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A freshly minted physician advisor shares thoughts on the engagement process.

Working in the clinical revenue cycle arena has taught me a lot about engaging physicians, while being a physician advisor has been an enlightening experience.

It is necessary to engage physicians especially for utilization review, clinical documentation integrity (CDI), and sometimes coding. There are actually regulations that demand they be included in decision-making. Over the years, however,  I have found a way to categorize the various methods of responses from physicians when attempts at engagement from the various components of clinical revenue cycle occur and I believe that most have met several of these categories:

  • The first is the curmudgeon which is defined as a “bad-tempered, difficult, cantankerous person…”. Hate to admit it, but that was me and it was not uncommon for me to say “…and what medical school did you go to?” It usually did not result in a very productive conversation.
  • The runner – This is the doc who starts walking down the hall and spots a CDS or UR specialist ahead. Seems they are thinking ‘they want to talk with me’ and so they run off in another direction. I’ve even seen them run into the OR, and they weren’t even a surgeon.
  • The invisible man/woman – This is the doc who makes rounds at 6 AM or after 9 PM just so they didn’t have to see a CDS or discuss the case with anyone
  • The evader – In today’s world of technology with various devices, texting, cell phones and more ways to communicate, they avoid responding. This type of person is not seen as much in today’s environment. Yet, when it occurs they do have ways of ignoring calls and texts saying, “I never got it.”
  • The sneak – Unfortunately, this is another technique that I ashamedly have to admit to. When I was practicing, a discharge summary was not required from any patient in an OBS level of care. If I had a patient as IP, I would write the change to OBS and then immediately discharge the patient so neither UR or CDI could catch me and ask why.
  • The pleaser – Essentially, this is the doc who says that he/she will do what is asked and then goes ahead and does whatever they want
  •  The collegiate – This is the doc where there is actually a great conversation and gives the information needed.
  • Electronic – With the advent of the electronic medical record (EMR), there have become many easier ways to get the engagement and a response.
  • Success – Probably happens more often than thought, often referred to as query success rate.

Today, there are more physician advisors (PA) around, and they are the ones who may run into similar situations and personalities but not as often. Physicians can’t play as many tricks when it is a peer they are talking with.

Docs behave better then, but not always.

Programming note: Listen to Dr. John Zelem today on Talk Ten Tuesdays at 10 Eastern.

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