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Despite our best efforts, we continue to face challenges in getting our attending staff on board with revenue-cycle initiatives. Any suggestions?

Patient Financial Services Weekly Advisor, March 26, 2004

Although the relationship between attending staff and hospital staff is often tenuous, a team approach is vital to ensuring efficient and financially viable management of an inpatient. I can offer several suggestions.

Foremost, it's vital to create a dedicated team of physician advisors who can forward the hospital's revenue-cycle agenda. These doctors should have excellent interpersonal skills, and be able to have direct conversations with other physicians that result in a measurable change in behavior - and preferably not have a referral relationship with your attending staff.

In addition, focus continuing medical-education programs on teaching doctors why revenue-cycle initiatives are important, instead of getting them to change specific behavior. Anyone who has tried will tell you that InterQual is poorly absorbed at a noon lecture!

Once the context is established, implement a daily program of education and reinforcement on issues such as managed-care payment methodologies, documentation and compliance, guidelines, and discharge planning. Some of the successful methodologies we've seen include inviting challenging physicians to round with case management, creating accountabilities for department chairs so they support physician-advisor programs, and utilizing aggressive clinical denial-appeal programs as an avenue to change not only payer behavior, but attending-physician behavior as well.

The bottom line is that working with your attending staff is a long-term challenge. It can only be met with a multidisciplinary, long-term strategy that can be monitored with concrete metrics, and be fine tuned to meet the changing needs of your institution.

This question was answered by Joseph Zebrowitz, MD, executive vice president and senior medical director at Executive Health Resources.

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