In this Update:

Editor's Note

Ronald Hirsch, MD, FACP, CHCQM-PHYADV, CHRI

Member, ACPA Advisory Board

Member, ACPA Government Affairs Committee 

Editor, ACPA Update

Whew! We made it through 2022. Hopefully all of you came through relatively unscathed. I know many physician advisors continue to practice clinically and I once again salute you and all our non-physician members who worked at the bedside in 2022, faced with the tripedemic and ongoing staffing shortages. I wish I could say that 2023 is going to be better but we truly have no idea what’s coming next. I am sure all of your hospitals have a budgeted admission volume, surgery volume, observation rate, and likely more. But show me one hospital that sat down in 2019 and prepared a 2020 budget that included a line item for a world-wide pandemic. Budgeting how many people will get sick, will get cancer, will break a hip just makes no sense to me. I just continue doing what is right for every patient every day, even if we did not budget for their illness.  

In that light, for this issue Dr. Bart Caponi has written an article about benchmarking the observation rate. Be sure to read it and take the lessons back to your C-suite when you hear them talk about benchmarking.  

We also have an article from Dr. Waldo Herrera about another procedure which you may have as a budgeted target- performance of TAVRs. His article though talks about a very important aspect of this procedure – the assignment of the correct DRG. I have heard, but have not verified, that many cardiologists are advised by external sources how to document these cases to maximize revenue for the hospital. Note that I used the word maximize and not optimize. There is a big difference. Read Dr Herrera’s to learn more. 

I am also delighted to include a great article from the CMSA president, Colleen Morley, on disruptive innovation. ACPA proudly works closely with our nursing and social work colleagues at CMSA as partners in advancing our professions. And if I can brag, an article I wrote for CMSA Today, their official journal, on readmissions was the most read article in 2022. December’s CMSA Today also saw an article from Dr. Anuja Mohla, another ACPA member and one of the 2022 Hirsch’s Heroes, on appeals. It is just so cool that we are sharing our knowledge with CMSA and vice versa. 



What would an issue of ACPA Update be without some interaction with readers? Be sure to read the Observation Committee cases and go online to submit your answers. No, really, do it. I can almost guarantee that you have seen this month’s cases in your hospital so tell us what you would do. You can even go directly on line right now and review the cases by clicking here: https://www.surveymonkey.com/r/32Z9RJN.   

Finally, have you heard that CMS has posted a proposed rule to clamp down on Medicare Advantage plans? You will be hearing more about this and the ACPA Government Affairs Committee is going to be asking you to submit comments to CMS supporting these proposals so stand by. If you are anxious to read the 957-page rule, go here: https://www.regulations.gov/document/CMS_FRDOC_0001-3474

2023 Medicare Inpatient Only (IPO) Lists

Edward Hu, MD, CHCQM-PHYADV

Member, ACPA Government Affairs Committee 

The 2023 Medicare Inpatient Only (IPO) lists by specialty are now available for American College of Physician Advisor (ACPA) members! These contain both "inpatient only" procedures and "not inpatient only" procedures in different columns to assist you in identifying the right procedure. The design is to give you a more thorough view of the codeset that currently exists, so you can identify nuances that may swing a procedure between an inpatient (IP) only procedure or not an IP only procedure.

Similar to prior years, the lists are organized into 16 specialties that are further divided by organ system, anatomic location, or purpose (depending on what makes the most sense for that specialty). Minor procedures that are obviously not inpatient only are sometimes omitted (such as screening colonoscopy or transthoracic echocardiography). Anesthesia, laboratory, and drug codes are, as a rule, omitted from the lists, as well. 

The major change this year is a new set of CPT codes to describe anterior abdominal wall hernia procedures. With this change, CMS has specified some of these procedures to be Inpatient Only for 2023. This will lead to some confusion as anterior hernia procedures were rarely Inpatient Only prior to 2023. Recognizing when a hernia procedure becomes an Inpatient Only procedure will be important to prevent revenue loss. We have created a graphic that attempts to explain in which situations an anterior abdominal wall hernia can become inpatient only. It may depend on whether a hernia is reducible, the total length of hernia defect, and the type of mesh used. We hope you will find this useful in your own education and the education of your medical staffs.

