Physician advisory programs, which educate clinicians in peer-to-peer fashion, are growing in several ways. This video at the AHIMA Annual Conference explores the many uses of these programs, as well as how to implement them and make sure they’re effective. The speakers are Dr. Adriane Martin, Vice President of Physician Services at Enjoin, a CDI consulting firm, and Shameka Hooks, Executive Director, Midcycle Operations: Coding, CDI, Revenue Integrity and HIM at WakeMed. WakeMed is a non-academic teaching hospital located in Wake County, North Carolina. It includes 3 hospitals, 970 beds, 6 Emergency Departments, and over 90 clinic locations. They employ 10,000 staff members and 1,200+ providers, serve as the 10th busiest ED in the United States, and provide $256 million in community benefit, delivering 80% of Medicaid care in the county.
Hooks said they started their physician advisory program with a single doctor, and experienced enough succes with it that they are now seeking to train a second one. The two key steps she identified, for starting such a program, are to find an interested physician and then to demonstrate the return on investment to management.
However, she says that she doesn’t want to focus on costs or revenue. Instead, doctors should be “telling the story of the patient”: making sure to document the severity of conditions and all the complications and comorbiditiies. She also advises not to just “optimize here and there,” but to look at patients in all their complexity.
By improving care, they strengthen the metrics that lead to financial success: their Observed vs. Expected Mortality Rate, their Case Mix Index (CMI), average length of stay, etc.
Patients look at such metrics when choosing a facility, and payers also reduce denials when clinician documentation demonstrates that they are treating all the patient’s conditions comprehensively.
Martin explains the history of physician advisory programs. They started with utilization management, and most still focus on that. Hooks said that utilization management was the first goal of their program, which was then “focusing on medical necessity.” But many institutions, including WakeMed, are moving to Clinical Documentation Improvement (CDI).
There is also a move to using programs to build physician leadership. Physicians can learn to take more strategic roles and translate concepts from the C-Suite to clinical staff.
Physician advisory programs are also leading educational efforts, primarily for clinical staff, but also for those doing coding. WakeMed partnered with Enjoin to leverage their expertise with Physician Advsiory Programs.
Martin warned organizations to plan how they can best employ their advisors, having seen some programs “fizzle out” because the advisors weren’t placed strategically.
Watch the video for more details on these programs, as well as the contribution AI has made in documentation and CDI.
Learn more about Enjoin: https://www.enjoincdi.com/
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