Health system and individual hospital chief medical officers face a number of new challenges that are markedly different from those of their predecessors. While quality improvement and patient safety are still paramount, efforts to integrate and coordinate care in preparation for value-based and capitated payments further expand the role of the CMO. Becker's Hospital Review asked several hospital and health system CMOs about their goals for their healthcare organizations, the obstacles they face and how they plan to deal with these challenges.
Steven Berkowitz, MD, Founder, SMB Health Consulting; Former CMO, St. David's Healthcare in Austin, Texas. "The overriding primary concern or challenge for all CMOs is all hospitals are dealing with unprecedented cost pressures, and we will see more pressure on cost reduction than we have ever seen in our careers. Given that pressure, how do we continue to improve our clinical outcomes and patient safety? That is the single biggest challenge of the medical officer today."
Dr. Berkowitz believes — like many throughout the industry — these pressures will dramatically change "how we do business." While he expects this change to be a challenge for both CMOs and the overall healthcare delivery system, he is optimistic about this transformation. "It's not all doom and gloom," he says. "I believe with effective management on part of the CMO and the rest of the hospital team, we'll get to [a better model for healthcare delivery]."
Robert Fabrey MD, MMM, CMO, San Juan Regional Medical Center in Farmington, N.M. Dr. Fabrey agrees that declining reimbursement is a top concern for physician leaders, as are physician and healthcare workforce issues and uncertainty surrounding funding for infrastructure.
Joel J. Reich, MD, MMM, FACEP, Senior Vice President for Medical Affairs and CMO, Eastern Connecticut Health Network, based in Manchester. "The biggest problem most of us are facing right now is not losing focus of day-to-day issues of quality, safety and customer service [while preparing for value-based care]. These are the key to better outcomes, expense reduction and maximizing resource utilization regardless of payment system."
Dr. Reich adds that strengthening the role of physicians in health system leadership will also be critical. "The role of physicians in health system leadership to help manage the direct business-clinical connection (e.g., pay-for-performance, pay-for-outcomes, accountable care, bundled payments, etc.) will require increasing interest by physicians to participate in leadership, leadership training and an interest by health systems to create truly meaningful roles," he says. "We realize that employment is not the answer in itself."
Instead, these physicians must play a role in building the infrastructure needed for accountable care and designing the processes (e.g., disease management processes) used to reduce variation and improve care. Additionally, physician leaders should play a role in helping to integrate the continuum of care through "connecting hospitals, physicians, home health care and extended care facilities through business, clinical and information technology relationships," says Dr. Reich.
They will also play an instrumental role in determining when is the right time for the hospital or system to actually form or join an accountable care organization or other coordinated models. "Timing is everything. Moving either too slowly or too aggressively could result in significant quality of care issues and potential financial losses," he says.
Joseph Salipante, MD, FACP, Vice President for Medical Affairs and Medical Director, Unity Health System in Rochester, N.Y. "The biggest challenge will be to decrease the hospital length of stay, when appropriate, for hospitalized patients. Providing efficient care requires close collaboration and communication among doctors, nurses, other caregivers, patients, their families and sites of care outside the hospital. It is often a challenge to fully coordinate the care a patient requires in such a complex process. Unity Health System is striving to continuously improve the effective coordination of patient care."
In response to this challenge, Unity is focusing its efforts on teaching patients and families about their responsibilities in managing illness and developing process of care that provide established standards of care and reduce variability. "The goal is the development of an effective team with the patient being at the center of our efforts to provide optimal care and outcomes," says Dr. Salipante
Dr. Salipante recommends other CMOs working to improve quality of care abide by the following best practices: Set clear goals for each initiative, obtain buy-in and commitment to the goals; hold physicians and others accountable for the results of the initiative; develop meaningful measures for the results and share them often; and celebrate success and critically review the causes for less than optimal results of any initiative.
Linda Efferen, MD, CMO of South Nassau Communities Hospital in Oceanside, N.Y. Dr. Efferen explains many challenges currently facing South Nassau and healthcare in general are caused by uncertainties surrounding healthcare reform. "We all know we need to be more efficient, which speaks to the need to look outside the proverbial box in terms of our prior way of taking care of patients," she says. "We need to be moving toward a different model of care, but not knowing where that's going or how we're going to be reimbursed [creates significant challenges]."
