A Publication for Case Management and Transitions of Care Professionals I S S U E
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In This Issue:
Recommending Post-Acute Discharge: Leveraging Predictive Models to Support Clinical Decisions
T H E O F F I C I A L P U B L I C AT I O N O F T H E A M E R I C A N C A S E M A N A G E M E N T A S S O C I AT I O N
Communicating the Physician Advisor Role Lori David Wiviott, MD; Robert T. Grant, MD, MSc, FACS
As the primary liaison and the individual who transmits timely and accurate information between attending physicians, case managers, utilization review, IT and hospital administration, the role of physician advisor (PA) is a key component in the delivery of high-quality patient care in the most cost-effective manner. However, an ability to effectively communicate how the physician advisor role benefits the various hospital constituencies can be a major factor in the success of a PA program. This article discusses the importance of this communication, and its impact on patient experience and cost of care.
LEARNING OBJECTIVES 1. Describe why the role of the physician advisor is so important to the organization. 2. Describe how the physician advisor can improve case managerphysician communication. 3. Identify a physician advisor’s potential impact on patient experience. INTRODUCTION With the increasing need for providers to standardize care, minimize variation and submit detailed
documentation to insurers concerning the medical necessity of the prescribed treatment plan, the role of physician advisor (PA) has become increasingly important. Since the PA role is still relatively new, many hospitals are looking for best practices on how to incorporate the position into their care continuum. Training and orientation to the physician advisor role for case management team members, physician peers and others involved in the delivery of care will increase the effectiveness of the role. This increased effectiveness, in turn, can lead to better patient experiences and reduce costs of care for hospitals and health systems. PHYSICIAN ADVISOR: EFFECTIVE COMMUNICATOR At a minimum, a PA should have five years of experience on a medical staff; be knowledgeable about medical necessity; understand current issues pertaining to their area of expertise; and stay abreast of changes in the medical necessity criteria. However, while physician advisors must demonstrate that they have both the medical skills and experience required to earn the respect of their peers, the skill that often distinguishes an effective PA from an ineffective one is communication. Because the PA role is built on an ability to lead by collaboration, it requires excellent communication skills to interface with numerous staff members and departments engaged in the delivery of quality health care.
Often, physician advisors must shift their mindset from one of a practicing physician to one where they will need to build consensus. Most physicians were trained to believe that they were the final arbiters of decisions involving patient care. However, the PA role is much less about directing and much more about listening. Being an effective communicator requires a level of empathy or emotional intelligence and the ability to garner trust. Successful PAs possess the ability to reach across multiple job functions and different constituencies – whether they are patients, colleagues or external partners – and share information in a way that is meaningful to each group. This means that not only do PAs need to understand their own personal communication style, they also need to understand the communication style of others. Negotiation is a constant in the PAs daily interactions. Understanding group dynamics, how to work with a group, and how to achieve consensus are vital to developing solutions that benefit both patient and hospital. Strong communication skills are often not part of a physician’s training. However, they are skills that can be learned, and once learned, they can help PAs be more effective in their roles. DEVELOPING A COMMUNICATION STRATEGY The goal for implementing a solid communication strategy is to develop a platform for the PA to demonstrate the value
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this role brings to their organizations. There are a number of key elements that should be part of any comprehensive outreach strategy: participation in a variety of meetings, standardizing communications, a case manager mentoring program and participation in multidisciplinary care team rounds.
“The PA should also be willing to speak up on behalf of case managers.” Physician advisors must be comfortable with public speaking. It is essential that a PA attend a variety of meetings – including those sponsored by physicians, the administration, hospitalists, nurses and case management, among others. This is an opportunity to not only describe the role the PA plays in creating an efficient workflow, but also to identify the agendas of each constituency. Physician advisors may find themselves addressing the Utilization Management committee one day and offering training to colleagues on best practices and new treatment protocols the next. Sharing how the PA’s intervention achieves the desired results demonstrates the value of the PA role and encourages colleagues to listen to their advice. Standardization is a useful tool when communicating with busy physicians and case managers. Having a universal format helps the recipient know where to look for key information and helps them respond quickly and effectively without struggling to locate what they are looking for. Creating a template for all routine communication as a follow-up to rounds or a patient’s treatment promotes efficiency. However, it is still appropriate to use the medical record for supplemental information. The patient record should be the single source of truth for clinical information.
medical necessity criteria for an inpatient hospital stay. The objective of the program is to give case managers the tools they need to have professional, effective and respectful, but firm, conversations with physicians. Not only does this empower case managers, it creates an environment where each can draw upon the expertise of the other.
