ACDIS tip: Have you talked to your physician advisor lately? Increase involvement with these five ideas

by Alvin Gore, MD, CHCQM

Since the establishment of physician advisors, this important role has seen consistent growth in its scope of work. While most physician advisors began in the realm of ensuring medical necessity, there has been a gradual recognition of the importance of involving physician advisors in the realm of CDI, too.

A nationwide survey conducted by the American College of Physician Advisors (ACPA) in 2019 revealed that only 41% of respondents acknowledged participating in regular CDI and coding activities. Approximately the same number of respondents stated they participate in the CDI query escalation process.

But new data has shown continued CDI expansion for physician advisors in the hospital setting. A preliminary analysis of 2021 ACPA survey data shows 56% of physician advisors currently participate in the CDI query escalation process, 46% are involved in clinical validation denials, and 7.5% are involved with the generation of primary CDI queries. On the other hand, only about 1/3 of physician advisors are involved in CDI and coding staff education.

This data demonstrates that many opportunities remain in fostering collaborative work between physician advisors and CDI specialists. While the opportunity of involving a physician advisor in the CDI escalation process seems like an obvious opportunity for collaboration, there are numerous other reasons for establishing a comprehensive CDI physician advisor program. We will mention five examples:

1. First and most straightforward, organizations should foster ongoing longitudinal communication between CDI physician advisors and CDI staff, with the goal of decreasing incomplete or non-codable query responses. Questions such as, ‘Is this query needed?’, ‘Is this query non-leading?", or ‘Do you think the query is worded correctly for its intended purpose?’ can be easily answered through quick conversation and will avoid unnecessary or inappropriate queries. Additionally, CDI staff can easily reach out to their physician advisor for guidance on complex cases. Furthermore, a quick follow-up can be done with those providers whose query answers are either incomplete or non-codable. Educational guidance for improved documentation could be easily delivered to physicians or other providers in real-time.
2. Physician advisors can provide appropriately targeted medical staff education at multiple venues. This could be done formally, for example at department or section meetings, or informally, such as a simple hallway or lunchroom conversation. 
3. Physician advisors could be directly involved in clinical validation denials and appeals work. Just as with medical necessity tasks, our colleagues can contribute to appeal writing and participate in Administrative Law Judge (ALJ) Level 3 hearings providing medical justification to support denied DRGs.
4. Physician advisors could be a tremendous resource for those CDS who are involved in CDI/Quality work, providing advice on PSI metrics, POA and other related topics.
5. Physician advisors can assist with the implementation and adoption of a formal escalation policy, ensuring that it is understood and adopted by your organization’s medical staff. Physician advisors can serve as the initial escalation step in this policy, since they serve in a unique position to liaise between the medical staff and CDI. 

All this (and more) will be discussed at the upcoming virtual National Physician Advisor Conference, October 18-20, 2021. Please consider registering and participating at the ACPA website.

In summary, reach out to your physician advisor to start working together collaboratively in the CDI process. And if your facility does not currently have a physician advisor program, be an advocate and establish one. Let’s keep advancing the collaboration between physician advisors and CDI specialists.

Editor’s note: Alvin Gore, MD, CHCQM, is physician advisor and director of utilization management for Providence. You can reach him at alvin.gore@stjoe.org