Steven Berkowitz, MD, Founder, SMB Health Consulting; Former CMO, St. David's Healthcare in Austin, Texas. "The overriding primary concern or challenge for all CMOs is all hospitals are dealing with unprecedented cost pressures, and we will see more pressure on cost reduction than we have ever seen in our careers. Given that pressure, how do we continue to improve our clinical outcomes and patient safety? That is the single biggest challenge of the medical officer today."
Dr. Berkowitz believes — like many throughout the industry — these pressures will dramatically change "how we do business." While he expects this change to be a challenge for both CMOs and the overall healthcare delivery system, he is optimistic about this transformation. "It's not all doom and gloom," he says. "I believe with effective management on part of the CMO and the rest of the hospital team, we'll get to [a better model for healthcare delivery]."
Robert Fabrey MD, MMM, CMO, San Juan Regional Medical Center in Farmington, N.M. Dr. Fabrey agrees that declining reimbursement is a top concern for physician leaders, as are physician and healthcare workforce issues and uncertainty surrounding funding for infrastructure.
Joel J. Reich, MD, MMM, FACEP, Senior Vice President for Medical Affairs and CMO, Eastern Connecticut Health Network, based in Manchester. "The biggest problem most of us are facing right now is not losing focus of day-to-day issues of quality, safety and customer service [while preparing for value-based care]. These are the key to better outcomes, expense reduction and maximizing resource utilization regardless of payment system."
Dr. Reich adds that strengthening the role of physicians in health system leadership will also be critical. "The role of physicians in health system leadership to help manage the direct business-clinical connection (e.g., pay-for-performance, pay-for-outcomes, accountable care, bundled payments, etc.) will require increasing interest by physicians to participate in leadership, leadership training and an interest by health systems to create truly meaningful roles," he says. "We realize that employment is not the answer in itself."
Instead, these physicians must play a role in building the infrastructure needed for accountable care and designing the processes (e.g., disease management processes) used to reduce variation and improve care. Additionally, physician leaders should play a role in helping to integrate the continuum of care through "connecting hospitals, physicians, home health care and extended care facilities through business, clinical and information technology relationships," says Dr. Reich.
They will also play an instrumental role in determining when is the right time for the hospital or system to actually form or join an accountable care organization or other coordinated models. "Timing is everything. Moving either too slowly or too aggressively could result in significant quality of care issues and potential financial losses," he says.
Joseph Salipante, MD, FACP, Vice President for Medical Affairs and Medical Director, Unity Health System in Rochester, N.Y. "The biggest challenge will be to decrease the hospital length of stay, when appropriate, for hospitalized patients. Providing efficient care requires close collaboration and communication among doctors, nurses, other caregivers, patients, their families and sites of care outside the hospital. It is often a challenge to fully coordinate the care a patient requires in such a complex process. Unity Health System is striving to continuously improve the effective coordination of patient care."
In response to this challenge, Unity is focusing its efforts on teaching patients and families about their responsibilities in managing illness and developing process of care that provide established standards of care and reduce variability. "The goal is the development of an effective team with the patient being at the center of our efforts to provide optimal care and outcomes," says Dr. Salipante
Dr. Salipante recommends other CMOs working to improve quality of care abide by the following best practices: Set clear goals for each initiative, obtain buy-in and commitment to the goals; hold physicians and others accountable for the results of the initiative; develop meaningful measures for the results and share them often; and celebrate success and critically review the causes for less than optimal results of any initiative.
Linda Efferen, MD, CMO of South Nassau Communities Hospital in Oceanside, N.Y. Dr. Efferen explains many challenges currently facing South Nassau and healthcare in general are caused by uncertainties surrounding healthcare reform. "We all know we need to be more efficient, which speaks to the need to look outside the proverbial box in terms of our prior way of taking care of patients," she says. "We need to be moving toward a different model of care, but not knowing where that's going or how we're going to be reimbursed [creates significant challenges]."