www.medicareadvocacy.org

Center for Medicare Advocacy, Inc.

 

Advancing fair access to Medicare and health care

 

 

 
   

Beyond QIO:
Modeling a Medicare Beneficiary Complaint Process for Quality of Care

PARTICIPANTS' BIOGRAPHIES


Ignatius Bau, J.D.

Mr. Bau joined the California Endowment in 2003 and is currently Director of Culturally Competent Health Systems there. In his current capacity, he is responsible for the program planning, grant making, and budget for the foundation’s Cultural Competence and Work Force Diversity programs. Prior to joining the Endowment, Mr. Bau served for seven years in a number of capacities with the Asian and Pacific Islander American Health Forum, a national health policy advocacy organization headquartered in San Francisco. His most recent position there was deputy director for Policy and Programs. Mr. Bau, a San Francisco resident, received his J.D. from the Boalt Hall School of Law at the University of California, Berkeley.

Christine A. Bechtel

Ms. Bechtel is Vice President of Government Affairs for the American Health Quality Association (AHQA) where she represents the interests of AHQA’s members before Congress and the Administration. Prior to joining AHQA, Ms. Bechtel served as Senior Research Advisor at AARP and as the Director of Community Development for Louisiana’s Medicare Quality Improvement Organization. Ms. Bechtel also worked for United States Senator Barbara A. Mikulski (D-MD).

Robert Berenson, M.D.

Dr. Berenson is a Senior Fellow at the Urban Institute. From 1998-2000, he was in charge of Medicare payment policy and managed care contracting in the Health Care Financing Administration. Dr. Berenson is a board-certified internist who practiced for 20 years. He recently co-authored with Rick Mayes Medicare Payment Policy and the Shaping of U.S. Health Care. His current research focuses on modernization of the Medicare program to improve efficiency and the quality of care provided to beneficiaries.

 Sheila C. Blackstock, R.N., B.S.N., J.D.

Ms. Blackstock received her B.S.N. from Texas Woman’s University in 1985 and her J.D. from the University of Houston Law Center in 1999. She served 9 ½ years in the United States Air Force Nurse Corps and rejoined the uniformed services as an officer in the United States Public Health Service in 2002. She is currently a Division Director in the Quality Improvement Group (QIG) of the Centers for Medicare & Medicaid’s Office of Clinical Standards and Quality. QIG is responsible for implementing the QIO program, including the beneficiary complaint response program.

Chad Boult, M.D., M.P.H., M.B.A.

A geriatrician by training, Dr. Boult has extensive experience in developing, implementing, and evaluating the outcomes of new models of health care for older populations. His current research includes Guided Care, a new model of primary care for older people with multiple chronic conditions. At Johns Hopkins University, he directs the Lipitz Center for Integrated Health Care. 

Eric Carlson, Esq.

Mr. Carlson is an attorney for the National Senior Citizens Law Center. He is the author of Long Term Care Advocacy, the leading legal treatise on long-term care issues, and two recent publications for consumers: 20 Common Nursing Home Problems, and How to Resolve Them and (with Katharine Hsiao) The Baby Boomer’s Guide to Nursing Home Care

Alfred J. Chiplin, Jr., Esq. (Steering Committee)

Mr. Chiplin is a Senior Policy Attorney and managing attorney in the Washington, D.C. office of the Center for Medicare Advocacy, Inc. He specializes in Medicare beneficiary coverage and appeals, with an emphasis on access to home health care, discharge planning and transitional care services, and assuring and assessing the quality of care.  With Judith A. Stein, Esq., Mr. Chiplin is Editor-in-Chief of the Medicare Handbook, Aspen Publishers (8th Edition, January 2007). He is a member (and past chairperson) of the Public Advisory Group on Health Care Quality, Joint Commission on Accreditation of Healthcare Organizations (JCAHO), a Fellow in the National Academy of Elder Law Attorneys (NAELA), and a member of the National Academy of Social Insurance (NASI). 