CMS also removed a handful of facial fracture CPT codes from the Inpatient Only list for 2023, and a few other minor changes as well. Every year, there are also new codes added, some of which will also be Inpatient Only. We emphasize that the official IP only list remains CMS OPPS Addendum E, and that the CPT codeset is owned and maintained by the American Medical Association (AMA) which revises code descriptions from time to time which may not be reflected in these lists. The HCPCS codes are maintained by CMS. These official references remain the "source of truth," and these ACPA lists cannot be relied upon as definitive information.

Do not post any of the lists on the internet, please. Members may share them with staff at their institutions who can benefit from them, but encourage them to join ACPA for all the other educational and networking opportunities ACPA provides! 

Breaking the Silos: Role of CDI in Reporting Patient Safety Indicators (PSIs) 

Neelima Divakaran, MD, MBBS 

Member, ACPA CDI committee 

‘To err is human’ but to learn from our errors is perhaps more human, and evermore pertinent as our healthcare systems continue to bear the burden of adverse events that negatively impact both patient outcomes and financial health of hospitals. The Agency for Healthcare Research and Quality (AHRQ) developed 26 measures or Patient Safety Indicators (PSIs) that identify patient safety issues related to procedures, surgeries, and childbirth to capture and quantify potentially preventable adverse events. The CMS Patient Safety and Adverse events Composite (CMS PSI 90) is a subset of these indicators that is more relevant to the Medicare population and impacts comparative rating and quality improvements efforts in hospitals. Furthermore, when health systems report PSIs in their quality data they can carry financial consequences as part of the pay for performance initiatives.  

The PSI 90 composite includes the following measures: 

PSI 03 Pressure Ulcer Rate  

PSI 06 Iatrogenic Pneumothorax Rate  

PSI 08 In-Hospital Fall with Hip Fracture Rate  

PSI 09 Perioperative Hemorrhage or Hematoma Rate  

PSI 10 Post-Operative Acute Kidney Injury Requiring Dialysis Rate  

PSI 11 Postoperative Respiratory Failure Rate  

PSI 12 Perioperative Pulmonary Embolism or Deep Vein Thrombosis Rate  

PSI 13 Postoperative Sepsis Rate  

PSI 14 Postoperative Wound Dehiscence Rate  

PSI 15 Unrecognized Accidental Puncture or Laceration Rate 

PSIs are risk-adjusted and incorporate diagnostic-related groups (DRG) which are captured from documented data. Accurate documentation and coding of these measures is, therefore, critical in reflecting the true safety climate of a hospital. This also means that avoiding false positive reporting of PSI should also be an inherent part of the process. This is where clinical documentation integrity (CDI) can play an important role.    

Understanding that certain comorbid conditions when present would exclude cases from being reported as PSI cases is an easy strategy to avoid false capture of an adverse event. For example, if a clinically significant pleural effusion is present, it would exclude PSI 6 Iatrogenic Pneumothorax. Clinical documentation specialists (CDSs) can be vigilant for comorbid conditions that can help exclude PSIs and query for them if not documented or coded appropriately.  

Another situation is when physicians document in such a way that a condition may be coded inappropriately as a complication, even though it may be an expected or inherent condition with the procedure and does not impact overall care of the patient. CDI can query physicians to clarify if such a condition was ‘inherent’ or an ‘expected occurrence’ with the procedure. A good example would be documenting accidental laceration of small bowel during extensive lysis of bowel adhesions which was then repaired during the same surgery and with minimal impact on overall outcomes.  

