An Emerging Healthcare C-Suite Role: Chief Physician Advisor
Although Physician Advisors have been around for a little over a decade, since the dawning of the two-midnight rule in 2013, it is still a...
Although Physician Advisors have been around for a little over a decade, since the dawning of the two-midnight rule in 2013, it is still a relatively new and an evolving physician specialty role. It is rapidly gaining in notoriety and importance due to its potential to significantly impact the bottom line and improve physician well-being for many healthcare systems.
Historically, the Physician Advisor was a voluntary role for a member of the medical staff or faculty sitting on a UR committee while also maintaining their clinical practice and acting more or less as a liaison between hospital administration and clinical staff — focusing on utilization review/management, regulatory requirements and compliance, inpatient status, and medical necessity. Recently, however, I’ve begun to see this role evolve into a more elevated position such as System, Enterprise or Executive Medical Director, CDI & UM or Revenue Operations up to Chief Physician Advisor. More than ever, hospitals and health systems must maintain their focus on containing costs, ensuring revenue integrity and enhancing provider engagement and wellness to not only survive but thrive in their competitive markets.
Rise of the (Chief) Physician Advisor
A recent survey conducted by the Association of Clinical Documentation Integrity Specialists (ACDIS) in collaboration with 3M Health Information Systems, titled “Rising Stars: Physician Advisors are Tackling Big Problems in Healthcare“, reports “only a quarter of healthcare organizations have a team of more than five full-time Physician Advisors. Most commonly, 35% of physician advisors serve in a single location but a notable 25% are responsible for physician advisory responsibilities across three-five hospitals.” Surprisingly, these numbers seem very low especially with so much on the line and the potential ROI. Additionally, many still report spending more time clinically than in their Physician Advisory role/responsibilities. According to the report, nearly 60 percent of respondents spend 50% of less of their time in their Advisory capacity.
Today Physician Advisors assume a wide range of responsibilities and 32% still report directly to the Chief Medical Officer, an increase from 25% in the prior year as reported in the ACDIS survey. Similarly, the report noted a decrease in those reporting to the revenue cycle or finance – CFO departments, which is now 28% compared to the prior year of 35%. Additionally, 14% of the survey respondents report to multiple departments, highlighting the interdisciplinary nature of their work. The survey also reported Physician Advisors are focusing more on UR, UM, and denials management as principal responsibilities. Currently, 41% of Physician Advisors spend a significant part of their time—ranging from 26% to 75%—on UR and UM tasks, an increase from 34% last year. Denials management has also become a more substantial part of the role for 39% of Physician Advisors, up from 30% previously, while CDI is now a principal responsibility for 35%, a significant hike from 22% last year.
“Hospitals and Health Systems increasingly value Physician Advisors and are allocating more time and resources to drive systemwide change,” the report added. These new and elevated roles are becoming more administrative than clinical, bringing with them salary and bonus eligibility rather than a simple stipend on top of their clinical compensation. They are moving well beyond the regulatory sphere and into areas ranging from revenue cycle to quality reporting to managed care contracting to outpatient CDI. The Chief Physician Advisor is a documentation, revenue, quality and physician champion who collaborates with multidisciplinary teams across the organization from revenue cycle, compliance, quality, nursing, and EMR/HIM teams. They are in tune with the potential of AI to improve workflows which will ultimately impact provider wellness.
The Chief Physician Advisor is typically charged with meeting systemwide goals and objectives for facilitating complete and accurate clinical documentation in the medical record to support the diagnoses, treatment, medical necessity, severity of illness, and risk of mortality. The executive will engage in teaching, consulting, and advising the medical staff, CDI, care management, utilization review, coding departments, and health system leadership teams.
The Chief Physician Advisor should have expertise on matters regarding compliance with governmental and private payer regulations and appropriate physician coding and documentation requirements, as well as matters regarding physician practice patterns, over and under-utilization of resources, medical necessity, levels of care, care progression, and appeals and denials management. The successful candidate will usually be a board-certified physician with a knack for collaborating with others to foster change and improvement.
What’s Next?
Although many Physician Advisors naturally ascend to become a Chief Medical Officer, the role of Chief Physician Advisor is emerging given the myriad of complexities navigating constant changes in payor rules, regulatory compliance, coding/billing, and quality reporting – not to mention the increase in queries, denials, appeals and peer to peer, that most healthcare systems are attempting to better manage. These areas impact their revenue cycle as well as the well-being of their physician workforce through decreased administrative burden. As with most specialties it takes time, board certification, and often five or more years of clinical experience along with strong interpersonal and emotional intelligence to be a successful Physician Advisor who can ascend to higher levels of leadership as a Chief Physician Advisor.
For those interested in cultivating the skills necessary to begin a journey as a Physician Advisor and potentially a Chief Physician Advisor, organizations like the American College of Physician Advisors (ACPA), Association of Physician Leadership in Care Management (APLCM), American Board of Quality Assurance (ABQAURP), and Association of Clinical Documentation Integrity Specialists (ACDIS) have certification programs.
Please reach out to me at [email protected] to learn more about Chief Physician Advisors or other emerging physician leadership roles.
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