The Exec: Good Clinical Care and Sustainable Finances Are Compatible

At health systems and hospitals, it is necessary to generate a positive financial margin to be able to invest in key elements of clinical care, this new CMO says.

CMOs can help boost a health system's financial sustainability while simultaneously promoting care quality and access, according to the new CMO of Cedars-Sinai Health System.

Ravi Thadhani, MD, MPH, became executive vice president of clinical affairs and CMO of Cedars-Sinai Health System and Cedars-Sinai Medical Center on Oct. 15. His prior leadership experience includes serving as executive vice president for health affairs at Emory University, vice chair of the Emory Healthcare Board of Directors, and executive director of Emory's Woodruff Health Sciences Center.

At health systems and hospitals, high quality care and sustainable finances can go hand in hand, according to Thadhani.

"If we deliver the best care, that means we are delivering on the promise of prevention, which brings down the total cost of care," Thadhani says. "It means that we are reducing hospital readmissions, which brings down the total cost of care. It means that we are reducing infection rates in hospitals, which brings down the total cost of care."

Thadhani has experience as a clinical leader in helping to turn around health systems from negative to positive financial margins.

"I have reduced expenses to improve margins, while at the same time reinvesting positive margin to improve quality and patient safety," Thadhani says. "You need to create dashboards, establish accountability for safety officers, and invest in virtual nursing as well as following patients after discharge. You cannot implement these kinds of measures without creating a positive financial margin."

At health systems, providing timely access to care contributes to financial sustainability, Thadhani explains.

"When patients have poor care access, care is delayed,” Thadhani says "If care is delayed, the cost of care goes up. Hospital systems generate revenue when they see patients, but they lose revenue when patients go to other hospital systems because of poor care access."

Ravi Thadhani, MD, MPH, is executive vice president of clinical affairs and CMO of Cedars-Sinai Health System and Cedar-Sinai Medical Center. Photo courtesy of Cedars-Sinai Health System.

Addressing maternal morbidity and mortality

Thadhani is an internationally recognized clinical leader in preeclampsia, a leading cause of maternal and perinatal morbidity and mortality.

Maternal mortality should be a top concern for CMOs, according to Thadhani.

"Birthrates have gone down in the United States; however, maternal mortality rates have not gone down," Thadhani says. "The rates of maternal mortality and morbidity in the United States are among the highest compared to other developed countries."

Thadhani says a combination of factors are contributing to the high U.S. maternal mortality rate, including problems with access to care, limited access to prenatal care, and comorbidities such as diabetes.

Prenatal care must be a focal point for CMOs and other clinical leaders, Thadhani explains.

"Many women across the country have difficulty gaining access to good prenatal care, particularly individuals in underserved communities and individuals with a low socioeconomic status," Thadhani says. "The limited access to good prenatal care puts a burden on clinicians such as family medicine practitioners, primary care physicians, obstetricians, and midwives."

CMOs and other clinical leaders need to rethink how they are providing care for pregnant women who have comorbidities, according to Thadhani.

"The way we try to provide care today for pregnant women with comorbidities, which is to try to have these women receive care more frequently, is unfortunately not working," Thadhani says. "We do not have enough caregivers for pregnant women with comorbidities, which mirrors the shortage of prenatal care specialists."

The best path forward for providing care for pregnant women with comorbidities is to embrace innovation, Thadhani explains.

"We need to explore ways to monitor pregnant women at home," Thadhani says. "We are looking at innovative tests that can predict comorbidities during pregnancy. We need to have an early understanding of risk in terms of screening—we should be screening for risk factors before pregnancy such as cardiac disease, diabetes, and high blood pressure."

Promoting patient safety

Transparency is crucial in boosting patient safety at health systems and hospitals, according to Thadhani.

"At the hospital systems where I have worked, some of them have embraced transparency about patient safety but others have been reluctant to be open about patient safety," Thadhani says. "Once the transparency barrier is overcome, it helps create an environment where caregivers are encouraged to deliver the best safety measures when patients come to the hospital."

Patient safety should be a primary consideration in efforts to reduce length of stay and hospital readmissions, Thadhani explains.

"We want to get patients out of the hospital quickly, but we need to discharge patients safely," Thadhani says. "If we discharge patients too early, they can end up being readmitted to the hospital. We need to strike a balance between the desire to discharge patients quickly and readmissions."

As a clinical leader, Thadhani has been involved in several patient safety initiatives, including efforts to reduce falls in the hospital setting.

"People often think that infections are the most common complication experienced in the hospital setting, but falls are just as common if not more common," Thadhani says. "When you think of falls, they happen in patient rooms, they happen when patients get transferred from one bed to another, and they happen when patients go to an imaging procedure."

One of the fall reduction initiatives that Thadhani helped to lead involved embracing technology.

"We put monitors in patient rooms to watch patients and predict when a patient was at risk of falling from a bed," Thadhani says. "For example, if a patient's leg was slipping out of bed, the monitoring system would trigger an alarm that the patient could be falling."