The country's increased focus on high-quality but cost-effective care is setting off a sea change in the healthcare industry. Pushed to be more conscious of prices and efficiency, more physicians are adopting team-based approaches to care and seeking business degrees. The traditional relationship between hospital CEOs and CMOs is also evolving, as the two work more closely to trim costs without interfering with quality of care. 
Stephen Moore, MD, is senior vice president and CMO at the Englewood, Colo.-based Catholic Health Initiatives, the country's third-largest Catholic healthcare system with 73 hospitals and other facilities in 19 states. Here, Dr. Moore explains how physicians have developed business skills out of necessity, how he stays attuned with CHI physicians and why CMOs have to prove themselves valuable to hospital CEOs right now.
Q: A recent report in the New York Times found more physicians across the country are thinking like entrepreneurs and adding an MBA to their title. Have you noticed this trend? How do you think it might change the industry, if at all?
Dr. Moore: I think the New York Times is probably about 10 years behind. What we've seen nationwide in physician markets is — as reimbursements declined and pressure began in the mid-90s and accelerated — a lot of physicians were driven to become entrepreneurs around diagnostic perspectives. Many started their own diagnostic centers. Orthopedic surgeons ended up going in on joint ventures or opening their own ambulatory centers. We merged with group [of physicians] in Nebraska who created their own heart hospital.
I think the entrepreneurial [trend] has been going on for a number of years. As the business of medicine is becoming more complex, more physicians are going to earn MBAs. We're also seeing that in the CMO world. Probably 10 years ago, if you were going to have additional degree, it would more likely be a master's degree in public health rather than business administration. [MBAs are] more of an opportunity for organizations employing CMOs, because it provides medical expertise that is necessary in business.
Q: There has been a much sharper focus on medical team-based care. Do you think that comes naturally to physicians? How can CMOs help their physicians work more collaboratively?
Dr. Moore: I'll give you my idea of what medical team-based care is all about. From a clinical quality and patient safety perspective, there's been more multi-disciplinary team rounding in inpatient services. In the [physician's] office — and again I think it was originally driven by financial issues —we've been seeing more physicians broadening their team. This might be with nurse practitioners, health coaches or leveraging people to much higher levels of their license. We've seen it within the orthopedic community, within the cardiology community and now primary care.
Physicians are looking at multiple different team members to perform patient care tasks. In managed care and HMO programs, more traditionally in California and Florida, we've seen a huge shift to that. I think in a continued traditional fee-for-service community hospital setting, we're still seeing some autonomy issues clearly being expressed by the physicians. But that's wearing away quite a bit as they realize the benefits of multi-disciplinary teams, how they help quality outcomes, [ease] time commitments and are financially necessary.
Q: What's your communication strategy with physicians? How do you stay in-the-loop with their concerns, opinions and ideas?
Dr. Moore: I think the answer is multi-dimensional. One of the key things we do within the organization is an annual survey of employed physicians and medical staff physicians. Catholic Health Initiatives is so large that many personal interactions, all the way down to hospital staff levels, are fairly limited.
It starts with the survey process, which gives us a glimpse at how we're viewed by physicians. We'll look at commonalities and put feedback loops and mechanisms into place. We have a physician executive counsel that has more than 25 members. We meet with them on a monthly basis and then face-to-face twice a year. I conduct hour-long, monthly calls with new CMOs at our hospitals for a 12-month period of time. We also have a communications specialist with us in clinical services who is a communication liaison and helps us develop key communication strategies through the CEO, CMO and other leaders of each hospital.
I try to visit 50 percent of facilities on an annual basis for key meetings with physician leadership. Maybe it's attending a medical committee or going to dinner with key physician leaders. It also involves social networking events, like celebratory staff parties and speaking events. I've been here almost three years now so I'm pretty well-known and sometimes invited to local-level events. Most of the folks we need to work through [to reach physicians] are our CMOs and CEOs, and the relationship we establish with those folks and intermittent relationships with physicians across the organization is our [communication] method.
Q: Can you share an accomplishment from this past year that you are most proud of, either on behalf of CHI or personally?
Dr. Moore: I think the most noteworthy thing we've done is to be extremely successful with an enormous HIT investment across the country. It's a $1.5 billion organization, [and we faced] all the complexities of putting in electronic health records, meeting [meaningful use] requirements, connecting physicians and staying on time and on budget. To date we've done this extremely well, and I've been really impressed with our ability as an organization to learn from others and learn from ourselves, quickly reinvent processes and approaches to this product. I'd say given the large size of it, and how nimble we've been, it's a huge accomplishment.
One of the key issues around EHRs is computerized physician ordering. We came out with a physician ordering process [organized by] six or seven physicians nationally, called OneCare. [They] developed order sets for physicians, and physicians then reacted to those sets. It was a pretty lukewarm reaction.
