The Physician Advisor role assists institutions to realize improved financial,
quality and patient flow measures that are essential
to achieving the goals of value-based care. The ultimate goal of the Physician Advisor: advocacy
for patients and families, as well as fellow practitioners.
PA Standards and Scope Brochure
Standards of Practice
The Physician Advisor Standards of Practice outline the
requirements and competency to function in this role.
The Physician Advisor holds an active medical license
and participates in ongoing continuing medical
education as required by their healthcare delivery
entity to remain up to date on practice, procedures
and treatment protocols. Expectations regarding
professional conduct include confidentiality,
interprofessional collegiality, ethical behavior and
a commitment to ensuring high quality, appropriate,
safe and compassionate care for all. The Physician
Advisor manages conflict of interest issues and recuses self, as needed.
The Physician Advisor leads by example, is an
influencer and acts as a change agent to achieve
programmatic goals. The Physician Advisor
demonstrates operational effectiveness within the
structure of the organization and advocates for the
role of the Physician Advisor within the organization
as a catalyst for value-based care initiatives. The
Physician Advisor develops organizational knowledge,
utilizes and leverages strengths and resources within
the organization, and identifies and addresses local
and regional factors which affect care delivery. The
Physician Advisor provides support for strategic goals
and drives behaviors which achieve meaningful and
measurable outcomes. The Physician Advisor also
collaborates with case management leadership.
The Physician Advisor balances advocacy and
support for patients, families, practitioners and
professional staff and the organization that he/she
is serving.
The Physician Advisor represents the medical staff
and medical community standards of practice.
The Physician Advisor demonstrates accountability,
which is exhibited in a variety of ways: supports
performance improvement to drive care
management metrics, remains current on healthcare
and payor regulatory provisions, provides timely
follow up on case prioritization with physicians
and care management leaders, attends utilization
review meetings and represents care management
in hospital wide initiatives. The Physician Advisor
reviews cases as needed to meet criteria for medical
necessity, quality and desired outcomes. The Physician
Advisor is responsible for addressing and escalating
challenging, high conflict or outlier case circumstances,
and serves as a mentor for clinical documentation.
Excellent and timely follow up of communication
amongst patients, families, care managers, physicians
and payors are important components of the
Physician Advisor role. This includes peer-to-peer
discussion and clinical documentation opportunities.
The Physician Advisor demonstrates the ability to
facilitate and de-escalate difficult conversations in
a professional manner.
The Physician Advisor respects and values the
contributions of all disciplines and builds relationships
that foster trust and confidence. The Physician Advisor
demonstrates credibility and problem-solving skills.
The Physician Advisor mediates amongst different
departments, teams, or individuals involved with
the patient’s episode of care.
The Physician Advisor aligns and drives performance
improvement opportunities within the Medical Staff
and Care Management to achieve the highest
quality and regulatory compliance. A keen
understanding of the payor market and managed
care contracts is essential.
The Physician Advisor exhibits an understanding of
value-based care models, including a longitudinal
perspective of the care delivery focused on the
right intervention, at the right time, and in the right
care setting. The Physician Advisor works to align all
stakeholders across the care continuum.
Essential to the Physician Advisor role is the ability to
identify, interpret, synthesize and apply relevant quality
measures to achieve meaningful outcomes. The
Physician Advisor leverages outcome data to drive
and improve strategic organizational performance
and demonstrates expertise in optimizing the
electronic medical record.
Scope of Services
The Physician Advisor scope of services outlines
general expectations of the role and responsibilities.
Services delivered by Physician Advisors include:
• Promotes alignment and collaboration with
physicians regarding culture, satisfaction,
engagement and problem solving
• Acts as a liaison to case management, the CMO,
professional staff and hospital administration for
questions or concerns
• Demonstrates balance and equity with advocacy
for patient and family-centered care, medical and
professional staff and organizational stewardship
• Concurrently reviews cases to achieve timely
and effective care across the continuum
• Participates in case reviews regarding levels
of care, length of stay, resource utilization and
avoidable delays
• Applies clinical knowledge for appropriate
length of stay
• Supports care management in progressing care
to meet length of stay goals
• Demonstrates up-to-date knowledge of
newest technologies, clinical practice guidelines
and treatments
• Promotes and supports patient safety initiatives
• Assists medical and professional staff with
education regarding DRG LOS, denials, clinical
documentation, practice guidelines within the
EMR and any regulatory changes
• Drives performance improvement by sharing
physician-specific data regarding LOS, readmissions,
use of hospitalist program and case denials
• Supports education to minimize clinical variability
throughout the medical staff
• Serves as a resource for CDI and coding specialty
• Ensures compliance with CMS conditions of
participation and managed care contracts
• Drives performance improvement
• Participates in Medicare audit reviews
• Participates in the appeals process
• Performs clinical reviews on cases referred by
healthcare professionals and ensures quality
and effective patient care is provided
• Advises physicians regarding patient status and
appropriate and necessary documentation
• Supports efficient patient flow, appropriate
patient placement, effectively coordinates with
stakeholders across the continuum of care
• Collaborates with clinical documentation team to
ensure timely documentation to support working
DRG, in compliance with ICD 10 requirements
• Follows up with physicians and professional staff to
address documentation deficiencies and to update on procedural and terminology changes