PSIs are not triggered if complications are present on admission. CDSs can be useful to determine if a condition was present on admission (POA) and obtain clear documentation to support a POA of ‘yes’ or of ‘clinically unable to determine’ status. For example, presence of thrombocytopenia on admission can exclude a case from PSI 09 Postoperative Hemorrhage or Hematoma Rate. If providers document ‘clinically unable to determine if POA’, coders can assign a W code as the POA status. The implication of POA-W is equivalent to POA-Y, which can then exclude the condition from triggering the PSI.  

As can be noted from the above examples, the query process for PSI can be problematic as quality related queries can be perceived differently by providers versus asking for simple documentation clarifications. To develop a compliant query process and avoid risk of underreporting, a close collaboration with Quality department of the hospital is vital. As programs begin to expand the role of CDI and lean more towards quality driven metrics, these can be some of the key strategies to begin including CDI in the PSI review process: 

• Education to both CDSs and providers around the PSI concepts especially its implications for quality. Early focus on understanding the latest inclusion and exclusions for each PSI and the need to clearly validate principal diagnosis or procedures is a good starting point.  
• Create a collaborative team such as a PSI review committee and having a clearly written process for escalating cases that are being flagged for PSI inclusion. Ideally this team should be representing Quality Dept (leadership level), Physician Advisor, CDS representative (lead), and a coding lead. Tracking and sharing data around PSI rates for the hospital, monitoring productivity impact due lengthy case reviews, and developing metrics to align leadership goals with CDI program goals are areas that will need constant review.  

In summary, breaking the silos and creating seamless communication between Quality, CDI and Coding can significantly impact reporting of safety measures such as PSI and should be seen as an essential part of all CDI program activities. We physician advisors can be vital participants in this endeavor. 

Dr Neelima Divakaran is a Hospitalist and Physician Advisor for Clinical Documentation at NorthShore University HealthSystem in Chicago, Illinois.  

Disruptive Innovation: A Challenge to Physician Advisors and Case Managers

Colleen Morley, DNP, RN, CCM, CMAC, CMCN, ACM, RN, FCM 

I am honored to have taken on the reins as the National President of the Case Management Society of America in June of 2022. The theme for my CMSA presidency is ‘disruptive innovation.’ This term is usually defined in use of technology that “creates a new market by applying a different set of values which ultimately and unexpectedly overtakes an existing market” (Sensemeir, 2012, p. 13).  

I will presume to extend the premise of ‘disruptive innovation’ beyond technology, but rather looking at issues with an eye to creating simpler, perhaps more radical ways to use existing resources or developing new resources in response to the new perspective on the issue.  

Simply put, I believe and advocate that it is our right and responsibility to disrupt processes when they are not working and propose new and innovative solutions to the issues we identify. Change is not comfortable. It makes us stretch, it challenges us and makes demands. We seek comfort in the “ways things have always been,” but how is anything, especially healthcare, supposed to grow if we stay in what is comfortable?  

Physician Advisors are in a key role to foster an environment of disruptive innovation. 

Just as case managers, regardless of discipline, have been the experts in patient centered care and the social determinants of health long before they became fashionable and buzzwords; physician advisors have long had an enhanced insight into the gaps within continuum of care. “The physician advisor role initially grew out of a staffing need—a role with clinical knowledge that also understands government and commercial payer regulations in order to assist with administrative functions, such as conducting peer-to-peer reviews for medical necessity denials, reviewing inpatient versus observation status, and more. Over time, healthcare leaders have leveraged this role to relay crucial nonclinical information to the provider community and also to drive targeted education efforts” (ACPA, 2021).  

