Workshop A:
Understand the Role and Responsibilities of the Physician Advisor
Fulfilling the role of the Physician Advisor efficiently while being an
effective communicator is a common goal for both those new to the role
and those who are established in the position. This workshop provides
in-depth exploration and clarification of the role and responsibilities that
define a successful Physician Advisor.
Review responsibilities and define the role of the Physician Advisor to
ensure benchmarks that lead to success are met and learn what
metrics to monitor
Case mix index
CC/MCC capture rates
Physician agreement rates and physican response rates
Length of stay/mean length of stay
Agreement and disagreement rates
Communicate the role to others to increase efficiency and coordination
Outline daily tasks and determine annual goals that are specific
and achievable
Review status determination
Determine observation management criteria
Manage denials and changes in the marketplace
Set goals for clinical documentation
Discuss how to establish goals and communicate responsibilities with
physicians and leadership
Recognize when to be involved in other hospital initiatives such as
quality improvement and streamlining admissions
Workshop B: Build a Template for Case Management to Increase Efficiency and Coordination
Shifting responsibilities and more stringent regulations put a stronger emphasis on monitoring status criteria and documentation for each case, which underscores the importance of working closely with clinicians to organize care. This workshop focuses on the responsibilities specific to Case Management to help outline consistent and quality processes.
Develop strategies to assist physicians in making decisions related to
status and documentation
Participate in Physician Advisor coaching and peer-to-peer collaboration
Develop disease specific documentation education fact sheets, algorithms
Create pocket cards or inpatient-versus-outpatient checklists
Assess the Case Manager and admitting physician’s roles in relation to case management protocol and admission status management
Understand the necessary language important to effective communication with clinicians
Navigate separation and/or integration of physician’s clinical and administrative duties
Discuss documentation clarity issues, especially with regard to Code 44 and W2
Understand the CMS rules and interpretation for compliance
Examine language used in your hospital outpatient services policy and procedure or Hospital UR Plan
Discuss the Physician Advisor’s role in UR Committee participation
Standardize scripts for the Physician Advisor
Engage in Physician Advisor documentation coaching
Identify the hospital process regarding patient notification of status change (Code 44)
Learn ways to develop a consistent and coordinated approach to each case
