SHM Converge Scientific Abstract ePoster Gallery-Hospitalists as Physician Advisors Provide Value Beyond Utilization Review

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UC San Diego Health implemented an internal physician advisor program led by hospitalists to improve admission status review, reduce external review costs, and add broader institutional value beyond traditional utilization review.<br /><br />Hospitals must assign patients correctly as inpatient or outpatient to comply with CMS rules and optimize reimbursement. Incorrect status can lead to revenue loss, audits, and penalties. Many hospitals rely on commercial tools such as InterQual or Milliman, and may also use third-party physician reviewers, which adds expense and can delay decisions. UC San Diego Health, an 808-bed, two-hospital system, began its internal physician advisor program in January 2018. By FY 2021–2022, four hospitalists dedicating 2.4 FTEs handled most review work internally.<br /><br />The program produced substantial savings: hospitalists completed 3,090 of 3,338 Medicare secondary reviews and 1,242 of 5,720 Medi-Cal reviews, avoiding approximately $643,000 in third-party review costs. The authors argue that hospitalists are especially well suited for physician advisor roles because they work closely with multiple specialties, understand hospital operations, know inpatient disease management, and are experienced in clinical documentation.<br /><br />Their responsibilities extend beyond status review. They serve as liaisons between treating physicians and care management, lead barriers-to-discharge rounds, help resolve discharge delays, advise on denials and peer-to-peer appeals, and teach departments about admission status selection. They also contribute to initiatives such as post-acute care transitions, readmissions reduction, patient flow optimization, charity approval processes, and hospice program implementation.<br /><br />Overall, the presentation concludes that internal physician advisor programs staffed by hospitalists can reduce dependence on external agencies, lower direct costs, improve revenue capture, and support a wide range of hospital improvement efforts.

Asset Subtitle

Diana Childers

Meta Tag

Author List Brian Clay, Bryan Huang, Diana Childers, Maryann T. Ally, William J. Frederick III

Category Innovations

Concept Inpatient Status

Concept Outpatient Status

Concept Physician Advisor

Concept Utilization Review

Concept Compliance

Distinguished Non-Finalist

Presenter Organization UCSD Health

Presenting Author Diana Childers

Track Value in Hospital Medicine

Keywords

physician advisor program

hospitalists

admission status review

utilization review

CMS compliance

reimbursement optimization

third-party review costs

inpatient outpatient status

denials appeals

hospital operations

Inpatient Status

Outpatient Status

Physician Advisor

Utilization Review

Compliance