As the experts in care management, it is our joint responsibility to identify these gaps, provide the disruption and take a leadership role in the in the development of the innovative solutions to these care gaps. Evolving the partnership between case managers and physician advisors to include disruptive innovation opportunities is the natural “next step”  

Examples of this “disruptive innovation” are demonstrated in the CMSA Standards of Practice and publication of Case Management Adherence Guidelines (CMAG).  CMSA was the 1st case management professional organization to publish Standards of Practice, the very backbone of the case management profession. The 2022 updates were unveiled at the CMSA National Conference to include a new standard for Health Information Technology. This standard addresses not only HIPAA but also the need to assess our patients for the ability to use technology to manage their healthcare journey. The CMAG for C.Difficile, in collaboration with CMSA partner, Ferring Pharmaceutical, also premiered at the Conference. The presentation gave me new insight to new ways of thinking about the role of case management with this patient population. From a personal perspective, I have partnered with Physician Advisors on disruptive innovation process improvement projects, including the 2020 CMSA Foundation CMPI Award winning project to address health literacy and health confidence to reduce readmissions.  The sky is the limit on how Physician Advisors and Case Managers can work together to create these opportunities for innovation! 

American College of Physician Advisors (ACPA). (2021). Physician advisors: bridging the gap between revenue cycle and clinical care. May 2021. https://www.acpadvisors.org/docs.ashx?id=830509 

Sensmeier, J. E. (2012). Disruptive innovation and the changing face of healthcare. Nursing Management (Springhouse), 43(11), 13–14. https://doi.org/10.1097/01.numa.0000421681.71712.86 

Dr Morley is Associate Chief Clinical Operations Officer-Continuum of Care at UI Health and president of the CMSA national Board of Directors 

Transcatheter Aortic Valve Replacement   

Reimbursement and Documentation Challenge 

Waldo Herrera, MD, MBA, MSc, FACP, SFHM, CHCQM-PHYADV  

ACPA CDI Committee Vice Chair 

Every day the healthcare landscape becomes more complex. The financial penalties the hospitals face and the ever-increasing cost of doing the business of medicine put significant financial stress on health systems and clinical providers.  

Generally speaking, surgical procedures provide greater reimbursement than caring for patients in the medical wards. One intervention gaining rapid traction is transcatheter aortic valve replacement (TAVR) in patients with symptomatic severe aortic stenosis at increased risk of complications with surgical replacement. A TAVR is a minimally invasive procedure that replaces the aortic valve without removing the damaged native structure. Like the placement of a coronary stent, a fully collapsible valve is inserted through a catheter using an angioplasty balloon to expand and seat the new valve, which pushes the old leaflets out of the way and controls the blood flow. 

TAVR is an inpatient-only procedure, and two diagnosis-related groups (DRGs) are available based on the presence or absence of major complications or comorbidities (MCCs) during the hospital stay. DRG 266 applies to procedures with MCCs, while DRG 267 is for TAVR procedures without MCCs. Since DRG 266 has a higher payment, most TAVR programs are looking for ways to improve their clinical documentation to capture all the complications or comorbidities (CCs) and MCCs present during the inpatient stay. While only the documentation of an MCC changes the DRG to the highest tier, documenting all comorbidities is equally crucial to achieving accurate and often optimal quality measures. These key performance indicators include mortality index, expected length of stay (GMLOS), CMI (case mix index), risk adjustment factor (RAF) score, patient safety indicators (PSI), hospital-acquired conditions (HAC), and CC/MCC capture rates.  

While it is acceptable and advisable that healthcare organizations optimize documentation and coding to support appropriate reimbursement, they should also safeguard that only compliant strategies are in place. In line with industry standards, it is acceptable for device companies to provide training and advice to their customers. Still, coding, compliance, and clinical documentation integrity (CDI) staff need to be closely involved to guarantee that any tactic executed is ethical and legal. 

Chronic heart failure is prevalent in patients undergoing TAVR. Historically, the procedure is urgent if performed during admission for acute or acute on chronic heart failure. Elective surgeries apply to patients with chronic and stable symptoms. Only when the TAVR is urgent and performed in a patient with acute or acute-on-chronic heart failure, specified as systolic, combined, or diastolic, will this HF diagnosis be considered an MCC and move the DRG from 267 to 266. Most institutions find heart failure is the most significant opportunity to capture an MCC. Nevertheless, providers should be vigilant for other MCCs (e.g., ATN, ESRD, acute myocardial infarction, pancytopenia due to chemo and drugs, pressure ulcers stage III and IV, severe malnutrition, sepsis, SIRS, and acute or acute-on-chronic hypoxemic or hypercarbic respiratory failure) 

