Name: Howard Stein, D.O., MHA
Employer: Associate director of medical affairs, physician adviser for care management at CentraState Medical Center in Freehold, New Jersey
Undergraduate: Muhlenberg College, Allentown, Pennsylvania
Postgraduate: Nova Southeastern College (D.O.), Fort Lauderdale, FloridaUniversity of Maryland (MHA), Adelphi, Maryland
Residency: Union Hospital, Union, New Jersey
A physician adviser serves as a liaison between the medical team and hospital administrators. Stein is a national speaker advocating the physician adviser position and the importance of performing multidisciplinary rounds.
He left clinical practice in 2003 as his role at CentraState Medical Center evolved into full-time administrative work. He obtained his MHA in 2014, which gave him insight into the administrative and economic aspects of medicine.
What does it take to become a physician adviser?
In general, preparation for the physician adviser position involves practicing medicine for at least five years and showing an interest in utilization, quality assurance, coding, billing or informatics.
What do you like about your role?
I like working on all of the hospital floors and interacting with all of the physicians as they come around to see patients.
I also like multidisciplinary rounds; I do six sets of rounds per day. I interact with nursing staff, physical therapists, clinical pharmacologists, pastoral care workers, social workers and case managers. They’re all part of multidisciplinary rounds, so each day we efficiently discuss each patient.
We communicate on an interdisciplinary level so everyone knows what each discipline is working on. I find out what the physician issues are so that I can address them. And when an insurance company is not going to pay for a patient’s stay, I know about it while a patient is an inpatient instead of finding out about it a week later. So we can react to it by either appealing it or by helping the patient obtain an earlier discharge.
There are multiple other good things that happen when you do multidisciplinary rounds from a quality and economic perspective.
What’s the most challenging part?
I don’t like how insurance companies take advantage of hospitals and patients by denying them care when it’s appropriate for them to have the care. The physician adviser’s role is to be an advocate for that patient.
As denials are issued by an insurance company, the physician adviser reviews the case, talks with the doctors who were involved and makes the decision to appeal the decision or work toward a safe discharge plan if that’s an accurate decision.
Was there anything about becoming a physician adviser that surprised you?
In some hospitals, there’s a large divide between the administration and the medical staff. So, there’s some natural pushback by the medical staff on what the physician adviser does. In some organizations, the physician adviser is looked at as an outsider, not really a member of the medical staff.
I don’t have this problem. Those that do have to work hard to be credible and to gain the trust of the physicians on the medical staff, make them understand that the physician adviser is there to help them and their patients.
Physician advisers are not just somebody from administration telling them what to do.
How can other physicians pursue physician adviser roles?
The optimal candidate is a primary care physician, although there are a lot of non-primary care physicians that do it. The primary care physician has a somewhat greater perspective on a wider variety of cases that come into a hospital.
Interested physicians should spend some time with a physician adviser in a hospital to get to see what they do on a day-to-day basis. I suggest joining the American College of Physician Advisors. The other organization that’s very helpful is the American Board of Quality Assurance and Utilization Review Physicians.
There are some conferences each year that I think are helpful. There is also a physician adviser boot camp held yearly. ABQAURP holds an annual conference as well.
It’s about combining the clinical knowledge from practicing medicine for a number of years and learning to understand the utilization rules given by insurance companies and Medicare.
Then, the physician adviser needs to be able to teach the medical staff and finance department the ins and outs of the rules to maximize quality and the reimbursement received by using hospital services efficiently and billing correctly.
It’s definitely a field that’s expanding and growing. There are physician advisers now in different fields of administrative medicine. It’s not just utilization, but it’s also quality, informatics, coding and documentation.
Physician advisers are key to successful organizations. Physician advisers bridge the gap between hospital administration and clinical medicine.