The role of a physician advisor has evolved considerably in the past decade and has become a critical one especially when it comes to utilization management and quality improvement initiatives. Read on to understand what this role is all about and what are the goals that govern it.
In the past, it was common that physicians and administrators lacked the communication necessary to provide patients with the best possible care. Billing errors and recordkeeping delays often lead to lessened quality of care and reduced profitability. The role of the Physician Advisor, or PA, has gained much popularity over the years as they act as a bridge between the physician and administrators. The PA encourages the team to focus on patient safety, compliance, quality, and evidence-based medicine. A successful PA program has patients at its epicenter and can enjoy the following benefits:
- Higher Physician Engagement Level – A PA can bring a physician’s perspective to the table, making it possible for administrators to take into consideration the physicians’ viewpoint while implementing techniques and programs aimed at improving utilization and cutting wastage. As a result, the clinical teams may feel much more involved in the decision-making process, and the animosity between the two camps can temper down.
- Better Recordkeeping and Documentation – A PA program can help improve the recordkeeping standards of a healthcare facility. Completion of clinical documentation within 24-48 hours of discharge and reduction in the time taken to answer queries raised by case management teams are habits that be ingrained through a PA program. These best practices are very effective in reducing the claims denial rate and in using medical resources frugally.
- RAC Audits Can Become An Easier Task – Recovery Audit Contractor (RAC) is an auditory program that is implemented by CMS to zero in on incorrect payments made under Medicare programs and recover them from the facilities. With appropriate documentation that is completed promptly, thanks to a good PA program, such audits can be sailed through without incurring any financial loss.
- Reduction in Readmits – Value based reimbursements have become the new payment model today. As a result, readmissions warrant harsh scrutiny and potential fines especially if Medicare covers the patients. A PA program can reduce the chances of readmits by improving the coordination between case management teams and physicians to smoothen the transition process and ensure appropriate post-discharge care.
- Improved Patient Outcomes – A patient’s experience is infinitely better at a facility where the teams involved are interconnected, and there is a seamless flow of information between them. A team-based approach that is possible through a well-established PA program can be the key to fostering such an integrated environment.
- Enhanced Star Ratings And HCC – Providers, plans or facilities which are compliant, quality conscious and have a high rate of positive patient outcomes are more likely to get excellent ratings from CMS. Since these ratings are public information, they tend to serve as popularity enhancers too.
Mirra Health Care is an organization that has substantial experience in the area of designing and implementing successful PA programs across healthcare entities of all sizes and types. They are also adept at playing the part of Physician Advisors for such establishments and have some solid experience under their belt especially in this area. Reach out to the experts at Mirra® if you are looking for advice on rolling out a PA program. You can contact us by sending us an inquiry through this page.