uft-a - The Business Case for Quality: A Unified Field Theory Applied to Health Care Alice G. Gosfield P.C. line_2px.gif (105 bytes) The Reinertsen Group

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Alice G. Gosfield

Alice G. GosfieldALICE G. GOSFIELD, Esq.’s entire legal career has been devoted to health law with an emphasis on representation of physicians and their group configurations and a focus on non-institutional reimbursement including Medicare; managed care; fraud and abuse compliance and avoidance; medical staff issues; and utilization management and quality issues. A graduate of Barnard College and New York University School of Law, since 1973 her varied health law career has ranged from an OEO ("War on Poverty") and then DHEW funded research program to develop a consumer-oriented analysis of the PSRO law, to drafting codes of regulations for state health care agencies, and since 1978 to include the private practice of law.

Ms. Gosfield served as Chairman of the Board of Directors of the National Committee for Quality Assurance, reelected to serve five terms from 1998 through 2002. She served on the Board for twelve years from1992 through 2003. In the public policy arena, she has served on four committees of the Institute of Medicine of the National Academy of Sciences studying issues involving utilization management and clinical practice guidelines and has served as an advisor to the Agency for Health Care Policy and Research in both evaluating one of their first three clinical practice guidelines and in developing methodologies to translate guidelines into medical review criteria, performance measures and standards of quality. She is currently participating as an Advisory Board Member of an 8 person group convened by the American College of Physicians to serve for three years in developing an approach to pay for performance. She is also part of a small, national, multistakeholder project to develop a new provider payment model (PROMETHEUS Payment®) that will base provider payment on the cost of delivering guidelines based care as measured in a comprehensive scorecard. The model is designed for and expected to lower administrative burdens in the system over time, while improving the quality of care by paying for what science says patients should be treated with for their condition.

She has been called on by the Congressional Budget Office, the General Accounting Office, the Robert Wood Johnson Foundation, the Federal Agency for Healthcare Research and Quality, the Joint Commission on Accreditation of Healthcare Organizations, and others to advise on issues pertaining to Medicare reimbursement, medical evidence, legislation dealing with medical necessity in managed care and tort reform. Ms. Gosfield served as President of the American Health Lawyers Association (formerly the National Health Lawyers Association, from 1992-1993 and Chairs their Physician and Physician Organizations Institute.

A highly sought after speaker, Ms. Gosfield has been invited to lecture throughout the country and internationally to diverse audiences including physicians and other health care professionals, chief executives and chief financial officers, boards of trustees and directors, group managers, managed care executives and others throughout the health care industry. She is noted for her practical yet provocative, incisive, down-to-earth style and ability to make complex technical information understandable as well as entertaining. She lectures often for a variety of organizations including the American Health Lawyers Association (AHLA), the American Medical Association (AMA), the Medical Group Management Association (MGMA), America’s Health Insurance Plans (AHIP), and the American College of Cardiology as well as other national, state and regional groups.

A frequent author in a wide range of health care publications, her second book – Guide to Key Legal Issues in Managed Care Quality– was written primarily for non-lawyers and was published in 1996 by Faulkner and Gray. Since 1989, she has been the editor of the annual HEALTH LAW HANDBOOK, published by West, a Thomson Company which issues a completely new book each year . She also now authors MEDICARE AND MEDICAID FRAUD AND ABUSE, an annually updated treatise also published by West. She serves on the editorial boards of multiple diverse journals and newsletters including Healthplan (published by AAHP), Medical Economics, Managed Care, several Brownstone Publisher newsletters and The Journal of Health Care Compliance. She is a contributing editor to Family Practice Management.

She has been a member of several physician-organization sponsored consulting networks including those of the AMA, the American College of Physicians, the American Academy of Family Physicians, and the American Society of Plastic and Reconstructive Surgeons.

She has been listed in The Best Lawyers in America (Health Law) in every edition since the inception of the health law category. She has been recognized internationally for her health law expertise by the International Centre for Commercial Law in the United Kingdom as one of The Legal 500, a select group of 500 law firms in the United States recommended for their specific abilities in particular areas of the law.


James L. Reinertsen, M.D.

James L. Reinertsen, M.D., heads The Reinertsen Group, an independent consulting and teaching practice helping health care leaders create organizational environments in which the work of nurses and doctors can thrive. He brings to this work an unusual combination of skills and experience:

  • He practiced rheumatology for twenty years, earning a reputation as a superb, patient-centered consultant
  • He was a respected CEO of complex health care systems in two challenging markets, Minneapolis and Boston, over a fifteen-year span
  • Throughout his career, he has functioned as an innovative thought leader in health care leadership development, clinical quality improvement, patient safety, and health care market design.

Dr. Reinertsen now brings his skills and experience to the Institute for Health Care Improvement in Boston, (where he is a Senior Fellow, responsible for IHI’s Executive Quality Academy,) and to hospitals and health care systems throughout the United States and Europe. He was a subcommittee member of the Institute of Medicine’s work that produced the landmark publications “To Err Is Human” and “Crossing the Quality Chasm,” and continues to author influential papers in major medical journals.

From July 1998 to August, 2001, Dr. Reinertsen was Chief Executive Officer of both CareGroup, a six hospital, 1400 physician system, and of Beth Israel Deaconess Medical Center, a teaching hospital of the Harvard Medical School. During his tenure at CareGroup, he was also Professor of Medicine at Harvard Medical School.

Before his engagement at CareGroup, he served as the Chief Executive Officer of Park Nicollet Health Services (formerly HealthSystem Minnesota) in Minneapolis, an integrated care system that includes Methodist Hospital and Park Nicollet Clinic. He was President and CEO of Park Nicollet Medical Center from 1986 to 1992, and President of Park Nicollet Medical Foundation from 1983 to 1985.

From 1992 to 1997, Dr. Reinertsen was Chairman of the Institute for Clinical Systems Improvement (ICSI), a collaborative effort to develop and implement best practices in health care, sponsored by the Buyers Health Care Action Group, Park Nicollet, Mayo Clinic, and HealthPartners - a Twin Cities health plan. ICSI is a nationally recognized example of what physician groups that otherwise compete with each other can accomplish when they collaborate around common professional and business goals.

A frequently invited speaker on these issues for physician, hospital, and integrated delivery system organizations, he also has authored more than 40 articles in journals such as Health Affairs, Annals of Internal Medicine, British Medical Journal, New England Journal of Medicine, and the Joint Commission Journal on Quality Improvement.

Dr. Reinertsen’s new book, Ten Powerful Ideas for Patient Care Improvement, coauthored with Dr. Wim Schellekens, CEO of the Dutch Institute for Quality, was published by Health Administration Press in April 2005.

Dr. Reinertsen is Past President of the American Medical Group Association, and is a former member of the Board of Directors of the American Board of Internal Medicine.

He joined Park Nicollet Medical Center as a consultant in rheumatology in 1978, following two years as a Clinical Associate at the National Institutes of Health in Bethesda, Maryland. A member of Alpha Omega Alpha, he received his medical degree from Harvard Medical School in 1973, and completed an internship at San Francisco General Hospital in 1974, and a residency at the University of California Hospital in 1976. Doctor Reinertsen is a 1969 summa cum laude, Phi Beta Kappa graduate of St. Olaf College in Minnesota. He makes his home in Alta, Wyoming.

 

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