Physician Advisor Services
The Physician Advisor/Medical Director of Case Management is increasingly-acknowledged as a critical position in hospitals, health systems, and ACOs. The Physician Advisor has become a physician practice specialty, often while maintaining part-time clinical practice. The Center provides job descriptions, competency evaluation tools, and organized 1:1 onsite coaching for physicians that are newly appointed to the role or those that want to upgrade their effectiveness.
Collaborative relationships with front-line providers and a comprehensive understanding of case management regulations and workflow are key to an effective case management service. The Physician Advisor is the link between case management and the medical staff by providing ongoing education about the rules of reimbursement, CMS Conditions of Participation (including the mandated Utilization Review Committee), peer consultation for removing clinical risks and barriers to outcomes and transition, denials and appeals advocacy, and avoiding potential ethical and legal complications.
Physician Advisor Deliverables
- Initial Assessment of role and learning needs
- Staffing / Demand assessment
- Recommendations for Physician Advisor workflow including daily rounds and interventions, weekly complex care rounds and review of outliers, monthly utilization review and finance/decision support tasks, and quarterly/periodic events
- ROI for in-house versus contracted service
- On-site or remote education for hospitalists/medical staff
- Ongoing 1:1 coaching schedule, if desired
Case Management and the Physician Executive
This article presents an overview of current case-management operational considerations, important benchmarks to monitor, and likely challenges for physician executives. – authored by Thomas L. Higgins, MD, MBA, FACP, FAAPL, and Bonnie Geld, MSW