Today's special guest is Dr. Juliette Ugarte-Hopkins, and good morning, Juliette.

Good morning, Chuck.

Good morning, everyone.

Let's talk about something practical but incredibly important, documentation and utilization review.

More specifically, we're talking about why physician advisor notes need to say more than just inpatient, observation, or maybe even outpatient and event.

In medicine, documentation has always mattered and still matters a great deal, as we just heard from Cheryl.

Physicians, nurses, therapists, pharmacists, and many others learn early.

A good note can

And good morning, Dr. Hopkins.

Good morning, everyone.

Medicine has many specialties.

Organ-based fields like nephrology, cardiology, and neurology.

plus broader categories like adult and pediatric medicine.

Most doctors in training figure out fairly early where they belong.

My moment came during my first week on an adult medicine rotation when I realized that while it's one thing for a four-year-old to vomit on you, it's something very different when a 40-year-old does the same.

If chronic kidney disease, heart failure, anemia, obesity, malignancy, or another clinically significant condition was evaluated, monitored, and treated but never clearly documented, the administrative record may make a complex patient look deceptively simple.

And good morning, Juliet.

Good morning, Chuck.

Good morning, everybody.

More than a decade after the Medicare Two Midnight rule took effect, you might think hospital status assignment would be simple by now.

In theory, it should be.

But in practice, it's still one of the most confusing and consequential decisions hospitals make.

The confusion isn't limited to traditional Medicare either.

And good morning.

Good morning, Chuck.

Good morning, everybody.

An important shift in Medicare surgical status decisions is underway related to the phase-out of the Medicare inpatient-only list.

Beginning on January 1, 2026, the Centers for Medicare and Medicaid Services started removing procedures from the inpatient-only list, beginning largely with musculoskeletal procedures.

The full list is expected to be eliminated by January 1, 2028.

But as with prior years, the key point remains.

And good morning, Juliette.

Hello there.

Today, I want you to consider the role of the physician advisor within your hospital or health system.

If you think they're mainly there for secondary reviews or peer-to-peer calls, it may be time to broaden that view.

In reality, they should be visible leaders, trusted resources, and go-to educators for both case management teams and their medical staff.

And if that's not how the role looks in practice, it may be worth rethinking what the position is meant to accomplish.

The physician advisor role can look a little different from one hospital to another, but there's one area where the expectations should be crystal clear.