Part of promoting physician collaboration is boosting a shared purpose such as providing patient-centered care, this new CMO says.

A CMO should be engaged in promoting physician collaboration, according to the new CMO of AdventHealth Apopka hospital.

Max Baumgardner, DO, became the new CMO of AdventHealth Apopka on June 2. Prior to assuming his current position, he served in several leadership roles at AdventHealth, including working as facility medical director at AdventHealth Altamonte, AdventHealth Lake Mary, and AdventHealth Oviedo. Baumgardner has a clinical background as an emergency medicine physician and has served in leadership roles overseeing multiple emergency departments at AdventHealth.

A primary element of promoting physician collaboration is having a shared purpose such as aligning physicians to the mission of providing patient-centered care, according to Baumgardner.

"It involves building relationships between physicians and leadership, which involves building trust and inclusion with our physician leaders," Baumgardner says. "It also involves being able to share actionable data with our clinicians regarding important topics that improve patient care and experience."

Building trust and inclusion among physicians requires listening to them and involving them in decision-making, Baumgardner explains.

"When we have a problem, the people who are most likely to have good ideas on fixing the problem are the people who are closest to the issue," Baumgardner says. "The more that we engage with our frontline physicians and leaders to seek their feedback for solutions, the more likely we are to have support for solutions and be more successful as a team."

In leveraging data to promote physician collaboration, CMOs and other healthcare leaders need to share performance on key metrics to ensure that physicians are meeting or exceeding national standards for evidence-based practice, according to Baumgardner.

"We share this data with our physicians so that they do not have blind spots or miss opportunities to improve the care they deliver to patients," Baumgardner says.

Another element of promoting physician collaboration is having aligned incentives such as using scorecards and metrics to bolster patient-centered care and the best quality outcomes, Baumgardner explains.

"This allows us to have collaboration on our shared goals," Baumgardner says.

Max Baumgardner, DO, is the new CMO of AdventHealth Apopka hospital. Photo courtesy of AdventHealth.

Improving patient experience

In the hospital setting, joint rounding by physicians and nurses is a primary strategy for improving patient experience, according to Baumgardner.

"When physicians do MD-RN rounding, it is extremely valuable for them and their patients," Baumgardner says. "They garner information. They have improved care plans. There are also less errors and follow-up calls to adjust for issues that were not brought up in the absence of team-based rounding."

MD-RN rounding not only improves patient experience but also improves clinician and nurse experience because they can work together as a team as opposed to a fragmented care model, according to Baumgardner.

The best practices for MD-RN rounding include asking patients about how they are doing and prompting patients to ask questions about their care, Baumgardner explains.

"Physicians and nurses should ask questions about discharge or follow-up care issues," Baumgardner says. "They should review all pertinent tests or diagnostics. For patients and their families, they feel that they are included in decision-making, which generally results in productive conversations at the bedside."

CMOs and hospital financial performance

CMOs can play an important role in boosting the financial performance of their hospitals.

One way hospital CMOs can boost financial performance is by optimizing patient throughput, according to Baumgardner.

"CMOs need to understand how they can take care of patients in a timely manner and provide them with great quality care whether that is in the emergency room or in the hospital wards," Baumgardner says. "A key factor is reducing length of stay."

CMOs should be aware of costs and look at high-value care items or alternatives to high-cost treatments that are just as effective, Baumgardner explains. CMOs can also look for quality savings opportunities such as avoiding penalties for hospital readmissions.

"We can provide quality care in the hospital, but we want to make sure that discharged patients continue to receive quality care as an outpatient to stay healthy outside of the hospital," Baumgardner says.

Lastly, CMOs can also help promote strategic growth through partnership with the rest of the C-suite, which gives a hospital an opportunity for financial growth, Baumgardner explains.

"A CMO needs to understand what is needed in a hospital's market compared to what is offered at competing hospitals," Baumgardner says. "In addition, a CMO must understand the capabilities of their medical staff and hospital to support strategic growth initiatives."

A second opinion in any profession is the best practice. That's why Karmanos Cancer Institute implemented a streamlined process to provide patients with second opinions within seven days of an initial diagnosis.

At Karmanos, a second opinion results in a revised treatment plan or even a new diagnosis up to 20% of the time, according to George Yoo, MD, CMO of the comprehensive cancer center.

"The second opinion allows for a more comprehensive and expert review by a multidisciplinary team of doctors who specialize in a cancer type," Yoo says. "This review includes reviewing the pathology slides and the radiology images."

View the infographic below to get four tips on how Karmanos provides times second opinions to cancer patients. Click here to read the accoompanying HealthLeaders story.

The proposed rule would increase the conversion factor used to set physician payments by more than 3%.