Mike Connors

Over the last 30 years, Mr. Connors has worked for and helped establish advocacy organizations that fight to prevent neglect and abuse of nursing home residents and others needing long-term care. He currently works for California Advocates for Nursing Home Reform (CANHR) as a member of its advocacy team.

Paul Cotton

Mr. Cotton is a Senior Legislative Representative at AARP, lobbying Congress and the Administration on Medicare and Medicaid issues. He worked for several years as a reporter for publications including the Journal of the American Medical Association. He also was Director of Hearings and Policy Presentation at the Centers for Medicare and Medicaid Services. 

Carol Cronin, M.S.W., M.S.G.

Ms. Cronin has over twenty years experience working on health care and aging issues – with a particular interest in consumer health information and Medicare. Since 2000, she has worked as a consultant and advisor to a number of non-profit organizations, foundations and government agencies. These include the California Endowment, AARP, and the Delmarva Foundation. 

Kenneth Dardick, M.D.

Dr. Dardick is a family physician and a member of a five-physician group practice, which he founded in 1976. His patients include infants, children, and adults of all ages. Dr. Dardick’s interests include public health and health policy. He has served as Director of Health and is currently the Medical Adviser to a local health district in Connecticut. He has been a Councilor to the Connecticut State Medical Society and was instrumental in the passage of Connecticut's Seat Belt Law as President of the Connecticut Safety Belt Coalition. 

Joyce Dubow (Steering Committee)

Ms. Dubow is Senior Advisor in AARP’s Office of Policy and Strategy where she has responsibility for a broad health portfolio related to AARP’s health care reform initiatives. She has had a special focus on private health plans in the Medicare program, health care quality and health literacy. Ms. Dubow recently completed two terms on the Standards Committee of the National Committee for Quality Assurance (NCQA) and serves on the NCQA Geriatrics Measurement Panel as well as its Consumer Council. She is also a member of the National Quality Forum Review Committee on Standardizing Ambulatory Care Performance Measures; the Personal Health Technology Council of the Markle Foundation; and the Public Advisory Group on Health Care Quality of JCAHO.  

Toby S. Edelman, J.D. (Steering Committee)

Ms. Edelman is a Senior Policy Attorney with the Washington, D.C. office of the Center for Medicare Advocacy, Inc. Since 1977, she has focused on long-term care, particularly issues involving quality of care, the public regulatory system, and various legal aspects of residents' rights. She has written a monthly mailing on nursing home enforcement issues since 1999. 

Sue Felt-Lisk, M.P.A.

Ms. Felt-Lisk is a senior health researcher at Mathematica Policy Research who has led many studies of quality improvement initiatives for the Centers for Medicare & Medicaid Services and foundations including hospital case studies to identify ways the Quality Improvement Organizations could better support transformational change, and the evaluation of a health plan collaborative pay-for-performance program in Medicaid. She is currently studying the implementation of pay-for-performance for small physician practices under Medicare through the Medicare Care Management Performance Demonstration.

Vicki Gottlich, J.D., L.L.M.

Ms. Gottlich has been an attorney at the Center for Medicare Advocacy, Inc. since 2000, when she helped open the Washington, D.C. office. Previously, she was a staff attorney at the National Senior Citizens Law Center for 13 years. She has focused on Medicare-related work including policy, research, and education regarding the importance of Medicare as a social insurance program. She is a member of the National Academy of Social Insurance. Ms. Gottlich received her J.D. from New York University and her L.L.M. from George Washington University. 

Stuart Guterman, Ph.D.

Dr. Guterman directs the Commonwealth Fund’s Program on Medicare’s Future. Previously, he led the Office of Research, Development, and Information at the Centers for Medicare & Medicaid Services, and was Deputy Director at the Medicare Payment Advisory Commission and its predecessor, the Prospective Payment Assessment Commission.

