SHM Converge Scientific Abstract ePoster Gallery-System-Level Value of a Centralized Physician Advisor Program at Emory Healthcare.

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Emory Healthcare implemented a centralized, all-hospitalist Physician Advisor program in 2024 to standardize denial management, improve admission status decisions, and support clinicians across six hospitals. The program was created in response to increasing medical necessity denials, which place substantial administrative burden on frontline providers.<br /><br />The team compared utilization review metrics from FY24, before centralization, with FY25, after implementation. Key measures included the number of denials reviewed and completed, overturn rates, actual and expected revenue recovered from denials, and estimated time saved for clinicians. Time savings were calculated based on the average time needed for denial review and payer peer-to-peer discussions.<br /><br />Results showed substantial improvement after implementation. Completed denials more than doubled, increasing from 3,465 to 6,977, a 101% rise. The system-wide overturn rate increased from 47% to 59.5%, and the number of overturned cases rose by 155%, from 1,629 to 4,151. The program was also associated with meaningful financial gains, contributing $71.8 million in actual recovery and $92.0 million in expected recovery in FY25. In terms of workload reduction, the program saved an estimated 750 provider hours annually, equivalent to 62 full 12-hour shifts.<br /><br />In addition to denial management, the Physician Advisor team conducted secondary reviews to support accurate admission status decisions, provided documentation education, and helped reduce length of stay by improving care progression.<br /><br />Overall, Emory Healthcare’s centralized Physician Advisor program improved denial management, reduced physician administrative burden, and strengthened financial outcomes through a scalable, system-wide approach.

Asset Subtitle

Babar Junaidi

Meta Tag

Author List Babar Junaidi, Maha Sulieman, Rashida La Barrie, Sarah O. Decaro, Sathyabama Naidu, Viniya Patidar

Category Innovations

Concept Physician Advisor Program

Concept Medical Necessity Denial

Concept Denial Overturn Rate

Concept Centralization

Concept Denial Management

Distinguished Non-Finalist

Presenter Organization Emory University Hospital

Presenting Author Babar Junaidi

Track Value in Hospital Medicine

Keywords

Emory Healthcare

Physician Advisor program

denial management

medical necessity denials

utilization review

admission status decisions

overturn rate

revenue recovery

clinician time savings

hospitalist centralization

Physician Advisor Program

Medical Necessity Denial

Denial Overturn Rate

Centralization

Denial Management