The Framingham criteria is an evidence-based and valuable tool to diagnose chronic heart failure. The latest ejection fraction on an echocardiogram determines if the heart failure is systolic or diastolic. On the other hand, the acuity of the HF relies on valid clinical indicators that apply to all patients since no specific criteria exist exclusively for TAVR patients. Some indicators suggestive of heart failure exacerbation include:  1) Symptoms: dyspnea, orthopnea, and nocturnal cough. 2) Exam: lung rales, edema, JVD, and a 3rd heart sound. 3) Imaging: acute pulmonary edema and pleural effusions. 4) Laboratory: elevated BNP levels. 5) Therapies: IV diuretics, higher doses of HF medications (e.g., oral diuretics), and urgent device therapy (e.g., TAVR, PCI, hemodialysis, and mechanical ventilation). 

Our ACPA CDI committee recently discussed this topic and the challenges that many physician advisors face when requested to help improve the capture rate of MCCs. Very little information is available to guide physician advisors regarding the criteria for heart failure exacerbation in TAVR patients. In addition, since some device companies often suggest interventions to move the DRG from 267 to 266, it is crucial to have reference documents that physician advisors can use to talk with the system leadership and the cardiovascular surgery team. 

I encourage the reader to visit the CDI Resource Page under the Education tab on the ACPA website for materials on transcatheter aortic valve replacement documentation for the physician advisor. You will also find a one-page CDI tip that you may disseminate to your providers, as well as materials on other important CDI topics. 

Dr Herrera is the Senior Physician Advisor, Care Management and Documentation Integrity at NorthShore University HealthSystem 

Lowering Your Observation Rate 

Bartho Caponi, MD 

ACPA Observation Committee Vice-Chair

Based on the number of times I’ve been asked to comment on the issue, I suspect that many or most of you have heard this before: 

“My CEO/CMO/CFO says we need to lower our Observation rate!”   

“These consultants recommend we decrease our Observation rate from x% to y%!” 

“Our Observation rate is above the benchmark!” 

ACPA has addressed this issue before and it bears repeating—there is no benchmark observation rate.  The idea behind “reducing the observation rate” is understandable from the outside.  In the broadest sense, having a patient in inpatient status is likely to result in better access to benefits for the beneficiary, like skilled nursing benefits (temporary changes owing to the public health emergency notwithstanding), and probably better reimbursement for the institution.  While it is not always correct to say that inpatient care costs a patient more than observation care (Medicare’s Part A deductible will be $1600 in 2023; Part B copayment for an individual service is capped at the Part A deductible, but a patient could have many individual services increasing the aggregate total).  Also of note, patients have been told of the risks of observation care for many years and often want to be “inpatient” regardless of the clinical situation.  When you start looking at commercial insurers, Medicare Advantage, Medicaid, and Managed Medicaid plans, costs and benefits for all parties become very challenging to calculate accurately. 

The question of Observation benchmarks comes up regularly.  The simple answer is that there is no external, national, validated benchmark because there is no standard definition of what constitutes appropriate observation services.  CMS says that “Observation care is a well-defined set of specific, clinically appropriate services, which include ongoing short term treatment, assessment, and reassessment before a decision can be made regarding whether patients will require further treatment as hospital inpatients or if they are able to be discharged from the hospital,” and we know that Inpatient status for a Medicare beneficiary is determined by the 2-Midnight rule.  Non-Medicare payors can establish any criteria set you are willing to contract with--they may use a clinical tool (e.g., InterQual), time-based criteria, judgment, or a combination of them.  The point is, neither bedside clinicians nor physician advisors can arbitrarily decide whether a patient should receive observation services as a hospitalized outpatient or be admitted as an inpatient—we are obligated to follow the criteria provided by the payor, and payors have a significant interest in keeping patients under observation rather than letting them be inpatient status.  Since every patient population is different, and every payor mix is different, every hospital necessarily has a different rate of appropriately provided observation services.   