physicians are fairly siloed and are not interested in partnering with case management. Training should also address this issue and provide guidance for case managers to deal with difficult situations. The PA should also be willing to speak up on behalf of case managers. They need to let physicians know that case managers are
Template for CM Email 1. Patient Name: 2. MRN: 3. Acct: 4. Location: – Campus/bed 5. Insurance: 6. Status: – Input vs Obs –In-house vs discharged 7. Pre-Auth: – Include auth # / dates authorized – DO NOT PERFORM REVIEWS/ESCALATE authorized days 8. Care Date(s) in question: – Indicate specific care date(s) 9. Attending MD: – Hospitalist vs. non-hospitalist - escalate to appropriate PA 10. Comments: paste comments from MIDAS Entry Point (ED, direct, transfer, Obv to IP): Chief complaint/Current symptoms and onset: Vital Signs:
Training can begin with basic skills such as asking, “Do you have a moment to talk?” before beginning a conversation about the topic the case manager needs to discuss. This simple step ensures that the physician is ready to listen. It is also true that some
following CMS requirements and are approaching the physician at the PA’s request with the support of administrative leadership. Let the physician know that they are expected to engage with the case manager to better serve the patient. It is part of the PA’s
Creating a case manager mentoring program serves to facilitate conversations between case managers and physicians. It can be challenging at times for the case manager to have a conversation with a physician distracted by the many demands of his or her workload. They do not want to hear that their patient may not meet the 17
responsibility to pave the way for the conversations that need to take place. If one of the objectives of a communication plan is to gain a deeper understanding of the issues facing team members, then participating in the multidisciplinary care team rounds and the weekly multidisciplinary complex care rounds is vital. The PA’s participation helps them identify barriers and track avoidable delays, gives PAs the
publish results, share best practices and celebrate successes. CONCLUSION Physician advisors are committed to assisting physicians in meeting regulatory requirements, utilizing resources in the most effective manner, removing barriers to timely treatment, and ultimately to helping the team achieve high-quality care for all
Case Manager Mentoring Program Agenda
1. The WHY?
Create a CM-MD mentoring relationship for: • Improved CM-MD communication • discuss the “hidden curriculum” • CM retention strategy
• Assign 1 MD to 2 new hire CMs for regular meetings for 3 months • Required for CMs new to the organization
• 1 hr meetings • Month 1: Weekly • Month 2: Every other week • Month 3: 1x
Session Leader: Physician Advisor for Each Campus
Case based learning focused on MD-CM communication • 30 min to discuss one interaction that went well - dissect • 30 min to interaction that didn’t go well - dissect When appropriate and in line with above, may discuss: • Obtaining admit order - reconcile with IQ result • Proactive dc planning - expected DC date, dc dispo Educational Techniques: Simulations, Role Play, Scripting & Teach Back
opportunity to use their expertise to incorporate clinical guidelines, and facilitates real-time problem solving as part of a
“When solutions are arrived through collaborative efforts, the team speaks to the patient with one voice.” team. When solutions are arrived through collaborative efforts, the team speaks to the patient with one voice. As an active member of the multidisciplinary team rounds, PAs also gather the information they need to
patients. By strategically communicating the benefits the PA role delivers to both patient care and hospital operations, others in the organization will proactively turn to the PAled team to help solve problems. ABOUT THE AUTHORS Dr. Lory David Wiviott is Chairman of Medicine at California Pacific Medical Center in San Francisco and a practicing infectious diseases physician. He is also Assistant Clinical Professor of Medicine at the University of California San Francisco Medical Center. Dr. Wiviott received his medical degree from the Albert Einstein College of Medicine in New York. He completed his residency training at Columbia Presbyterian Medical Center-College of Physicians and Surgeons in New York.
Following this, he was a research assistant in infectious diseases at Memorial Sloan Kettering Cancer Center. He completed a fellowship in infectious diseases and was a visiting postdoctoral fellow in cancer research at the University of California, San Francisco Medical Center, prior to joining the California Pacific Medical Center teaching faculty in 1989. He has published and lectured extensively on the management of various types of infectious disease and is a member of the Infectious Diseases Society of America and the Physicians Association for AIDS Care. Among his many honors and awards are his listings in Best Doctors in America, Best Doctors in the Bay Area, and Who’s Who in Healthcare & Medicine. Dr. Robert T. Grant, MSc, FACS is Plastic Surgeon-in-Chief for the Divisions of Plastic Surgery at New York-Presbyterian Hospital, the University Hospitals of Columbia and Cornell. He is also a Professor of Surgery at Columbia University Irving Medical Center, College of Physicians and Surgeons and an Adjunct Professor of Surgery (Plastic Surgery) at Weill Medical College of Cornell University. Dr. Grant received his MD degree from Albany Medical College and completed his General Surgery and Plastic Surgery Residencies at The New York HospitalCornell Medical Center. He finished clinical training with a Microsurgical fellowship at NYU Medical Center/Bellevue Hospital. In 1999 he received his MS degree in Management from NYU. He is also the Plastic Surgery Residency program director at New York-Presbyterian Hospital. Actively board-certified in and holding full maintenance of certification (MOC) in General Surgery and Plastic Surgery, Dr. Grant is a member of the American Association of Plastic Surgeons, the American Society of Plastic Surgery and the American Case Management Association. He is a fellow of the American College of Surgeons. He is the Inaugural President of the Association of Physician Leadership in Care Management (APLCM)-ACMA’s physician advisor/care management leader organization. He serves as New York-Presbyterian Hospital System’s Physician Advisor and Director of Care Coordination.