ABQAURP News: Physician Advisor as the ‘Great Communicator’

Ronald Rejzer, MD, CHCQM

ACPA President and ABQAURP Diplomate

I was recently asked by a care manager to “please educate the docs” on the difference between inpatient and observation. How many times in the daily work routine of a physician advisor have we heard that request or something similar? What I have come to realize over the years participating either full time or part time as a physician advisor is the unique position we have as physician advisors to seize the moment as a timely educational opportunity by grasping the attention of our clinical providers in real time, in their own element.

The expanding role of today’s physician advisor has no boundaries.
A trained and experienced physician advisor can become fluent in the many “languages” of health care that are foreign to most frontline providers. I now recognize this opportunity to educate as a welcome part of my role and gladly accept the challenge of convincing providers that our utilization management team, care coordinators, and utilization review specialists alike are really on the same side. It is very satisfying to watch providers “see the light” when it comes to deciphering the mass of CMS regulations and the quagmire of acronyms that was previously considered just a thorn in the clinician’s side. They can now directly impact their published quality of care metrics and even their individual reimbursement. Explaining to clinicians how compliance with certain regulations can potentially directly benefit them and their patients—and possibly prevent a call from a medical director or, worse, the Office of Inspector General—helps to grab their attention and ultimately obtain their trust.

The physician advisor has an indispensable role because he or she is willing to accept a challenge that no other clinical provider is willing to undertake: mastering the nuances of the esoteric hospital regulatory environment. This role is often welcomed by medical staff leaders, including the chief of staff and chief medical officer, and is an important way an engaged physician advisor can provide value to an organization. Performing medical necessity reviews, care management support, and peer-to-peer discussions with managed care medical directors are only a small part of the physician advisor’s range of potential contributions to the organizational leadership. Developing unique expertise in assorted areas previously unwelcomed by clinicians, such as CMS regulations, quality and patient safety metrics, revenue cycle integrity, clinical performance metrics, utilization management, coding and documentation improvement, RAC denials and appeals, and third-party contract negotiations, allows the physician advisor of today an opportunity to provide a meaningful contribution to the success of an organization while supporting the various health care providers.

With the American College of Physician Advisors (ACPA) teaming up with the American Board of Quality Assurance and Utilization Review Physicians (ABQAURP), we have established a defined pathway to allow our aspiring clinical leaders of today to achieve a core foundation of knowledge and a true board certification by becoming certified in Health Care Quality and Management (HCQM) (with a sub-specialty of physician advisor) administered by the National Board of Medical Examiners®! This will allow our physician champions to achieve their educational goals as well-rounded physician advisors and prepare them for a long-term career as a physician leader of tomorrow in many diverse areas of the health care ­environment.

For further information on the requirements of becoming board certified as a physician advisor, check out the ACPA website and join hundreds of your colleagues from across the country by becoming a member of ACPA. Go to ­www.­ACPAdvisors.org. For information on HCQM certification, visit www.abqaurp.org.