There are pitfalls, of course.  Observation services should be used for provision of acute care leading to a decision point—admission or discharge.  Observation services are not appropriately used as a substitute for adequate routine outpatient access to care; research suggests that the most disadvantaged patients are more likely to end up in observation status than others.  The (unproven) possibility of using observation services to avoid readmission penalties (a patient hospitalized for observation is NOT admitted) creates conflict of interest for hospitals; heterogenous data makes definitive information hard to come by.  As we get better at providing complex care more efficiently, two-midnight expectations may become one midnight expectations, and lead to more appropriate observation stays.  Likewise, an expected one-midnight stay prolonged by avoidable delays does not suddenly become appropriate for inpatient status.  Finally, there are emphatically two kinds of observation patients—patients for whom a period of focused evaluation and management leads to an appropriate decision point, and patients who are acutely hospitalized for any number of reasons but “don’t meet criteria” per the payor. 

So, where can a Physician Advisor make a difference?  The first order of business is to ensure that your status determination is appropriate and consistent across cases, with reference to payor. You should work with your provider teams and your Clinical Documentation team to ensure that the patient’s story is told properly, to accurately reflect severity of illness and complexity of service and let you make an appropriate status determination—ACPA’s CDI Committee has many valuable resources available to members.  If you find that patients are hospitalized under observation for logistical reasons, you can work with your organization to address those barriers where possible.  You should also make sure your expertise is represented at the contracting table, where the terms of status determination are defined.  Track your data—your rates before and after intervention, your status changes (both observation to inpatient and inpatient to outpatient since appropriate status determination has to be a two-way street).  Finally, get involved and advocate for the policy changes you would like to see; again, ACPA’s Government Affairs committee is a leader in that space. 

To summarize: 

1. There is no standard benchmark for “observation rates.” 
2. The definitions used to determine observation or inpatient status are out of the control of the hospital or its physicians and vary between facilities and patient populations. 
3. You may be able to change your observation rate by making accurate status recommendations, driving improvements in documentation, and improving overall resource utilization. 
4. Support ACPA’s advocacy efforts and get involved! 

Dr Caponi is Medical Director of Utilization Management/Physician Advisor Program at UW Health – Madison, Wisconsin 

Observation Committee Cases for January 2023 

Provided by the members of the ACPA Observation Committee

Go to https://www.surveymonkey.com/r/32Z9RJN to submit answers 

Case 1  

Seventy-five-year-old female with a history of atrial fibrillation on blood thinner was brought to the emergency room by ambulance after falling at home. She also had a recent fall about a week ago. She said she hit her head but did not lose consciousness. She was placed in hospital bed to be closely observed, especially with blood thinner usage. Physical therapy evaluation recommended a short-term skilled nursing facility to improve her mobility. The patient also tested positive for COVID with no active symptoms. Based on freedom of choice, the patient selected two skilled nursing facilities close to her family and was willing to go to either. The social worker contacted both facilities and noted that the first facility required a negative COVID test before admission, and the second facility could not accommodate the patient for another three days due to staffing shortage. Noted, the hospital also has one floor closed due to staffing shortage as well; at the same time, the hospital has outside transfers lining up to be admitted urgently. 

 1. Since this patient highly likely will not be discharged for several days, what is her most appropriate status, observation or inpatient? 

2. With the need for hospital beds to accept urgent transfers, what is the best way to handle this discharge dilemma considering the patient's medical condition is stable to be discharged and can be managed in a skilled level of care? 

• Await until patient’s facility of choice can accept patient 
• Expand referrals to additional facilities in the region or state 
• Issue an advanced beneficiary notice as patient is custodial care at this point with no further acute medical needs.  
• Other – comments open. 

3. There are many challenges imposed on healthcare due to the pandemic; what are your thoughts regarding how healthcare system should act differently, especially when facing staffing shortages? 

