Children's National Medical Center in Washington D.C. this month named joint chief medical officers, among the first hospitals to do so, to handle the "complexities of the evolving healthcare landscape."
When Denice Cora-Bramble, MD, MBA, FAAP, answers her phone at the Children's National Medical Center, she says she's chief medical officer.
So does David Wessel, MD.
What gives? This isn't a new version of the old TV show "To Tell the Truth," but reality at the Washington D.C. hospital, where both physicians hold the title of chief medical officers.
Children's National Medical Center believes it is the first pediatric hospital, if not one of the first hospitals in the nation, to employ joint CMOs. The American Hospital Association, for one, says it has not heard of a hospital having dual CMOs.
CNMC officials are convinced having two CMOs may be increasingly suitable as hospitals continue to deal with what the hospital called the "complexity of the evolving healthcare landscape" and population health management.
What's not surprising is that physicians are playing significant leadership role in this. As Kurt Newman, president and CEO of CNMC said in a recent statement announcing the appointments, the dual CMO posts are designed to help the hospital continue on a two-pronged approach.
One is to develop ambulatory and community health programs to help keep patients out of the hospital; the other is to maintain specialty care when patients do need in-hospital treatment.
Previously, Cora-Bramble was senior VP for the hospital's Diana L. and Stephen A. Goldberg Center for community pediatric health, and acting executive VP ambulatory services. She is now executive VP, CMO for ambulatory and community health services.
Wessel is executive VP CMO for hospital and specialty services, where he will lead the focus on providing the inpatient and subspecialty care. Before taking on this position, he was senior VP of the Center for Hospital-Based Specialties, which includes a neonatology team and one of the only dedicated pediatric cardiac intensive care units in the country.
The two new CMOS reflect an alignment with the realities of healthcare reform, which involves a shift toward value-based models, population health and patient-centered medical homes, and the need to develop surgical models. Working to improve relationships with other institutions and broaden specialties, especially in areas where there is demand for physicians, is another way the CMOs' role is inspired by the changing landscape of healthcare.
Nancy Foster, VP of Quality and Patient Safety at the American Hospital Association says she was not aware of two CMOs at a hospital, but she's not surprised by it by the Children's National Medical Center decision to have them.
"I have not previously heard of two people holding that title, but it is consistent with the trends we see in hospital and health system leadership," Foster says. "Hospital boards and CEOS are assessing what the organizational needs are and constructing leadership teams that will enable the organization to achieve them.
With growing ambulatory care programs, particularly, and the "increasing complexity (in) the kinds of care hospitals can providing without admitting patients," Foster adds, "it is not surprising that some hospitals are re-thinking how to best provide appropriate clinical care leadership in the ambulatory as well as the inpatient environment."
Children's National Medical Center has 303 beds and eight regional outpatient centers, focusing on medical needs ranging from cancer to emergency, trauma, critical care, neonatology, orthopedic surgery and neurology. It includes the Children's Research Institute and the Shiek Zayed Institute for Pediatric Surgical Innovation.
The two new CMOS succeed Peter R. Holbrook, MD, who spent 37 years at Children's National Medical Center. When he left last summer, the hospital released a statement saying that Holbrook's tenure "included significant contributions to the development and recognition of intensive care as an essential subspecialty in pediatrics."
Holbrook made lasting impressions on the hospital. His departure, too, represented a changing of the guard in how Children's National Medical Center, and I'm sure others as well, see the pace and complexity of leadership ahead for physicians, and how they respond within the orbit of the hospital and increasingly within its outpatient satellites.
As a hospital spokeswoman told me, during his tenure as CMO Holbrook "was responsible for clinicians—focused on quality and safety."
The two new CMOs see a much-expanded realm of responsibilities—individually and separately.
In his role, Wessel will be focused on clinical issues, but a hospital spokesman clarifies it a bit: "Much more hands-on in the business of running a hospital/clinical practices, and working with employed physicians to address the realities of a changing marketplace."
That changing marketplace? Wessell told me the hospital is contemplating formulating an Accountable Care Organization.
There is a great demand for outpatient programs in pediatric care, much as there is at hospitals involved in adult care. While Children's National is generating more outpatient programs, it still must broaden its inpatient base, Wessel says. There is a need to continue developing and expanding a variety of pediatric services, wrapped within specialties such as orthopedics to cardio to neurosurgery.
"Specialties are hard to find" in pediatric care, he adds. Those service lines will continue to flourish, reflected in the hospital's recent construction of a 26-bed cardio intensive care unit. "There is an opportunity for enormous advances," he says.
Clinically, while the hospital has made great strides in its delivery of pediatric care, there is always more to do. More than a decade ago, there was a mortality rate of 10% among children having cardiac surgery, Wessel noted. Now it's dramatically reduced to 2%.
"We want to not only have their hearts fixed, but have them contributing to society in an optimal way," he says. "We can continue to learn."
As it stresses clinical improvements, the hospital also places focus on "implementing cost reduction strategies and improving physician efficiency," Wessel says. Like adult care hospitals, the children's hospital is examining ways to reduce the use of CT scans and expose its young patients to less radiation. "It's not needed for every head bump," he says.
Joe Cantlupe is a senior editor with HealthLeaders Media Online.
