National Association of Physician Advisors

What is a Physician Advisor? Depending on who you ask, you'll get a variety of responses. After all, it's a vague term, isn't it?

The role of the physician advisor is evolving today. The physician advisor is not just participating in utilization review or a coding expert. They're not just concerned about RAC audits or being an appeals expert for denied Medicare claims.

You may want to know about this group called the National Association of Physician Advisors. The National Association of Physician Advisors was created in 2009 based on the need that physician advisors needed a central way to network and community.

World Congress is also planning the 10th Annual Physician Advisor Summit March 21-23 in Orlando, FL. The 2013 conference will focus on:

• How to start a physician advisor program in your hospital
• Newest updates on coding, documentation and reimbursement to keep you on top of new regulations
• Review various types of physician advisor jobs and see how that compares with your hospital
• What new and exciting responsibilities can physician advisors get involved in to help benefit the hospital
• How can physician advisors work closer with observation unit leadership

You can learn more about the National Association of Physician Advisors here. Plus, information about the 10th Annual Physician Advisor Summit can be found here.

Another Medscape article mentions NonClinicalJobs.com

A few weeks ago, you may have seen this Medscape article titled, "Tired of Being a Doctor? Choices for Opting Out of Medicine: Leaving the Profession Altogether." I was interviewed by the author of that article and she mentions NonClinicalJobs.com in the opening lines of the story. Thank you Shelly.

If you haven't read the article, I'd recommend it. Shelly does a very nice job outlining some options if you choose to leave the world of clinical medicine.

Deep Medicare pay cuts could drive physicians to seek sources for supplemental income

Deep Medicare pay cuts may drive physicians to seek out ways to generate supplemental income. Some physicians may drop Medicare by changing their Medicare participation (PAR) status to non-participation (non-PAR). Of course, this will mean that thousands of Medicare patients may need to find a new health care provider.

Another option is for physicians to find ways to supplement their income through a variety of non-clinical jobs and opportunities. Some may wish to explore the world of medical writing while others may carve out some time to do some consulting. Many physicians are already involved in medicolegal review or reviewing medical charts to assess hospital admissions around "medical necessity." Adventurous physicians who have access to capital are starting their own companies (often on the side while they continue to practice medicine).

CMS Innovation Advisors Program

In the months and years to come, the Center for Medicare and Medicaid Innovation (Innovation Center) will seek to introduce transformative models of care delivery across the nation that will meet the aim of reducing cost and improving quality for Medicare, Medicaid, and CHIP beneficiaries.

The Innovation Advisors Program is designed to support delivery system reform, strengthening the capacity for change by creating a network of experts in improving the delivery system.

Specifically, the Innovation Advisors Program will engage individuals in the health care system to test and refine new models of payment and care delivery. Selected Innovation Advisors will refine, apply, and sustain managerial and technical skills necessary to deepen several key skill sets, including:

• Health care finance;
• Population health;
• Systems analysis; and
• Operations research

After completing this orientation, these individuals will:

• support the Innovation Center in testing new models of care delivery;
• utilize their knowledge and skills in their home organization or area in pursuit of the three-part aim of improving health, improving care, and lowering costs through continuous improvement;
• work with other local organizations or groups in driving delivery system reform;
• harvest new ideas or innovations for possible testing of diffusion by the Innovation Center; and
• build durable skill in system improvement throughout their area or region

Attending the Executive Health Resources (EHR) reception tonight

Tonight, Executive Health Resources or EHR is having a Cocktails & Conversation event. If you're considering a  career change, perhaps you may enjoy working for a company like EHR. What would you do as a physician advisor? Get familiar with the phrase RAC (Recovery Audit Contractor).  Not familiar with the concept?  Click here to read about RACs on the Medicare website.

Click here to view physician advisor job openings at EHR.

Here's a snippet from their website that describes the "The Physician Advisor Approach"

EHR's Physician Advisor review provides an admission status certification, which is supported by clinical evidence, compliant with CMS rules and regulations, and robust enough to withstand external scrutiny.

EHR is at the forefront of regulatory changes and monitors CMS closely in order to anticipate high-risk areas before they become a liability for the hospital. EHR has built a team of leading industry experts to conduct ongoing research and development of evidence-based, risk-stratified protocols and algorithms surrounding high-risk DRGs to assist its Physicians Advisors in defending RAC denials.

One of the most important tools in EHR's arsenal is in the area of content development. EHR has a team of physicians and nurses who are responsible for supporting our Physician Advisor teams with the latest in risk assessment and risk stratification tools. Medicare's directions in the Medicare Benefits Policy Manual require that we examine the probability that a patient will have an adverse outcome. CMS ruling 95-1 directs EHR Physician Advisors to utilize an evidence-based, literature-based standard in determining such outcomes.

EHR develops and maintains this type of information and puts it in the hands of our Physician Advisors who work directly with your hospitals. These tools involve standard high-risk diagnoses such as chest pain, congestive heart failure, and gastroenteritis. Sometimes, these tools represent wholly unique offerings, such as our Interventional Cardiac Procedure Review, which focuses on ICD's, Pacemakers, and PCI – procedures in which little or no guidance exists anywhere else. These products are developed internally and offered to our clients as the market need evolves.

