Power Tactics Role Playing and Leadership

Report
Power Tactics, Role Playing and Leadership Opportunities for Physician Advisors
Jeffrey Farber, MD, MBA
Chief Medical Officer, Mount Sinai Care, LLC
Introduction
A Physician Advisor:
• is a hospital-based physician executive
who serves as a liaison between case
and utilization management, health
information management, treating
clinicians, and administration;
• is a content knowledge expert on
government and commercial payer rules
and regulations, clinical documentation,
coding, billing, and publicly-reported,
and severity-adjusted quality data;
The Greatest Challenge
for the Physician Advisor
is Physician Engagement
Power Tactics
Behaviors one utilizes to
influence:
• Legitimacy
• Rational persuasion
• manages length of stay, throughput,
efficiency, quality, and medical necessity
and coding denials;
• Coalitions
• ensures compliance with Medicare’s
conditions of participation, leading the
Utilization Management Committee.
• Consultation
• Inspirational appeals
• Exchange
• Personal appeals
What is Power?
Power: One’s capacity to influence
another’s behavior to be in accordance
with one’s wishes. The ability to mobilize
resources to achieve some end.
• Formal: based on one’s position in the
organization
• Ingratiation
• Pressure
Matching Power
Tactics to the Audience
- Coercion and Reward
- Legitimate: from position within
hierarchy
• Informal (personal) power
encompasses:
- Expertise (physician advisor
knowledge base)
- Referent power: if I like, respect, and
admire you, you can exercise power
over me because I want to please
you.
- Charismatic power: due to one’s
attractive visions (based on
personality and interpersonal style)
Upward influence: rational
persuasion
Downward influence:
everything except personal
appeals and coalitions
Lateral influence:
everything except
inspirational appeals and
pressure
Mount Sinai Medical Center, New York, NY
Role Playing Scenario 1:
Observation Unit
Role Playing Scenario 3:
Appeals Management
Physician Advisor wants the organization to build an observation
unit.
Physician Advisor wants to engage a chairman to
partner in working on front-line processes to
reduce medical necessity short-stay admission
denials.
Background:
Appeals Management Department was without
physician leadership and had limited outreach to
doctors.
New Physician Advisor role in 2006, expanded to
lead the department in 2007, and hired full-time
and part-time physician appeals coordinators,
eliminating the need to outsource appeals.
Requires expertise in revenue cycle, payment
models, quality, compliance, documentation,
and coding.
Power tactic for C-suite: rational persuasion.
Focus on revenue integrity, reducing $ lost to denials, back-fill of
inpatient beds with higher margin cases, readmission reductions,
alignments with value-based purchasing and accountable care
organization
Power tactics for physicians:
Rational persuasion: increased and more directed referrals,
improved care coordination and patient satisfaction
Consultation: I’d like your input on how best to handle admissions
to the unit from the voluntaries
Coalitions: Dr. Smith in cardiology thinks it’s a great idea
Ingratiation: that was a great talk you gave at grand rounds.
Role Playing Scenario 2:
Clinical Documentation
Power Tactics
Legitimacy: Messaging directly from CEO and
CFO as an organizational priority, including
metrics on service line dashboards.
Consultation and Ingratiation: Thank you for
encouraging your faculty to work with us in
crafting appeal letters. Partnering with us in
finance will ensure revenue integrity when
hospital and physician billing are aligned.
Exchange: Partnering with us on improved frontend documentation will allow us to improve
your service line’s case mix index (CMI) through
improved documentation and electronic medical
record templating.
Physician Advisor wants a staff doctor to answer a clinical
documentation query.
Background:
• Long-neglected clinical documentation improvement program
that lacked a physician leader. Revitalized in 2007 with a
physician champion.
• Physician advisor expands the program across two campuses in
2008 and increases the clinician response rate to queries from
77% to 100%.
• Rational persuasion:
improved documentation
defends the physician
from medical liability
allegations and enhances
the physicians’ reputation
through accurate
comparative analytics
and public reporting of
severity-adjusted quality
data.
• Consultation: Dr. John
prefers we contact him in
this manner. What works
best for you?
MSH CDI Program Performance
19,000
100%
17,000
95%
Future Directions
15,000
90%
13,000
Charts
Reviewed
(#)
85%
11,000
80%
9,000
75%
7,000
5,000
70%
2007
2008
2009
Total charts reviewed
2010
2011
Physician response rate
2012
Physician
Response
Rate
• There are many emerging career-enhancing
opportunities for physician executives in the
physician advisor realm.
• Thoughtful use of power tactics will assist the
physician executive in mobilizing resources to
achieve desired ends.
• Successful physician executives should be skilled
in leading and influencing not just down, but
across and up in complex organizations.

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