Structure your physician advisor program not just for financial ROI, but work-life balance

By Brian Murphy

Physicians are the lifeblood of a hospital. They provide lifesaving treatment and specialized care but also write the admission orders that keep the lights on.

So how do you take 15 physicians and carve out half of their priceless time for CDI? By demonstrating return on investment (ROI).

A.J. Hegg is an intensivist but spends half of his time serving as Medical Director of the physician & APP advisors team for Essentia Health. The team performs a diverse array of CDI responsibilities, including:

• Utilization management and status reviews to prevent medical necessity denials
• Chart reviews of complex cases, including clinical validation, DRG optimization, and query escalation
• Provider profee coding reviews 
• Quality work including observed to expected and morality reviews
• Prior authorizations assistance
• Constant education, on Zoom calls or directly at the provider elbow

Hegg did not give a number but says the ROI the team delivers is 10 times what it costs the organization.

As impressive as it is, they also deliver a different ROI: work-life balance to a profession under siege. Their CDI responsibilities are at a 0.3-0.5 level, and the rest of their time is spent practicing medicine.

The rebalance has worked wonders for them and the full-time medical staff whom they support.

“It really is about the people we work with and the culture that we have,” Hegg explains. “The first thing you need to do is take care of yourself and your family. Then it’s patients. Then it’s our team. And then it’s the organization. 

“For our team, people have found it to be refreshing, they’re learning, they’re engaged, they’re excited—and they have these boundaries. It’s been good for their burnout. And we are certainly also trying as much as we can to make it easier for our clinicians, to get it right the first time, to understand this so they’re getting less queries, they’re getting less taps, so that they can focus on the things that are taking care of patients. Which is what they want to do. 

“We always look at how we can make it easier for the docs and the APPs, and how we can make sure that we’re doing is also improving patient care.”

I’d say it’s working. The attached photo is Hegg (right) and some of his physician advisor team at the recent ACDIS conference, looking pretty comfortable and non-burned out. 

That’s me at left, looking somewhat uncomfortable.

Listen to the full episode of the podcast here.