, a member of the American Case Management Association, and a Fellow of the American College of Physicians. Dr. Hirsch is a member of the RACmonitor editorial board and is regular panelist on Monitor Mondays.

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