Should You Become a Physician Advisor?

As hospitals strive to remain profitable and competitive in today’s health care environment, the addition of a physician advisor to the administrative staff is viewed as not only good for business but also for patients.

What Is a Physician Advisor?

Once a role typically filled by physicians who were nearing retirement, the physician advisor has evolved into a position that is part compliance expert, part patient care coordinator, and part hospital administrator. The role of the physician advisor is to perform in an advisory capacity with:

• Utilization of hospital resources (level of care and stay)
• Documentation and compliance
• Clinical review of patients
• Medical necessity protocol
• Care/case management with physicians and staff
• Quality of care provided
• Referrals to alternative facilities (physical therapy, hospice, etc.)
• Insurance claims (appeals of denials)
• Informing physicians about regulatory changes
• Informing staff about ICD code changes and interpretation
• Patient satisfaction
• Physician peer review

The Affordable Care Act outlines specific guidelines for the unique role of a physician advisor as the job is complex and exists to serve both the provider (hospital) and patient. The physician advisor serves as a bridge between the hospital’s clinical staff and the administrative staff and works to improve communication on all levels. As a result of this increased interaction between physicians, staff, and patients, patients receive better care.

With the ever-changing compliance environment, a physician advisor must stay informed and current about every aspect of patient care—from quality of care to medical necessity guidelines. The physician advisor serves as a liaison to ensure that the patient receives appropriate care and that all medical services rendered are correctly submitted for reimbursement. When necessary, the physician advisor coordinates the appeal process if an insurance claim is denied.

How To Become a Physician Advisor

A medical degree and experience in utilization management is the ideal background for a physician advisor. Degrees in internal medical, family practice, or emergency medicine are particularly useful due to the broad background provided by these specialty areas, though other specialties can provide the background to perform well as a physician advisor. Success as a physician advisor is always dependent on the unique combination of training, experience, and temperament of any given individual.

Medical knowledge is integral to the role of the physician advisor in peer-review activities as well as in the process of appealing health insurance claim denials. Because the physician advisor coordinates and supervises a wide range of activities with the hospital’s medical and administrative staff, as well as with patients, their families, and health insurance carriers, excellent communication skills are a necessity.

Temperament Is Key

Even if you have a stellar background in medicine and can point to years of success as a physician, a successful physician advisor brings broad medical knowledge to the job as well as a comprehensive understanding of utilization management and necessity of care protocols, an interest in keeping current with compliance and insurance regulations, and a passion to deliver quality care to patients. But there is still one key ingredient that can’t be taught in any medical school or hospital setting—temperament. Are you a seasoned diplomat with the communication skills necessary to make a recommendation or suggestion contrary to what a physician has ordered or what the staff is accustomed to providing in a similar case? A successful and valuable physician advisor always maintains the delicate balance between advisor and advocate.

In addition to the daily interactions with physicians, patients, patients’ families, and hospital staff, a physician advisor must commit to a heavy load of committee work and meetings on topics such as quality of care, safety, and ICD-10 updates. Attending (or running) these topic-specific meetings and/or workshops is integral to the successful performance of a physician advisor’s duties.

This is an exciting area of medicine—one that directly affects a hospital’s bottom line. As a physician advisor, you not only ensure that your hospital receives every appropriate insurance reimbursement, but you also help the hospital achieve increased patient satisfaction and better health outcomes for its service area.

To learn more about becoming a physician advisor, contact the American College of Physician Advisors.