The Centers for Medicare & Medicaid Services (CMS) has released the proposed rule for the 2026 calendar year Physician Fee Schedule.

The CMS Physician Fee Schedule (PFS) sets payments for the services of physicians and other healthcare professionals who can bill CMS. The payment policies set under the PFS are for services provided in several healthcare settings, including hospitals, physician offices, ambulatory surgery centers, skilled nursing facilities, and hospices.

Under the PFS, payments are based on the resources required to deliver services. Relative value units (RVUs) are applied for each service for work, practice expense, and malpractice expense. The RVUs become payment rates with the application of a conversion factor.

There are two conversion factors under the 2026 calendar year PFS: a conversion factor for qualifying alternative payment model (APM) participants and a conversion factor for clinicians who do not participate in an APM.

The proposed rule would increase the APM conversion factor by 3.83% in calendar year 2026 as compared to calendar year 2025. The proposed rule would increase the conversion factor for clinicians who do not participate in an APM by 3.62% in calendar year 2026 as compared to calendar year 2025.

The proposed conversion factors include a 2.5% increase included in the One Big Beautiful Bill Act that became law on July 4.

For the first time, the proposed rule for the 2026 PFS would make an efficiency adjustment for some RVUs based on the sum of the past five years of the Medicare Economic Index productivity adjustment percentage, which is calculated annually by the CMS Office of the Actuary. The proposed rule calls for an efficiency adjustment of -2.5% for calendar year 2026.

The AMGA says the one-time 2.5% conversion factor increase established by the One Big Beautiful Bill Act is not a substitute for meaningful reform of the PFS.

"Last-minute congressional interventions to avert further reductions to the conversion factor are unsustainable and obscure the need for lasting structural improvements," the AMGA said in a prepared statement.

AMGA President and CEO Jerry Penso, MD, MBA, called on CMS to modernize the PFS and make payment policy more consistent with value-based care.

"Health systems and medical groups continue to bear the brunt of an outdated and underfunded reimbursement model," Penso said in a prepared statement. "Without systematic reform, Medicare's current fee-for-service framework will remain misaligned with the shift toward high-value care."

In addition to the conversion factor and efficiency adjustment updates, the PFS proposed rule has several other components, including the following:

• The proposed rule would create the Ambulatory Specialty Model (ASM). The ASM would hold specialists financially accountable for the treatment of congestive heart failure and lower back pain. The ASM would reward specialists for effective disease management, adhering to clinical guidelines for care, and coordinating care with other providers.
   
• The proposed rule would make significant changes to CMS telehealth provisions. These changes include a proposal to streamline the agency's telehealth services list. Under the proposal, CMS would simplify the process of adding services to the list by removing the "provisional" and "permanent" distinction and focusing the review on whether a service can be delivered via two-way audio-video.
   
• The proposed rule seeks to improve access to behavioral health services, including expansion of digital therapeutics coverage for attention-deficit/hyperactivity disorder.

CMS will accept comments on the proposed rule through Sept. 12.

Improved access to care is the most significant value associated with telehealth services, this new chief physician officer says.

Telehealth services deliver value for health systems and patients in several ways, according to the new chief physician officer of MultiCare Health System.

Todd Czartoski, MD, was named chief physician officer of MultiCare in June. Prior to being named chief physician officer, he served as president and CMO of the health system's Neuroscience Institute and virtual health service. Before joining MultiCare, he served as chief executive of telehealth and chief medical technology officer at Providence.

First and foremost, telehealth has proved its value in improving access to care, according to Czartoski.

"In the early days of telehealth, there was concern that people of lower socioeconomic status would not have access to a device that could support a telehealth visit," Czartoski says. "But there is data that shows this population may not have much money, but they still have smartphones that can conduct telehealth visits."

Telehealth is helping health systems cope with a growing physician shortage across the country in multiple specialties, including neurology, psychiatry, and primary care. Czartoski uses stroke care as an example.

"If someone has a stroke, having access to a board-certified neurologist or vascular neurologist via telehealth is incredibly important," Czartoski says. "So, telehealth can take specialized expertise and spread it across a geography."

There are more nuanced ways that telehealth delivers value, including patient satisfaction, cost savings, and a better experience for clinicians, according to Czartoski.

"With telehealth, clinicians often do not need a patient to drive two hours for a follow-up visit to collect information, then they can move on to the next patient," Czartoski says.

Traditionally, physicians have seen patients in a sterile environment at a clinic without any context of what is going on in their life. Telehealth generates value by allowing clinicians to get insights into their patients by conducting visits in a patient's home, Czartoski explains.

For example, if a physician sees a patient with gait instability or cognitive decline during a telehealth visit in their home, they can see the status of the home, such as whether there are rugs on the floor or stairs that have to be climbed.

