As hospitals strive to remain profitable and competitive in today’s health care environment, the addition of a Physician Advisor (PA) to the administrative staff is viewed as not only good for business but also as good for patients.
Once a role typically filled by physicians who were nearing retirement, the Physician Advisor has evolved into a position that is part compliance expert, part patient care coordinator, and part hospital administrator. The PA’s role is to perform in an advisory capacity with:
- Utilization of Hospital Resources (Level of Care and Length of Stay)
- Documentation and Compliance
- Clinical Review of Patients
- Medical Necessity Protocol
- Care/Case Management with Physicians and Staff
- Quality of Care Provided
- Referrals to Alternative Facilities (Physical Therapy, Hospice, etc.)
- Insurance Claims (Appeals of Denials)
- Informing Physicians About Regulatory Changes
- Informing Staff About ICD Code Changes and Interpretation
- Patient Satisfaction
- Physician Peer Review
The Affordable Care Act outlines specific guidelines for the unique role of a PA as the job is complex and exists to serve both the provider (hospital) and the patient. This pivotal position serves as a bridge between the hospital’s clinical staff and the administrative staff and works to improve communication on all levels. As a result of this increased interaction between physicians, staff, and patients, the patients receive better care.
With the ever-changing compliance environment, a PA must stay informed and current about every aspect of patient care from quality of care to medical necessity guidelines. The PA serves as a liaison to ensure that the patient receives appropriate care and that all medical services rendered are correctly submitted for reimbursement. When necessary, the PA coordinates the appeal process if an insurance claim is denied.
What Knowledge and Expertise Do You Need?
A medical degree and experience in utilization management is the ideal background for a PA. Degrees in Internal Medical, Family Practice, or Emergency Medicine are particularly useful due to the broad background provided by these specialty areas. Naturally, other specialty areas of medicine can also provide the appropriate background to perform well as a PA. Success as a PA is always dependent on the unique combination of training, experience, and temperament of any given individual.
Medical knowledge is integral to the PA’s role in peer review activities as well as in the process of appealing health insurance claim denials. Because the PA coordinates and supervises a wide range of activities with the hospital’s medical and administrative staff as well as with patients, their families, and health insurance carriers, excellent communication skills are a necessity.
Temperament Is Key
Is a PA role right for you? Even if you have a stellar background in medicine and can point to years of success as a physician, a PA position may still not be a good fit for you. The successful PA brings a broad medical knowledge to the job as well as a comprehensive understanding of utilization management and necessity of care protocols, an interest in keeping current with compliance and insurance regulations, and a passion to deliver quality care to patients. But there is still one key ingredient that can’t be taught in any medical school or hospital setting – temperament. Do you have the communication skills of a seasoned diplomat to help you navigate the choppy waters when you must make a recommendation or suggestion that is contrary to what a physician has ordered or what the staff is accustomed to providing in a similar case? Always maintaining that delicate balance between advisor and advocate is the mark of a successful and valuable PA.
In addition to the daily interactions with physicians, patients, patients’ families, and hospital staff, a PA also has to commit to a heavy load of committee work and meetings on topics such as “Quality of Care, “Safety,” and “ICD 10 Updates.” Attending (or running) these topic-specific meetings and/or workshops is integral to the successful performance of a PA’s duties.
This is an exciting and growing area of medicine – one that has a direct effect on a hospital’s bottom line. As a PA, you can not only ensure that your hospital receives every reimbursement dollar that is appropriate from insurance, but you also assist in helping the hospital achieve increased patient satisfaction and better health outcomes for its service area.