The Physician Advisor's Role in Case Management

Why Should You Attend:

RN case managers and case management leaders need to understand the role of the physician advisor, steps to ensure compliance with federal regulations and methods to improve case management outcomes when using the role of the physician advisor.

In this session Ms. Cunningham will introduce the role of the physician advisor and the important aspects for both staff RN case managers and case management leaders to ensure effective implementation and sustaining of this critical role.

The webinar will focus on regulatory requirements, optimal processes, auditing of effectiveness and the physician advisor impact on outcomes. The webinar will also discuss best practices for developing steps to ensure collaboration with this role, for both internal and external physician advisors. It will further discuss case management outcomes that can be positively affected by the physician advisor role.

Areas Covered in the Webinar:

• Review of the physician advisor role, including the job description
• Examine critical strategies for working with both internal and external physician advisors
• Discuss best practices both RN case managers and case management leaders as they collaborate with the physician advisor
• Describe best practices for auditing physician advisor activities
• Discuss strategies for decreasing hospital risk for noncompliance with conditions of participation and the 2 midnight rule
• Review the role of the physician advisor and the utilization review committee

Who Will Benefit:

• RN case managers
• Case management leaders
• Appeal and denial case managers
• Utilization review nurses
• Revenue cycle team members

Laura Ostrowsky
President, NYC chapter of CMSA

Laura Ostrowsky RN, CCM MUP is the current president of the NYC chapter of CMSA. She is teaching a CCM prep course with the Case Management Institute, working with Athena Forum and writing and consulting on case management and related topics. Laura has published articles on Case Management in CMSA Today, Professional Case Management, Case in Point, The Patient Flow Journal and other periodicals. She regularly presents at national conferences including CMSA, the Patient Advocate Institute, NTOCC and others on topics ranging from case management, patient flow and payer provider collaboration to advocacy, collaborative practice and case management’s role in the changing health care environment.

Laura is a past Director of Case Management at Memorial Sloan-Kettering Cancer Center (1999-2019) and the 2012 CMSA Case Manager of the Year. Her program was been nominated by Case in Point for excellence in Utilization Management, Discharge Planning and Transitions in Care and awarded the patient Advocate Award. She created a patient advocacy program to assist patients in obtaining access to specialty care despite network restrictions. The program has been featured in articles in Advance for Nursing, The Wall Street Journal, Case in Point, and Case Management Monthly.

Topic Background:

The role of the physician advisor in hospital case management is a varied role. Not every hospital has an internal physician advisor. If a hospital does not have an internal physician advisor, it usually has an external physician advisor. Rarely are physicians prepared to this role. Additionally, rarely are case managers or case management leaders prepared for implementing and/or collaborating with physicians in this role. With value-based reimbursement, the collaborative role of the physician advisor will be one of the lynchpins to assist the case management department and practicing physicians to positively impact hospital outcomes.

The CMS Conditions of Participation and the 2 midnight rule require intervention with physicians in the utilization review section of the conditions and auditing for compliance to the 2 midnight rule. Most hospitals do not follow the requirements of this important aspect of case management compliance. Furthermore, there is rarely auditing of the role of the physician advisor and most hospitals do not educate their staff for meaningful collaboration and use of the role.

As health care organizations and physicians endeavor to provide compliance to the Conditions of Participation and improve outcomes identified in the case management dashboard, the challenges mentioned above continue, leaving the hospital at risk for not complying with these requirements.

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