Go to https://www.surveymonkey.com/r/32Z9RJN to submit answers 

Case 2  

80-year-old male with past medical history of CVA, HTN, Atrial fibrillation on Xarelto who presents with brief episode of tingling in left arm. Initial CT head is negative for any acute process. By the time hospitalist comes down for evaluation, patient’s symptoms have resolved. Patient is placed in Observation status for TIA with expected LOS of 1 Midnight. Hospitalist orders the stroke order set which includes neurology consultation, neurological assessments, ECHO and MRI/MRA to rule out acute CVA. After 1 Midnight, the physician advisor reviews the case and notes patient has no recurrence of symptoms. Patient’s MRI/MRA is negative for acute process. However, given atrial fibrillation on anticoagulation, the attending does not want to discharge prior to ECHO being completed. Unfortunately, the ECHO team is backed up and may not be able to perform the ECHO until the next day.  

1. Since the patient is expected to spend a 2nd midnight pending ECHO, what status do you recommend?  

• Place in Observation status 
• Place in Observation status and document avoidable delay on ECHO department 
• Admit to Inpatient status  

2. After 2nd Midnight, ECHO is performed but it is 5pm and there is still no final read on the ECHO.

• Place in Observation status 
• Place in Observation status and document avoidable delay on ECHO department 
• Admit to Inpatient status  

3. Would your status recommendation change if this patient was Medicare fee for service or Medicare Advantage? Please add further details in comments.  

• Yes 
• No 

Go to https://www.surveymonkey.com/r/32Z9RJN to submit answers 

January 2023

Happy New Year!  I am hopeful your end of 2022 was not like mine – spent with a hospitalized family member half-a-dozen states away from home (more on that later…) and that you HAVE had a nice start to 2023.   

The new year always bring new things for us in this professional community – new Medicare, Medicaid, and TriCare Inpatient Only lists, new CMS Outpatient Prospective Payment System (OPPS) and Ambulatory Surgical Center (ACS) Payment System, new Physician Fee Schedule and Medicare Shared Savings Program, and more.  However, it’s not every year that we at the American College of Physician Advisors (ACPA) get to make the following announcement: WE HAVE A NEW PRESIDENT ELECT!   

Having completed two years serving as ACPA’s president (and two years as vice president before that), I am delighted about the prospect of training my successor over the next number of months.  From the operational ins-and-outs of the College to the conceptual goals and aspirations planted by our founders in 2014 which continue to grow and flourish with each passing year, there is a lot to learn!  But, my excitement is matched only by hers, and the ACPA leadership truly could not have chosen a more perfect individual for the job. 

You likely are already quite familiar with our up-and-coming leader, relying on her insights and cultivation of industry news and announcements on a routine basis.  For two years she has served as the voice of ACPA and my right-hand-woman functioning as “Encourager in Chief” of our membership as a whole.  She introduced concepts and questions of physician advisor wellness into our biennial Physician Advisor Survey, stepped-up our social media game, and spearheaded plans for an upcoming local mentorship program.  As Lead Physician Advisor in Clinical Documentation Integrity and Utilization Review for Avera McKennan Hospital and University Health Center in Sioux Falls, SD and a system-level Physician Advisor for Avera Health, she is also a Clinical Professor for the University of South Dakota Sanford School of Medicine and a practicing internist and hospitalist.  As such, her insights into case/utilization management, clinical documentation integrity, and the challenges of serving as a physician advisor as well as a practicing inpatient clinician have been and will continue to be invaluable toward the continued evolution of the ACPA. 

It is with great enthusiasm, pride, and excitement that I announce our new President Elect, Dr. Clarissa Barnes!  Please join me in welcoming her into this new role and we look forward to seeing YOU become more involved with ACPA in 2023, as well! 

Juliet B. Ugarte Hopkins, MD

(Pronouns: She/Her)

President, ACPA

Dr. Juliet B. Ugarte Hopkins is Physician Advisor for Case Management, Utilization, and Clinical Documentation for ProHealth Care, Inc. in Waukesha, WI