Building a Clinical Foundation for Value-Based Care
The role of the physician advisor (PA) has become essential to healthcare organizations today, especially with the need to build an infrastructure that supports the movement toward Value-Based Care. Keeping up with changes to policies and regulations from CMS and managed care payers require the kind of time and attention that would be difficult for most clinical professionals. Physicians who can assist their peers and other hospital personnel in these matters are more essential than ever today. While this role began about twenty years ago with a focus on Medicare compliance, utilization management and review functions, reversal and management of denials, and billing status determinations, the physician advisor role has in some organizations expanded beyond these functions. To support the move towards value-based care, the roles are expanding to include the support of care progression, the appropriate level of care placement, management of length of stay (LOS) through leading practices, appropriate utilization of clinical resources, clinical documentation improvement, payor contracting, revenue cycle, ongoing physician education, clinical quality improvement and safety/risk management when the opportunity presents itself.
Physician advisors should be involved in all of these areas if the organization is going to accomplish the largest return on investment from this role. A physician advisor’s typical day may consist of attending various multidisciplinary meetings with care management and clinical documentation teams regarding identified concerns, while ensuring compliance, seeing that quality care is being provided, and staff is communicating effectively.