A Physician Advisor:
• is a hospital-based physician executive who serves as a liaison between case and utilization management, health information management, treating clinicians, and administration;
• is a content knowledge expert on government and commercial payer rules and regulations, clinical documentation, coding, billing, and publicly-reported, and severity-adjusted quality data;
• manages length of stay, throughput, efficiency, quality, and medical necessity and coding denials;
• ensures compliance with Medicare’s conditions of participation, leading the
Utilization Management Committee.
Behaviors one utilizes to influence:
• Legitimacy
• Rational persuasion
• Coalitions
• Inspirational appeals
• Consultation
• Exchange
• Personal appeals
• Ingratiation
• Pressure
Power: One’s capacity to influence another’s behavior to be in accordance with one’s wishes. The ability to mobilize resources to achieve some end.
• Formal: based on one’s position in the organization
Coercion and Reward
Legitimate: from position within hierarchy
• Informal (personal) power encompasses:
Expertise (physician advisor knowledge base)
Referent power: if I like, respect, and admire you, you can exercise power over me because I want to please you.
Charismatic power: due to one’s attractive visions (based on personality and interpersonal style)
Upward influence: rational persuasion
Downward influence: everything except personal appeals and coalitions
Lateral influence: everything except inspirational appeals and pressure
Physician Advisor wants the organization to build an observation unit.
Physician Advisor wants to engage a chairman to partner in working on front-line processes to reduce medical necessity short-stay admission denials.
Power tactic for C-suite: rational persuasion.
Focus on revenue integrity, reducing $ lost to denials, back-fill of inpatient beds with higher margin cases, readmission reductions, alignments with value-based purchasing and accountable care organization
Background:
Appeals Management Department was without physician leadership and had limited outreach to doctors.
Power tactics for physicians:
Rational persuasion: increased and more directed referrals, improved care coordination and patient satisfaction
Consultation: I’d like your input on how best to handle admissions to the unit from the voluntaries
Coalitions: Dr. Smith in cardiology thinks it’s a great idea
Ingratiation: that was a great talk you gave at grand rounds.
New Physician Advisor role in 2006, expanded to lead the department in 2007, and hired full-time and part-time physician appeals coordinators, eliminating the need to outsource appeals.
Requires expertise in revenue cycle, payment models, quality, compliance, documentation, and coding.
Physician Advisor wants a staff doctor to answer a clinical documentation query.
Legitimacy: Messaging directly from CEO and
CFO as an organizational priority, including metrics on service line dashboards.
Background:
• Long-neglected clinical documentation improvement program that lacked a physician leader. Revitalized in 2007 with a physician champion.
Consultation and Ingratiation: Thank you for encouraging your faculty to work with us in crafting appeal letters. Partnering with us in finance will ensure revenue integrity when hospital and physician billing are aligned.
• Physician advisor expands the program across two campuses in
2008 and increases the clinician response rate to queries from
77% to 100%.
Exchange: Partnering with us on improved frontend documentation will allow us to improve your service line’s case mix index (CMI) through improved documentation and electronic medical record templating.
• Rational persuasion: improved documentation defends the physician from medical liability allegations and enhances the physicians’ reputation through accurate comparative analytics and public reporting of severity-adjusted quality data.
• Consultation: Dr. John prefers we contact him in this manner. What works best for you?
19 000
17 000
15 000
13 000
Charts
Reviewed
(#)
11 000
9 000
7 000
5 000
2007
MSH CDI Program Performance
2008 2009
Total charts reviewed
2010 2011
Physician response rate
2012
100%
95%
90%
85%
Physician
Response
Rate
80%
75%
70%
• There are many emerging career-enhancing opportunities for physician executives in the physician advisor realm.
• Thoughtful use of power tactics will assist the physician executive in mobilizing resources to achieve desired ends.
• Successful physician executives should be skilled in leading and influencing not just down, but across and up in complex organizations.