As the financial stakes for hospitals and health systems rise along with the shift from volume- to value-based care, aligning with physicians to achieve the goals of the organization is no longer optional—it’s essential. In fact, for many hospital executives, inadequate physician engagement may be preventing them from successfully transitioning to value-based care.
Hospitals across the country are making significant strides in achieving physician engagement through the invigoration of the physician adviser role. Physician advisers are typically physicians who serve as a liaison between case management, the C-suite and the clinical staff, with the ultimate goal of delivering the best possible patient care and facilitating the patient’s progression throughout the care continuum.
The role of the local physician adviser went by the wayside for many years, when hospitals increasingly outsourced the functions to audit contractors who focused their efforts upon patient status and claims. In more recent years, the pendulum has swung back toward the need for hospitals to internalize and localize this role to broaden the focus on quality improvement initiatives.
Because of heightened quality improvement measures, threatened reimbursements and the need for cost reductions, hospitals are again fostering the physician adviser role from within the organization and local healthcare community to engage more sustainably with physicians throughout the organization over the long-term.
Far beyond conducting patient status reviews, physician advisers today are expected to serve as advocates for case management, physicians and nursing staff. As physicians are often more responsive to the suggestions of other physicians, the adviser often facilitates patient care progression by supporting case managers’ efforts to make sure patients are receiving the appropriate level of care at the appropriate time. Physician advisers also help to minimize unnecessary testing and procedures that can be done in an outpatient setting rather than during a hospital stay.
With the multitude of changes coming forward from the government and private healthcare payers, hospitals can enlist the physician adviser role to educate other physicians about the changing regulatory landscape. Physician advisers can translate for attending physicians the importance of these regulations because they share clinical knowledge, while understanding what needs to be done to comply with these regulations so that appropriate reimbursement can take place.
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These efforts are most successful when physician advisers support a formalized education program in whatever modalities their clinical staff responds best to, whether it be a newsletter, workshops or other training. One-on-one “just in time” education is valuable in some cases, but is not sufficient to address the greater educational needs of an entire medical staff.
Every hospital will have its own formula for creating the physician adviser role. There are several different approaches that hospitals can take depending on their needs. Some will employ one full-time physician adviser, while others may have multiple physicians who share the role and better address specialists’ needs. Some hospitals continue to outsource physician adviser duties; however, this model has limitations because external or remote physician advisers may face difficulty in building the day-to-day relationships required to sustain quality improvement and cost reduction.
Some factors to consider in appointing the physician adviser role include whether physicians are still practicing and if so, their practice’s limitation to their availability and influence. Ideally, they should be leading interdisciplinary teams, making rounds and supporting case managers by consulting with patients and their physicians. It also can be helpful for physician advisers and case managers to be assigned to the same hospital unit so they can work together more seamlessly.
One of the more challenging yet essential skills a physician adviser must possess are the “soft skills” of communication. This includes the ability to communicate effectively and positively with peers, as well as interpret and influence their peers’ decision-making process based upon education and evidence of best practices.
The physician adviser must be a role model who is demonstrating to physicians as well as supporting clinical staff how best to address the payer and regulatory factors impacting patient care delivery. For example, if a patient is not progressing, and the payer is questioning the lack of care progression, the physician adviser should be able to engage in a productive dialogue with the attending physician about this and determine how best to address it. While the physician adviser can’t be involved in every case, this role can lead by example, representing and reinforcing the front-line case managers and other clinical staff to also find ways to facilitate patient care progression.
Finding the right individual within or outside the organization to take on this complex and critical role can often be made easier with help from the outside. It may help to have the organization strategically and objectively assessed in terms of culture to identify where the opportunities are for improvement and where the physician adviser role can make the greatest impact. While most organizations find their best fit through trial and error, there are significant benefits to a more strategic approach to identifying and preparing the ideal role of physician advisers.
Regardless of how a hospital organization creates this integral role, physician advisers can provide the missing link that hospitals need to achieve their financial and quality improvement goals within today’s changing healthcare landscape.
Nancy Lakier, RN, MBA, is founder and CEO of Novia Strategies, a national healthcare consulting firm, where she works with hospitals across the country to redesign care, reduce costs and improve safety and quality.
Donna Hopkins, MSN, RN, CMAC, is vice president at Novia Strategies, where she plays an integral role in the firm’s care management practice helping hospitals to reduce costs while improving their case management and care redesign capabilities.