Our physicians in the field thought it was very limited. We started to get feedback that order sets were too simplistic and that physicians couldn't see feedback from physicians in their specialty. So now we've reorganized our approach. Utilizing tools, we've created a social network online for physicians to have open and transparent interactions around order sets. We've been nimble and understanding in that we're able to rework things in short period of time.
Q: Do you think CEOs and CMOs will work more closely than in the past?
Dr. Moore: That's a great question. I'll add the CNOs, since that's how things work at CHI. CMOs and CNOs co-lead. Senior vice president and CNO Kathleen Sanford and myself co-lead all of this. We've identified key talent and physicians in the organization who we will fall short without. The CEOs, CMOs and CNOs are all positions that have been identified. We've been working at a service-group level with human resource leadership. We'll officially launch an 18-month leadership development program under the guidance of CEOs for CMOs and CNOs this month.
We're committed to leadership development around key competencies that will allow our organizations and CEOs to be more successful. These competencies include conflict management, how you discuss difficult topics and how you align with the CEO to better realize clinical operation opportunities. How do you work with others in the C-suite team to improve outcomes? There is tremendous amount of value in competencies for CEOs. This will naturally drive the hospital CEO, CMO, CNO and even COO and CFO together in a better understanding of how to utilize one another's competencies and skills. It is very well thought out leadership development tied to CEOs' needs.
We're finding that there is a value question called around CMOs and CNOs, especially with costs being so important in these times. I think if there isn't that [valued] relationship, and if we're not working on key skills through additional degrees or development, there is a value equation that [might be off] and CEOs might ask if they have the right person on board. We want to give [hospital] CEOs a colleague to depend upon for operations and quality.
Q: Can you share a few exciting things going on at CHI right now?
Dr. Moore: There are a bunch of exciting things happening. There's the IT investment, but we're also collaborating on an innovation arm at CHI and doing virtual health nurse mentoring. It's a very exciting project around supporting nurses who are new grads working at night. There is a tele-health presence for them from an experienced nurse with an advanced practice degree and who is also trained in mentoring. Now those nurses have someone to bounce ideas off and answer questions.
We're also working on our virtual health service platform, which is organization-wide. That will allow us to provide services inside and outside CHI. There is big demand for access to services that maybe can't be delivered due to shortage issues with nurses and physicians.
There is also a very exciting patient-employee safety program. We also just had our AA-bond ratings reconfirmed by all of our rating agencies. That really meant that we continue to be not only innovative from our clinical side, but it also serves as a reaffirmation that our financial stability is there.
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Stephen Moore, MD, is senior vice president and CMO at the Englewood, Colo.-based Catholic Health Initiatives, the country's third-largest Catholic healthcare system with 73 hospitals and other facilities in 19 states. Here, Dr. Moore explains how physicians have developed business skills out of necessity, how he stays attuned with CHI physicians and why CMOs have to prove themselves valuable to hospital CEOs right now.
Q: A recent report in the New York Times found more physicians across the country are thinking like entrepreneurs and adding an MBA to their title. Have you noticed this trend? How do you think it might change the industry, if at all?
Dr. Moore: I think the New York Times is probably about 10 years behind. What we've seen nationwide in physician markets is — as reimbursements declined and pressure began in the mid-90s and accelerated — a lot of physicians were driven to become entrepreneurs around diagnostic perspectives. Many started their own diagnostic centers. Orthopedic surgeons ended up going in on joint ventures or opening their own ambulatory centers. We merged with group [of physicians] in Nebraska who created their own heart hospital.
I think the entrepreneurial [trend] has been going on for a number of years. As the business of medicine is becoming more complex, more physicians are going to earn MBAs. We're also seeing that in the CMO world. Probably 10 years ago, if you were going to have additional degree, it would more likely be a master's degree in public health rather than business administration. [MBAs are] more of an opportunity for organizations employing CMOs, because it provides medical expertise that is necessary in business.
Q: There has been a much sharper focus on medical team-based care. Do you think that comes naturally to physicians? How can CMOs help their physicians work more collaboratively?
Dr. Moore: I'll give you my idea of what medical team-based care is all about. From a clinical quality and patient safety perspective, there's been more multi-disciplinary team rounding in inpatient services. In the [physician's] office — and again I think it was originally driven by financial issues —we've been seeing more physicians broadening their team. This might be with nurse practitioners, health coaches or leveraging people to much higher levels of their license. We've seen it within the orthopedic community, within the cardiology community and now primary care.
Physicians are looking at multiple different team members to perform patient care tasks. In managed care and HMO programs, more traditionally in California and Florida, we've seen a huge shift to that. I think in a continued traditional fee-for-service community hospital setting, we're still seeing some autonomy issues clearly being expressed by the physicians. But that's wearing away quite a bit as they realize the benefits of multi-disciplinary teams, how they help quality outcomes, [ease] time commitments and are financially necessary.
