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Abandoning insourcing: Turning to Optum360

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Saad Ehtisham:





You wanna bring the internal f- uh, resources physician advisors because they know the medical staff. That's- that's very important so that familiarity is very good. Well, while that's the good side, there's the flip side to that coin. They're very afraid to challenge the, uh, the placement that the, what their colleague has placed a patient in. Secondly, they're- they're busy. They're all independent private physicians. They're in their practices from 8:00 to 5:00. We would barely get five or six responses from them, and they would just respond, "I'm too busy. Call the second one." And then secondary, uh, thirdly, it was really condition code 44s. When a- a inpatient needs to be converted, rolled back into observation status and you see a spike in, uh, condition code 44, it's a trigger for Medicare audit.



Saad Ehtisham:









In my mind, it's, uh, the hybrid and the onsite physician advisor is very effective, uh, from, number one, cost, uh, perspective. So, the advantage is of our onsite physical advisor to us at Central Florida Health have been the education that the onsite physician advisor, number one, uh, is providing our case managers and our physicians on the medical staff. Number two, they're on site and they have, they're integrated with the medical staff. They're part of the medical staff, so there becomes a familiarity with the person being on the medical staff a- and them being, uh, adopted, uh, as part of the team. And thirdly, the, uh, process improvements that they are helping us, uh, initiate within the case management in the UR department, uh, at the hospital level, at both our hospitals, have been very invaluable for us.


Saad Ehtisham:





Our onsite physician advisor was able to meet with UR case management, ER physicians and attendings, and re-vamp our, uh, co- condition code 44 process and algorithm. Uh, some of the other problems, uh, that we saw that a onsite physician advisor helped us, uh, were with the, on the discharge, uh, process. Uh, there were some delays, uh, from, uh, consults not being done, and she was able to pick those up and she can real-time text me, "Hey, this consult's not done. As long as, as soon as this consult's done, I can recommend discharge." And so, those are helping us reduce the length of stay as well. I find that to be a very, uh, collaborative partner for us in, uh, that, I- I would say, uh, bar-none, has been a really good, uh, relationship for us.



In this short video, the COO of Central Florida Health describes the benefits of turning to Optum360 physician advisors. With a busy staff, the hospital struggled to manage medical necessity internally. Then they began using a hybrid of onsite and remote physician advisors.

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