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Defining the role of a physician advisor

Patient Access Weekly Advisor, August 15, 2007

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The physician advisor is a relatively new role in hospitals. Five years ago, few hospitals thought of using a doctor as a resource for case management on a regular basis-the position was usually a volunteer one. As clinical issues gain greater prominence in good revenue cycle management, hospitals have added administrative physicians to their cadre and the physician advisor was born.

Hospitals struggle with choosing physician advisors, because there is truly no road map to show what their responsibilities are, what traits they might have that are critical to success, and what sort of training and infrastructure must be brought to bear in order to realize a return on investment.

Clearly, it is vital to define the success of the physician advisor in real dollars. Hence, "denial percentage" is not as important as raw dollars lost to denials. You must measure how aggressive you are at appealing. Do not let the answer to the above questions be "pretty good"-that means no one is tracking how you are doing.

In doing the evaluation, please note that there is no right answer. It is vital to create an atmosphere of finding solutions, not punishing for bad results. There are many occasions in which we have evaluated programs; matters of "turf" and pride have gotten in the way of creating effective programs. The result is money lost for the hospital.

Clearly, the physician advisor must be a diplomat who can get things done. Frequently, a long-time member of the physician staff is assigned to this role in the twilight of his or her career. This individual rarely has the training or the attitude to develop the role of physician advisor into a revenue center and a leader in the hospital.

Note: This tip was adapted from the book Denial Management: Key Tools and Strategies For Prevention and Recovery by Pam Waymack, published by HCPro, Inc. Visit www.hcmarketplace.com for more information or to order.

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