Q: What's your communication strategy with physicians? How do you stay in-the-loop with their concerns, opinions and ideas?
Dr. Moore: I think the answer is multi-dimensional. One of the key things we do within the organization is an annual survey of employed physicians and medical staff physicians. Catholic Health Initiatives is so large that many personal interactions, all the way down to hospital staff levels, are fairly limited.
It starts with the survey process, which gives us a glimpse at how we're viewed by physicians. We'll look at commonalities and put feedback loops and mechanisms into place. We have a physician executive counsel that has more than 25 members. We meet with them on a monthly basis and then face-to-face twice a year. I conduct hour-long, monthly calls with new CMOs at our hospitals for a 12-month period of time. We also have a communications specialist with us in clinical services who is a communication liaison and helps us develop key communication strategies through the CEO, CMO and other leaders of each hospital.
I try to visit 50 percent of facilities on an annual basis for key meetings with physician leadership. Maybe it's attending a medical committee or going to dinner with key physician leaders. It also involves social networking events, like celebratory staff parties and speaking events. I've been here almost three years now so I'm pretty well-known and sometimes invited to local-level events. Most of the folks we need to work through [to reach physicians] are our CMOs and CEOs, and the relationship we establish with those folks and intermittent relationships with physicians across the organization is our [communication] method.
Q: Can you share an accomplishment from this past year that you are most proud of, either on behalf of CHI or personally?
Dr. Moore: I think the most noteworthy thing we've done is to be extremely successful with an enormous HIT investment across the country. It's a $1.5 billion organization, [and we faced] all the complexities of putting in electronic health records, meeting [meaningful use] requirements, connecting physicians and staying on time and on budget. To date we've done this extremely well, and I've been really impressed with our ability as an organization to learn from others and learn from ourselves, quickly reinvent processes and approaches to this product. I'd say given the large size of it, and how nimble we've been, it's a huge accomplishment.
One of the key issues around EHRs is computerized physician ordering. We came out with a physician ordering process [organized by] six or seven physicians nationally, called OneCare. [They] developed order sets for physicians, and physicians then reacted to those sets. It was a pretty lukewarm reaction.
Our physicians in the field thought it was very limited. We started to get feedback that order sets were too simplistic and that physicians couldn't see feedback from physicians in their specialty. So now we've reorganized our approach. Utilizing tools, we've created a social network online for physicians to have open and transparent interactions around order sets. We've been nimble and understanding in that we're able to rework things in short period of time.
Q: Do you think CEOs and CMOs will work more closely than in the past?
Dr. Moore: That's a great question. I'll add the CNOs, since that's how things work at CHI. CMOs and CNOs co-lead. Senior vice president and CNO Kathleen Sanford and myself co-lead all of this. We've identified key talent and physicians in the organization who we will fall short without. The CEOs, CMOs and CNOs are all positions that have been identified. We've been working at a service-group level with human resource leadership. We'll officially launch an 18-month leadership development program under the guidance of CEOs for CMOs and CNOs this month.
We're committed to leadership development around key competencies that will allow our organizations and CEOs to be more successful. These competencies include conflict management, how you discuss difficult topics and how you align with the CEO to better realize clinical operation opportunities. How do you work with others in the C-suite team to improve outcomes? There is tremendous amount of value in competencies for CEOs. This will naturally drive the hospital CEO, CMO, CNO and even COO and CFO together in a better understanding of how to utilize one another's competencies and skills. It is very well thought out leadership development tied to CEOs' needs.
We're finding that there is a value question called around CMOs and CNOs, especially with costs being so important in these times. I think if there isn't that [valued] relationship, and if we're not working on key skills through additional degrees or development, there is a value equation that [might be off] and CEOs might ask if they have the right person on board. We want to give [hospital] CEOs a colleague to depend upon for operations and quality.
Q: Can you share a few exciting things going on at CHI right now?
Dr. Moore: There are a bunch of exciting things happening. There's the IT investment, but we're also collaborating on an innovation arm at CHI and doing virtual health nurse mentoring. It's a very exciting project around supporting nurses who are new grads working at night. There is a tele-health presence for them from an experienced nurse with an advanced practice degree and who is also trained in mentoring. Now those nurses have someone to bounce ideas off and answer questions.
We're also working on our virtual health service platform, which is organization-wide. That will allow us to provide services inside and outside CHI. There is big demand for access to services that maybe can't be delivered due to shortage issues with nurses and physicians.
There is also a very exciting patient-employee safety program. We also just had our AA-bond ratings reconfirmed by all of our rating agencies. That really meant that we continue to be not only innovative from our clinical side, but it also serves as a reaffirmation that our financial stability is there.
Related Articles on Catholic Health Initiatives:
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