Leif Wellington Haase

Mr. Haase, Senior Program Officer and Health Care Fellow at the Century Foundation, was staff director of the foundation’s Task Force on Medicare Reform and co-author of its final report, Medicare Tomorrow. He is also the author of A New Deal for Health, a universal health coverage proposal for the United States.  

Sally Hart, J.D., M.B.T. (Steering Committee)

Ms. Hart is consulting counsel to the Center for Medicare Advocacy, Inc. in Willimantic, Connecticut. She graduated from Stanford University and Boston University School of Law (cum laude), and received a Masters in Business Taxation from U.S.C. Ms. Hart specializes in health benefits law and has represented Medicare beneficiaries in numerous class-action lawsuits that expanded rights to procedural protections when health services are denied.

Diane E. Hoffmann, J.D., M.S. (Steering Committee)

Professor Hoffmann is Professor of Law, Associate Dean for Academic Programs and Director of the Law & Health Care Program at the University of Maryland School of Law. She received her law degree from Harvard Law School and her Master’s degree from Harvard School of Public Health. Prior to joining the faculty at Maryland in 1987, she practiced with the firm of Dewey, Ballantine in Washington, D.C. From June 1994 to May 1995, while on leave from the Law School, she served as the Acting Staff Director of the Senate Subcommittee on Aging, reporting to Senator Barbara Mikulski.

Peter A. Hollmann, M.D. (Steering Committee)

Dr. Hollmann is a physician practicing in general internal medicine and geriatrics in Rhode Island. He is also a senior medical director for Blue Cross and Blue Shield of RI. He has been a medical director of a hospital for chronic diseases, a home care agency, a nursing facility and a Medicare Advantage health plan. Dr. Hollmann has served on the board of the Rhode Island QIO and his professional focus has been quality improvement. He is also vice chair of the American Geriatrics Society Public Policy Advisory Group.  

Carol Jimenez, Esq.

Ms. Jimenez represents consumers’ interests with respect to the health care system. She has been Director of Litigation and Supervising Attorney for the Center for Health Care Rights in Los Angeles and is Legal Counsel to California Health Advocates (representing the interests of California’s Medicare population). Since 1997, she has been in practice in Long Beach, California. She has successfully litigated numerous cases involving Medicare and managed care issues.

Eleanor Kinney, J.D., M.P.H.

Professor Kinney is the Hall Render Professor of Law and founding director of the William S. and Christine S. Hall Center for Law and Health at Indiana University School of Law – Indianapolis. She is also an adjunct professor in the Schools of Medicine and Public and Environmental Affairs. A widely published author and respected lecturer on the subjects of America’s health care system, medical malpractice, health coverage for the poor, and issues in administrative law, Professor Kinney is author or co-author of numerous law review articles, book chapters, and book reviews.

Wendy A. Kronmiller, Esq.

Ms. Kronmiller, appointed in April 2006 as Director of the Office of Health Care Quality (OHCQ), within the Maryland Department of Health and Mental Hygiene. As Director, she is responsible for managing federal and State regulatory activities in Maryland’s 8,000 health care and community residential programs including nursing homes, hospitals, HMOs, and group homes. 

Patricia Kurtz

Ms. Kurtz serves as the Director of Federal Relations for the Joint Commission on Accreditation of Healthcare Organizations (JCAHO). In that role, she is responsible for a range of activities that foster productive relationships with healthcare policy makers, federal agency officials, and key health care legislators. She strives to ensure that those who influence and set national health care policy understand how a voluntary program of standard setting and health care provider evaluation benefits the public interest. 

Yvonne Y. Lee

For over three decades, Ms. Lee has been a community advocate for civil rights for Asian Americans and Pacific Islanders, promoting awareness and relations between AAPI and other communities. She currently heads Lee Asian Community Affairs, a San Francisco-based public policy and media relations consulting business. She also writes an opinion column for a major Chinese language magazine. In 1995, Ms. Lee was appointed by President Clinton to serve on the U.S. Commission on Civil Rights, a bipartisan fact finding federal agency with a statutory responsibility to monitor and investigate civil rights violations and concerns. 

