The high and rising cost of health care has brought increased emphasis on the need to optimize the use of hospital services. Physician advisors – trained doctors who focus on the operational aspects of care rather than direct treatment – can help meet this need. Full-time physician advisors are gaining ground at hospitals across the United States. Last summer, Paul Simmons, MD, was appointed the first dedicated physician advisor to the MGH Case Management Department. The department had only part-time advisors in the past.
“I am delighted to have Paul in this role,” says Nancy Sullivan, executive director for Case Management. “He brings a wonderful combination of commitment, experience, humor and skill. Whether negotiating with a payer to cover a service or working with the patient care team on a challenging discharge, he always has the patient’s best interest in mind.”
Simmons worked as a primary care physician in the Mass General Medical Group since 2005 and served as associate medical director for utilization management at the MGH and MGPO since 2006. As physician advisor to Case Management, he serves as a facilitator and resource for care teams navigating obstacles – whether external or internal – that may impede the appropriate and timely progression of a patient from hospitalization to follow-up care after discharge. A liaison between case managers, physicians, other clinicians and even hospital administrators, Simmons is able to advocate for the early involvement of case management; offer guidance about level of care, length of stay and other quality issues; and help translate health plan rules and regulations.
“It is very difficult for busy caregivers to understand the frequently changing rules, regulations and policies related to discharge planning and utilization management,” says Elizabeth Mort, MD, associate chief medical officer. “Paul is now the go-to person for clinicians who need assistance with these matters.”
The other goal of the position is to develop new systems that enhance the quality and efficiency of care and to improve systems already in place. As part of this work, Simmons is collaborating with various units to help streamline their multidisciplinary rounds – a concept that came from the Direct Care Patient Affordability team – and works with nursing director Lee Ann Tata, DNP, ANP, BC, as one of three physician co-leads on the Innovation Unit on Ellison 16.
He co-chairs both the MGH Non-Acute Steering Committee, which works to strengthen the links between the MGH and the facilities receiving transferred MGH patients, and the Discharge Planning Workgroup, which helps manage the most challenging cases at the hospital. He also will continue his work on behalf of the MGH in utilization review and appeals to help ensure that the hospital is reimbursed for the care it delivers.
“There has never been a more important time for all of us to work together in providing patient-centered, high-quality, efficient care,” says Simmons. “I’m thrilled to be able to serve as a resource for case managers and all our providers.”
Read more articles from the 04/27/12 Hotline issue.