"A physician can see what real life is like for the patient and see whether there are risks in the home," Czartoski says.

Todd Czartoski, MD, is chief physician officer at MultiCare Health System. Photo courtesy of MultiCare Health System.

Identifying and addressing healthcare inefficiencies

CMOs and other leaders can play a pivotal role for healthcare organizations by identifying and addressing inefficiencies and friction points. While identifying inefficiencies, healthcare leaders should rely on frontline caregivers. Czartoski explains that executive leaders should be cautious about weighing in on operational challenges at a healthcare organization.

"I'm a big fan of listening to people who are in the trenches doing the work," Czartoski says. "There is no substitute for talking with as many people as possible about the experience of providing care and any inefficiencies that may be present."

Listening to patients is also important.

"Patients can tell you what is working and what is not working," Czartoski says. "You need to get patient feedback."

In addressing inefficiencies or friction points, there are two initial steps to follow, according to Czartoski.

"First, I try to quantify the size of the problem and the impact that it is having," Czartoski says. "Is a friction point adversely affecting the performance of team members such as doctors and nurses? Is it adversely affecting patients? If we fix a problem, is it going to improve the experience of our staff and patients?"

"Second, you need to look at the level of effort that is going to be required to fix a problem," Czartoski says. "Is the solution going to require a whole new process or new technology?"

With these two steps in mind, CMOs and other healthcare leaders should focus on fixing inefficiencies with solutions that generate high value and require manageable effort, according to Czartoski.

Once the impact of addressing a problem and the level of effort required to fix it have been assessed, there are three steps to take if pursuing a solution is desirable, Czartoski explains.

The first step is to identify a place to launch a pilot program.

"You want to start small," Czartoski says. "For example, if you decide to fix a clinic process, you should pilot the solution in one clinic."

The second step is testing the results of the solution and looking for opportunities to improve it.

"In most cases, the first attempt at a solution is not going to be perfect," Czartoski says.

The third step is scaling the solution once it is working effectively, and the outcomes such as clinical outcomes and quality outcomes have been documented.

"You take the expertise you developed at one site, and you spread the solution to the entire enterprise because you can show that the solution is better for staff and patients," Czartoski says.

Measuring the success of a solution is crucial to scaling it, according to Czartoski. After a pilot is complete and the solution moves to new sites, CMOs must be able to tell the story of how the solution worked.

"You need to be able to show that the solution benefits providers and patients," Czartoski says. "You need to learn from the pilot, then articulate the results to the new sites where you want to apply your solution."

Operating a successful hospital at home program

Czartoski helped lead an effort to design and implement Providence's hospital at home program. The foundation for the program was established with the health system's COVID at Home program during the coronavirus pandemic. The program was so successful that the health system decided to launch a hospital at home program for other high-acuity conditions.

"For us, it was a matter of increasing capacity in our hospitals at a time when we were overflowing with patients," Czartoski says. "We also wanted to create value by finding a less costly location for care, and allowing patients to recover from an acute illness in their home made sense."

Most of the patients enrolled in Providence's hospital at home program came from emergency departments, and the program gave emergency medicine clinicians a new option to care for patients, Czartoski says.

Prior to the hospital at home program, an emergency room clinician had two pathways for patients. If the patient was very ill, they were admitted to the hospital. If the patient was not very ill, they were sent home with a care plan that could include medication and a recommendation to see their primary care provider within a few days.

"Hospital at home introduces a third pathway for patients," Czartoski says. "You may be sick enough to be in the hospital, but we are going to send you home and bring the hospital to you."

Czartoski emphasized that the most important factor for a successful hospital at home program is ensuring that patients are safe, which addresses skepticism among emergency medicine clinicians, patients, and families about treating acute illness in the home.

"We had to be very thoughtful about creating a hospital at home program from a change management standpoint and doing it safely," Czartoski says.

In a hospital at home program, patient safety starts with enrolling patients selectively, according to Czartoski.

"You want to be thoughtful about who you are choosing to be admitted to the program, [because] it is not for everyone," Czartoski says. "You need to select patients depending on the severity of their condition and their medical history."

The Providence hospital at home program promoted patient safety by having at least one nurse visit for the patients in the home on a daily basis as well as having physicians available to visit patients in the home in person or virtually. Patient monitoring was also a key component, Czartoski explains.

"You can measure patients' oxygen status, blood pressure, and heart rate," Czartoski says. "For congestive heart failure patients, you can monitor their weight to make sure they are not taking on too much fluid."

Patient safety for a hospital at home program also includes having a mechanism in place to get patients to a hospital quickly if necessary, according to Czartoski.

"We had rapid ways of transporting a patient back to the hospital if hospital care was required, which was relatively rare," Czartoski says. "Over 95% of the time, patients did fine at home."