How will health care reform impact your job satisfaction?

If you're a health care professional involved in direct patient care, how will the proposed health care reform impact your level of job satisfaction? My wife is a primary care physician and we often talk about how a reformed health care system would impact her practice. Would you be more inclined to leave clinical medicine to pursue a non-clinical career?

I have met so many disgruntled physicians who feel "trapped" by their career. They can't imaging doing anything else. They don't know how they can make a career transition and they can't afford to take huge risks.

How closely are you following the discussion on health care reform? Even if you hate politics, it's very important to understand what's being proposed. It's not just about Medicare or the Public Option. It's not just about managed care companies and denied coverage. Perhaps all the recent discussions have renewed your writing passions as you draft letters to your senators. Perhaps you've recognized that you have a passion for health policy and politics. Maybe you're seeing the forest instead of the trees and you're planning to pursue a career in public health.

I've noticed that I can't see the trees anymore. For me, it's mostly about the forest. Blame that on my MPH. When we compare population health against individual health, we can't deny that our nation needs a new health care system. I just don't know that we've identified the right way to approach this problem yet.

Executive Health Resources (administrative medicine)

If you're trying tired of practicing clinical medicine, how about a career switch to administrative medicine? Consider this as a blend between medical management and business management. After all, I think we all recognize that health care is a business. You won't find any residencies or fellowships that focus on the specialty of "Administrative Medicine."

Executive Health Resources (EHR) is a company that provides different types of services, including:

• Medicare and Medicaid Clinical Compliance Management
- Concurrent Admission Review and Certification (Inpatient vs. Observation Status)
- Surgical/Procedural Setting Review and Certification
• Medicare and Medicaid Denials Review & Appeal Management
- QIO, MAC/FI and RAC Denials Management
• Concurrent Commercial Payor Denials Management
• Retrospective Commercial Payor Denials Management
• Length of Stay Management
• ER Admissions & Transfer Center Mgmt.

The acronym "EHR" is widely used to refer to electronic health records, so don't get that confused with this company. Here's a bit of history regarding this EHR (from their website):

Founded in 1997, EHR, The Physician Advisor Company™, is nationally recognized as the leading provider of real-time, point of care, expert Physician Medical Management Solutions that improve hospital revenue integrity and maintain the highest level of quality of care and regulatory compliance. EHR's expert physicians, the EHR Physician Advisors, provide hospitals and health systems with an outsourced operational, technological, and clinical resource to achieve the hospital’s goal of effectively managing clinical care while maintaining sound financial performance.

They appear to be hiring for a Physician Advisor. What are the qualifications? M.D. or D.O. with 3+ years of post-residency inpatient clinical practice preferred. Medical licensure mandatory; Board Certification preferred. To learn more, visit: http://www.ehrdocs.com

Another Physician Compensation Survey

According to the American Medical Group Association (AMGA) 2008 Medical Group Compensation and Financial Survey, physician pay went up in 2007 by roughly 3.5%. According to this report, medical specialties that experienced the lowest increases included allergy medicine, endocrinology, pulmonary medicine and emergency medicine. With Medicare reimbursement decreasing and managed care organizations trying to push pay-for-performance (P4P) and other initiatives, physician payment is all over the map for various specialties. The survey was conducted among 44,000 health care providers, 2,700 medical groups, and 116 specialties in the United States.

Medicare and Care Coordination - a disappointing study in JAMA

There's an interesting article in JAMA this month. It's titled, "Effects of Care Coordination on Hospitalization, Quality of Care, and Health Care Expenditures Among Medicare Beneficiaries"

Here's the bottom line: Care coordination programs don't seem to reduce healthcare costs among Medicare beneficiaries. This is very disappointing since you would hope that patient education would improve clinical outcomes. In this instance, nurses were contacting patients roughly twice each month. Since the patients mainly had heart failure, heart disease, and diabetes, these were patients with significant medical problems.

In my opinion, patient education that only occurs twice per month is not enough. We now have ways to automate and tailor messages. These can be sent via phone, SMS, e-mail, and a variety of other ways. When this study was designed, these resources may not have been refined like they are now. I'm sure a better study could be conducted that utilizes some of these automated technologies. After all, now we have older patients with implanted defibrillators living at home where wireless data is being captured and sent to clinicians in hospitals and offices. These types of systems can all be integrated with a robust care coordination program that can alert patients when they need to make some changes in their lifestyle before they end up being hospitalized.

Medicare selects 4 companies for a PHR pilot program

Medicare announced their selection of 4 companies to run a pilot PHR (personal health record) program in Utah/Arizona. So who are the companies? I don't think you'll be surprised to hear that Google Health is one of them. The other 3 are: HealthTrio LLC, NoMoreClipboard.com, and PassportMD.

This collaborative pilot should provide some really exciting results! There is such a need to improve health information management on the consumer end. As IT capabilities improve, so much can be done to improve public health by empowering consumers and helping clinicians have access to vital health data.

More information about the selected companies may be found here:

https://www.google.com/health
http://www.healthtrio.com/phr.html
http://www.nomoreclipboard.com/
https://www.passportmd.com/