By Barbara Abrams, MD, JD

Imagine being a Physician Advisor and not having any benchmarks to guide you. How much more difficult would your job be if you had no national comparisons for inpatient or observation length of stay? If you had no idea what an appropriate observation rate might be? If you had no guidelines to know if you’re on track for the number of observation-to-inpatient conversions or inpatient-to-observation conversions that you recommend? Are your numbers too low? Too high? What percentage of denials should you expect to overturn via peer to peer discussions? What’s an appropriate case mix index for your type of hospital? What if there were no data to show if a dedicated observation unit would be helpful for your patient population? Would you feel like you were flying blind? 

Welcome to the world of Pediatric Physician Advisors! Although our colleagues in the adult world have many national benchmarks and guidelines to guide their work and let them know if they are on the right track as compared to their peers, these are severely lacking for pediatric hospital populations. In an effort to improve this situation, the American College of Physician Advisors has formed a Pediatric Physician Advisor Committee, chaired by Dr. Denise Goodman of the Ann & Robert H. Lurie Children’s Hospital of Chicago. 

After several meetings, the Pediatric Physician Advisor Committee has reached a consensus to begin the information-gathering process with two key projects:

1. A national survey of Pediatric Physician Advisors designed to gather data on such things as who we are, (adult physicians working with pediatric populations? Pediatricians working with both pediatric and adult populations? Pediatricians working solely with pediatric populations?), what our observation rates are and what we think they should be, and how free-standing children’s hospitals compare with children’s hospitals housed inside “adult” institutions.
2. An online library of denials strategies with cases illustrating successful appeals to help us learn the answers to such questions as: What is working for us and what is not? What are successful strategies for dealing with denials that are unique to the pediatric population? Are pediatric peer-to-peer discussions likely to be more successful or less successful if the payer’s medical director is also a pediatrician?

Please check back in future editions of this newsletter to learn more about the ACPA’s Pediatric Physician Advisor Committee’s important work. At this point, we have more questions than answers, but we are able to share one crucial bit of information that we have gathered from our committee members – our favorite flavor of ice cream is chocolate!