Keith D. Lind

Mr. Lind is a Senior Policy Advisor in AARP’s Public Policy Institute. He provides analysis and advice regarding a variety of health policy issues with particular emphasis on Medicare reform, long term care, home health care, chronic care, and rehabilitation therapy issues. His work involves Medicare coverage and reimbursement issues, including prospective payment systems, fee schedules and cost-based reimbursement for hospitals, skilled nursing facilities, home health agencies, physicians, and supplies.  Mr. Lind monitors and assesses the implications of legislative and regulatory changes on the Medicare program, its policies and beneficiaries.   

Sarah Lock, Esq.

Ms. Lock is a Senior Attorney/Manager with AARP Foundation Litigation, advocating in court on behalf of older Americans. She specializes in health care impact litigation, particularly on Medicare, Medicaid, managed care, and prescription drug issues. Formerly, Ms. Lock was a Department of Justice trial attorney. 

Patricia Nemore, Esq.

Ms. Nemore is a senior policy attorney with the Center for Medicare Advocacy, Inc. She has been an advocate for people seeking health care for nearly thirty years. Her practice has focused on Medicare, Medicaid and long-term care, with special emphasis on issues of importance to those dually eligible for Medicare and Medicaid. She has engaged in individual advocacy, class action litigation and legislative and administrative advocacy at the national level. 

Diane F. Paulson, Esq.

Ms. Paulson is a Senior Attorney for the Medicare Advocacy Project of Greater Boston Legal Services (GBLS) in Boston, Massachusetts, a program which assists Massachusetts Medicare beneficiaries to obtain the coverage to which they are entitled. She has practiced elder law since 1982 and has specialized in health law since 1986. She writes and speaks extensively on Medicare and Medicare-related health issues. 

Lisa A. Robin

Ms. Robin is Vice President of Government Relations, Policy, and Education with the Federation of State Medical Boards (FSMB), a national non-profit association of the 70 medical licensing and disciplinary boards in the United States and territories. She oversees FSMB’s government relations, public policy analysis and development, education services, and Internet Clearinghouse. Ms. Robin earned a Bachelor of Science degree from Texas Christian University. 

Virginia Rowthorn, Esq. (Steering Committee)

Ms. Rowthorn joined the University of Maryland School of Law in 2006 as Director of Health Law Externships and Coordinator of the nationally recognized Law & Health Care Program. In that role, she advises students pursuing the certificate of concentration in health law, administers the Health Law Practicum and Externship Program, acts as liaison with the Student Health Law Organization, and teaches the Health Law Practice Workshop. Before joining the School of Law, Ms. Rowthorn was an attorney in the Legislative Division of the Office of General Counsel at the Department of Health and Human Services.  

Michael Rubin

Mr. Rubin is a project assistant with the Center for Medicare Advocacy, Inc. Previously, he was a research assistant at the New York State Psychiatric Institute, where he supervised the execution of psychopharmacological research protocols. Mr. Rubin graduated from Columbia University in 2004. 

David G. Schulke

Mr. Schulke is the Executive Vice President for the American Health Quality Association. He worked for both Democratic and Republican Members of the U.S. Senate and House of Representatives from 1983-1995, conducting congressional investigations of the quality of health care products and services in hospitals, physician offices, nursing homes, and dialysis clinics. From 1978 to 1983 he led a community-based organization that vigorously advocated the interests of long-term care facilities, focusing on quality and access problems. 

Chad E. Shearer, J.D., M.H.A.

