A primary goal of the dual CMO and COO role is integrating clinical care with operational leadership.

Fort Lauderdale, Florida-based Holy Cross Health, which features a 557-bed hospital and is a member of Trinity Health, has created a dual CMO and COO role.

A dual CMO and CCO role is uncommon at health systems and hospitals. Scripps Health is one of the only health systems in the country with established dual CMO and COO roles, with Ghazala Sharieff, MD, MBA, serving as chief medical and operations officer of acute care and Anil Keswani, MD, serving as chief medical and operations officer of ambulatory care.

Jose Lopez, MD, MBA, has been serving as CMO of Holy Cross Health since 2021. He took on the additional role of COO effective July 6. According to Holy Cross Health, one of the goals of creating the dual role is to integrate clinical care with operational leadership.

One of the advantages of forming the dual CMO and COO role will be facilitating connections between clinical leaders and operational leaders, according to Lopez.

"When we had a separate COO, the awareness of clinical and operational opportunities was not always there," Lopez says. "In the dual role, I will have line of sight to both sides, which will make it easier to make connections."

Infection prevention is an example of when the dual CMO and COO role can make a significant difference, Lopez explains.

"Temperature control and humidity control are usually issues that are under the privy of the COO, but they can affect infection rates significantly in a hospital," Lopez says.

Serving in the dual role will allow Lopez to influence care environments from a design standpoint and comfort-of-care standpoint for patients and staff members, including issues such as cleanliness.

"These factors are critical for running a hospital," Lopez says. "In this expanded role, I will be able to have line of sight to these factors and be able to efficiently affect change. "

Jose Lopez, MD, MBA, is CMO and COO of Holy Cross Health. Photo courtesy of Holy Cross Health.

Having the dual role will help identify and address opportunities for improvement, according to Lopez.

"Some improvement opportunities will be from the quality standpoint and how the environment of care affects quality metrics," Lopez says. "Other opportunities for improvement may be in operations such as the functioning of our call center and how that facilitates our patients arriving at our physicians' primary care offices in a timely fashion."

Common operational functions such as the call center have an impact on clinical care, and the dual CMO and COO role will help align operational and clinical staff, Lopez explains.

"In my dual role, I will be able to highlight for both the clinical and operational teams how what they do affects the other side," Lopez says. "Healthcare is a team sport, and we need to support each other."

One of the objectives of the dual CMO and COO role is helping Holy Cross Health achieve financial performance goals.

"My approach to healthcare is if you do a good job from a clinical standpoint and have solid operations, financial performance will follow," Lopez says. "Your reimbursement should improve, and your market share should improve."

In addition to continuing to focus on clinical performance in his CMO role, Lopez plans to be more involved in cost control in his dual role.

"If you control costs by making sure you are providing the appropriate care in the appropriate setting for the appropriate length of time, financial performance should follow," Lopez says.

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.