Pediatric Committee – Member Articles

Rebooting “Observing the Rules for Observation After Outpatient Surgery”
October 25, 2023 | Juliet B. Ugarte Hopkins, MD | RACMonitor.com
Written in March 2013 by the highly respected Dr. Steven Meyerson, “Observing the Rules for Observation after Outpatient Surgery” evolved over time into one of

Pediatric Physician Advisors – A Commonly Missed Key to Healthy Hospital Operations
September 25, 2023 | Juliet B. Ugarte Hopkins, MD | ICD10Monitor.com
Just as the role of physician advisors has come to the forefront of the healthcare world over the last decade and a half, so too...

Getting Down to Brass Tacks with Providers About Documentation
July 2023 | Juliet B. Ugarte Hopkins, MD | ICD10Monitor.com
Documentation started out as a record of patient condition for the documenters themselves – reminders of what they saw and addressed the visit before.

Medical Necessity: Realities and Hypotheticals
May 2023 | Juliet B. Ugarte Hopkins, MD | RACMonitor.com
While everyone is familiar with the notion that doctors practice medicine, did you know it extends to administrative decision-making as well?

Hail the Return of the Three-Midnight Rule
April 2023 | Juliet B. Ugarte Hopkins, MD | RACMonitor.com
The Three-Day Rule has returned and it’s causing confusion.

Hail the Return of the Three-Midnight Rule
April 2023 | Juliet B. Ugarte Hopkins, MD | RACMonitor.com
The Three-Day Rule has returned and it’s causing confusion.

Transfer Requests at the Intersection of EMTALA
March 2023 | Scott Ceule, MD, FACP, FAAP | RACMonitor.com
Physician advisors have numerous roles in their organizations. These roles focus on medical necessity, length of stay, utilization review (UR), and efficient delivery of healthcare. Transfer centers can be a significant entry point into healthcare organizations, and oversight by physician advisors is a perfect fit for their responsibilities.

NICU Baby Listed as “Self-Pay”: You’ve Got to Be Kidding!
January 2023 | Sumana Narasimhan, MD & Rhiana Lau, MD, FAAP
Hello from the Pediatric committee of the ACPA! We are a small but mighty group who have been active in discussing the unique issues that affect the youngest patients we all care about. This month, we are writing about a unique issue that affects newborns, specifically the ill newborn who requires...

Why Being Too Big to Fail is a Problem for Providers
December 2022 | Jerilyn Morrissey | RACMonitor.com
The combination of size, capital and lack of regulatory pressures seemingly make UnitedHealth Group too big to fail, placing the burden on providers to protect their own interests.

Academics and the Physician Advisor
January 2022 | Denise Goodman
Many of us practice in an academic environment, where advancement requires scholarly productivity. In addition, for Many of us practice in an academic environment, where advancement requires scholarly productivity. In addition, for those who may receive a mission-based incentive bonus, the research mission includes publication in...

Documentation of the Patient's Plan of Care
December 2020 | Mary McLaughlin Davis, DNP, ACNS-BC, NEA-BC, CCM 
I am always surprised by the circular path we follow in health care. In the early days of the COVID-19 pandemic the obstacles to continue to provide service and care appeared at first...

Non-Update on CMS Pay for Performance Programs and Inpatient Quality Reporting
November 2020 | Edward Hu, MD
With over 2000 pages in the CMS 2021 IPPS Final Rule, one might think that CMS would have published useful commentary on its quality programs. But it didn’t. The annual update to CMS’ three primary hospital pay for performance programs...

What if You Didn't Know?
September 2020 | Barbara Abrams
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...

Preparing for the Test
April 2020 | Edward Hu, MD
As physicians, we were all pretty good test-takers in school. As this country prepares for its COVID-19 future, the health and economic future of our country will depend on the same concept – preparing for the test – or in this case, preparing to test large numbers of people...

Helping Hospitals Survive
September 2019 | Mary McLaughlin Davis, DNP, ACNS-BC, NEA-BC, CCM 
A hospital cannot survive in today’s health care environment without a strong physician advisor (PA). This highly skilled professional must have competence in a diverse set of skills which includes; broad based clinical knowledge, understanding of regulatory...

Is It Time to Re-Think Readmission Penalties?
May 2019 | Rishi Garg
A patient was admitted to the hospital for a large bowel obstruction from colorectal cancer. The patient was treated conservatively and the symptoms completely resolved fairly quickly. The patient did not require any surgical or endoscopic intervention during the...

Post-Acute Waivers Urgently Needed
November 2018 | Edward Hu, MD | RACMonitor.com
A gap has arisen between the waivers that traditional Medicare has in place for post-acute destinations and those granted by health insurance plans. ACPA BOD member Dr. Edward Hu and ACPA President Dr. Charles Locke discuss how post-acute waivers are urgently needed during this latest COVID-19 wave.

Understanding the Clinical Diagnosis of Sepsis-3
November 2018 | Edward Hu, MD | ICD10Monitor.com
ACPA President Dr. Edward Hu explains how lack of a SOFA score does not rule out sepsis.