Mr. Shearer serves as Legislative Director for Congressman Pete Stark (D-CA), Chairman of the Ways and Means Subcommittee on Health. He handles healthcare, tax, trade, labor, financial services, and agriculture policy for the Congressman. He also acts as professional staff for the Subcommittee on Health. Prior to joining Rep. Stark’s staff, Mr. Shearer was a David A. Winston Health Policy Fellow with the Ways and Means Subcommittee on Health. Mr. Shearer earned J.D. and Master of Health Administration degrees from the University of Iowa, and holds a B.A. in Political Science from Coe College.  

Sharon Sprenger, R.H.I.A., C.P.H.Q., M.P.A.

Ms. Sprenger is the Project Director, Group on Core Performance Measurement in the Division of Research at the Joint Commission on Accreditation of Healthcare Organizations, Oakbrook Terrace, Illinois. In this position, she is responsible for performance measure identification, evaluation, pilot testing and implementation activities for core measures, and international initiatives as applicable to all Joint Commission accreditation programs/settings. In her current position she has been a primary interface with CMS and her respective QIO to create the common measure specifications for shared measure sets in the 7th and 8th Scope of Work. 

Judith A. Stein, Esq. (Steering Committee)

Ms. Stein founded the Center for Medicare Advocacy, Inc. in 1986 where she is currently the Executive Director. Ms. Stein has focused on legal representation of the elderly since beginning her legal career in 1975. From 1977 until 1986, Ms. Stein was the Co-Director of Legal Assistance to Medicare Patients (LAMP) where she managed the first Medicare advocacy program in the country. She has extensive experience in developing and administering Medicare advocacy projects, representing Medicare beneficiaries, producing educational materials, teaching and consulting. She has been lead or co-counsel in federal class action and individual cases challenging improper Medicare policies and denials. 

Barry M. Straube, M.D.

Dr. Straube is currently the Acting Director of the Office of Clinical Standards and Quality (OCSQ) and Acting Chief Medical Officer (CMO) at the Centers for Medicare & Medicaid Services (CMS). In his OCSQ role, Dr. Straube oversees several major elements of the CMS quality and clinical policy portfolio, including the development of national coverage policies and quality standards for Medicare and Medicaid providers; quality measurement and public reporting initiatives; and manages the Quality Improvement Organization (QIO) program. As Acting Chief Medical Officer, Dr. Straube serves as a senior advisor to the Administrator on clinical and scientific policy. 

Julie K. Taitsman, M.D., J.D.

Dr. Taitsman is currently Special Counsel for Health and Science on the U.S. Senate Finance Committee. She previously worked as senior counsel in the Industry Guidance Branch of the Department of Health and Human Services’ Office of Inspector General where she drafted advisory opinions on the anti-kickback statute. Prior to that, Dr. Taitsman worked as an associate with Arnold & Porter in the Health Care and Food, Drug and Medical Device Practice Group. She graduated from Harvard Law School and the Brown University School of Medicine. 

Ho Luong Tran, M.D., M.P.H.

Dr. Tran is President/CEO of the Asian & Pacific Islander American Health Forum (APIAHF), a national advocacy organization dedicated to promoting and researching efforts to improve the health and well-being of the Asian and Pacific Islander communities. 

Janet Wells

Ms. Wells is the Director of Public Policy at the National Citizens’ Coalition for Nursing Home Reform (NCCNHR), which provides information and leadership on federal, state regulatory and legislative policy development. NCCNHR also creates models and strategies to improve care for residents of nursing homes and other long-term care facilities. 

Jackson Williams

Mr. Williams is a Senior Policy Advisor in AARP’s Public Policy Institute. He provides analysis and advice regarding a variety of health policy issues. 

Mark R. Yessian, Ph.D.

Dr. Yessian is an independent consultant. He retired from the Office of Inspector General, U.S. Department of Health and Human Services in December 2005. There he oversaw many evaluations of the Medicare program, including the 1995 report entitled “The Beneficiary Complaint Process of the Medicare Peer Review Organizations.”

 
 



 

 
 
 
 

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