Physician Advisor Interactive Seminar

For both veteran Physician Advisors and those new to the role, it can be difficult to determine the typical duties important to the position as the role differs in every hospital. Participating in this interactive session helps Physician Advisors define the specific responsibilities and identify potential ways to improve workflow strategies that increase productivity and staff engagement.

Discussion points include:

• Educating medical staff
• Improving clinical documentation
• Reducing length of stay and readmission rates in order to gain better financial outcomes
• Participating in utilization review
• Collaborating with staff in other roles such as Case Management, Care Management, Coding, Quality, and Medical Affairs
• Discovering techniques to utilize the assistance of members of other departments and ways to integrate support services in order to alleviate aspects of a demanding workload

By setting benchmarks and determining valuable and specific goals, Physician Advisors can better organize time and resources, and create a vision for how the position or program should evolve.

• Determine annual goals based on hospital initiatives, including:
• Length of stay
• Readmissions
• Claim appeals
• Peer evaluation by Care Managers
• In order to achieve annual goals, define daily benchmarks such as:
• Frequency of case reviews
• When to have one-on-one peer meetings
• The amount to time to spend on rounds
• Develop peer-to-peer auditing of Physician Advisors
• Identify projects where the Physician Advisor viewpoint can benefit the institution

One challenge Physician Advisors face is defining and legitimizing their role and their program for other leaders in the organization. By clarifying the expectations of a Physician Advisor program, physicians can then leverage their position and gain buy-in from other members of the medical staff and administration.

• Determine expectations for the program, including the scope of support medical staff should expect from Physician Advisors and what Physician Advisors should expect from physicians and other medical staff
• Evaluate and create strategies for effective communication with other departments
• Discover methods for education and engagement of physicians, including what, when, and how to hold meetings or trainings

Regulations such as the Two-Midnight Rule and “Doc-Fix” Bill can affect the role of the Physician Advisor in multiple ways by changing requirements for how they handle short stay encounters or submit claims. Furthermore, the implementation of ICD-10 and more stringent audits have increased the focus of physicians and other medical staff on how to handle different issues like clinical documentation improvement, determining medical necessity, and billing for short-stays.

Attendees are invited to bring sample cases to informally review together and discuss medical necessity. A “working lunch” area will be designated for those wishing to collaborate during this time.

Physician Advisors do not typically have formal training in business or finance, but it is often necessary to understand various aspects of hospital finance such as how payer contracts are negotiated and who negotiates them, as well as enough understanding of claims management to be proactive in handling denials.

This session breaks down the most important aspects of hospital finance that are essential to the duties of Physician Advisors.

• Analyze the impact Physician Advisors have on hospital finances
• Understand the DRG system and how Physician Advisors affect hospital reimbursement through their determination of classification
• Learn about the impact of the shift to ACOs and bundled payments
• Determine the potential impact of short stay DRGs.
• Discuss strategies to best serve the needs of your colleagues in Finance

Physician Advisors often must write appeal letters when a claim as been denied and the hospital does not receive accurate payment for services provided. Learn successful strategies for communicating to auditors, including the preferred language that should be used in writing articulate and convincing letters.

• Share templates used to write successful letters
• Explore ways to reduce the number of denials
• Learn strategies to succeed in receiving claims

Collecting the appropriate data and tracking important metrics are essential to determine areas of improvement for a Physician Advisor program as well as what’s working well and what needs more focus. This data can also be important in demonstrating the worth of the Physician Advisor and illustrating growth in the program. By keeping track of data relevant to productivity and financial outcomes, Physician Advisors are better able to promote the value of their work, including the financial value to the organization.

• Review important metrics to track such as Code 44s, appeals won and lost, and number of cases reviewed
• Determine strategies to use data in order to show productivity and growth in the role and in the Physician Advisor program
• Understand what data to monitor in order to predict and track financial outcomes

With ICD-10 implementation quickly approaching, Physician Advisors must become champions of documentation improvement, DRG shifts, and training strategies in order to prepare physicians for the change.

• Discuss transition strategies and identify a plan for the crossover, including preparing physicians and other members of the medical staff
• Review ICD-10 terminology as well as ICD-9 codes that will be important to identify during the changeover
• Identify key focus areas for CDI including query rates, agreement rates, and chart reviews, that have a financial impact on an organization