Chief clinical executives such as CMOs are focused on a range of issues, including quality, patient capacity, care variation, and high reliability.
This year, HealthLeaders interviewed more than a dozen new CMOs, chief physician executives, and chief clinical officers. Here are seven executives that are poised to make an impact in 2025:
Frost was named senior vice president, CMO, and chief quality officer of Lifepoint in July. He has served in two other leadership roles at the Brentwood, Tennessee-based health system: chief medical officer of Lifepoint Communities and national medical director of hospital-based services. Frost is a member of the HealthLeaders CMO Exchange.
Frost says the core elements of promoting quality care include a leadership component, a process improvement component, and a culture of safety.
The leadership component includes the recognition of the importance of leadership in every aspect of the organization, according to Frost. It also includes engagement of all the quality stakeholders and an accountability process.
Frost says Lifepoint has a checklist of 10 critical components for performance improvement, including huddles that clinical care teams use to focus on clinical workflows, whiteboards at every clinical care unit to identify opportunities for improvement, and tracking data that demonstrate progress or regression.
The culture of safety at Lifepoint includes the engagement of patients and their families as well as fostering an environment where all team members experience psychological safety and have a voice in the safety process, according to Frost.
Galante was named CMO of the Sacramento, California-based academic medical center in July. He had served as interim CMO for a year and was the hospital’s trauma medical director for many years.
Addressing patient capacity is one of his top challenges.
A unique element of the medical center's patient capacity crunch has been California's seismic compliance requirements, which prompted the closing of many beds, according to Galante.
"We have had to close 70 beds over the past year," he says. "By closing those beds, we had to find 70 new beds to open in different locations throughout the hospital."
UC Davis Medical Center has had to do more than open beds to address the facility's capacity challenge, Galante explains.
"You must apply the operations and workflows to be able to move patients more seamlessly and get them discharged," he says.
3. Cameron Mantor, MD, MHA, chief physician executive at OU Health and president of OU Health Partners
In September, Mantor was named chief physician executive at the Oklahoma City, Oklahoma-based academic health system and president of OU Health Partners, the health system's physician practice. He had been serving in the roles on an interim basis since January.
OU Health Partners is positioned for growth, and one of Mantor's primary responsibilities is to help manage the recruitment of new physicians. Oklahoma ranks low for the number of physicians per capita in the country for almost every primary care area as well as specialties.
One recruiting advantage for OU Health and OU Health Partners is the tripartite mission of the organization: education, research, and clinical care, according to Mantor.
"Our goal is to show physician recruits what we are looking to create, so they see what our vision is and hopefully that aligns with them," he says. "That tends to attract recruits. We have a great academic health center, with seven colleges on our campus, so we can attract physician recruits both from an education standpoint and a research standpoint."
McGinn was appointed senior executive vice president and chief physician executive officer of the Chicago-based health system in September. He joined the health system in 2021 as executive vice president for physician enterprise.
McGinn says he is passionate about reducing clinical care variation to boost patient safety and quality.
"My background is in evidence-based medicine and looking at clinical standards," he says. "We have a national program that sets clinical standards."
According to McGinn, the key to success in setting clinical standards is to have clinicians drive the process.
"It is not a top-down approach," he says. "We put the standards in front of the clinicians, we give them some options, we have multiple group meetings, then the clinicians come to a consensus about the clinical standards."
Pancioli assumed the role of senior vice president and chief clinical officer at the Cincinnati-based academic health system in August. Prior to taking on his new position, he was chief transformation officer of the health system.
This year, UC Health launched an initiative to become a high reliability organization.
"Many healthcare organizations across the country have taken on the concept of high reliability," Pancioli says. "It is a well-studied science that is a methodology of improvement of an entire organization. We have just entered an engagement with a consultancy, and we are starting our journey to high reliability."
The first step in this process, he says, is assessment.
"The first thing you do is determine your current state and opportunities for improvement in high reliability, which is the pursuit of zero harm in a highly complex organization," Pancioli says.
Puri was appointed CMO of the Chicago-based academic medical center in September. He joined UChicago Medicine as an internal medicine resident in 1999 and has held several physician leadership roles, most recently associate CMO.
To address health equity concerns, a health system or hospital must be inquisitive, according to Puri.
"It starts with asking questions about health equity," he says.
The next step is harnessing data, Puri explains.
"You need to have data that you can act on," he says. "Our data and analytics team has done a good job of creating an equity lens that we can use when we look at any of our data and break data down along multiple patient demographics, including race, gender, and Zip codes."
Schissel became CMO of the 665-bed academic medical center, which is operated by RWJBarnabas Health, in August. He had been CMO and vice president of medical affairs at Brigham and Women's Faulkner Hospital in Boston, where he also served as associate CMO and chief of medicine.
Like Pancioli, Schissel is focusing on high reliability, which he also pursued in Boston.
"We had a system of just culture, where patient care was examined from the perspective of systems improvement and accountability that goes beyond individual human error," he says.
Staff from all disciplines at the Boston-based hospital shared a vision of high reliability and worked collaboratively on care and quality goals, Schissel says.
"In addition, every decision we made in healthcare leadership placed the patient's best interest and safety at the center," he says. "Creating and maintaining this kind of culture is hard work, and it is a continuous process."
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Since November 2020, health systems and hospitals have been providing acute care in the home setting through the Acute Hospital Care at Home (AHCAH) program under a waiver from the Centers for Medicare & Medicaid Services (CMS). Ochsner's Acute Care at Home program, which was launched in March, does not receive reimbursement from CMS and serves patients who are participants in value-based contracts.
"With the Acute Hospital Care at Home program, under the regulations you are providing inpatient care at somebody's home, and there are restrictions such as number of visits as well as continuous monitoring," says Sidney "Beau" Raymond, MD, CMO of Ochsner Health Network.
"In addition, Acute Hospital Care at Home billing is done as an inpatient visit," Raymond says. "With our Acute Care at Home program, there is not 24/7 remote patient monitoring, and we are not billing to insurers as you would with an inpatient visit."
Billing is a key difference between AHCAH and the Acute Care at Home program, according to Raymond.
"This is a pilot, and we are serving our value-based lives now," Raymond says. "In this pilot with about 400 patients, we are getting about a two-and-a-half times return on investment for the access that we are opening up."
In the Acute Care at Home program, patients participate in a 15-day episode of care at home, with virtual care provided by a physician, nurse, and care manager staffed by myLaurel, according to Logan Davies, MD, medical director of hospital access and throughput at Ochsner Medical Center—New Orleans. The virtual visits by a physician are accompanied by a paramedic in-person visit.
"Over the 15-day episode of care, myLaurel is managing acute care, the clinical plan, and transitional care services," Davies says, "where we have virtual nursing and virtual care management doing everything from medication reconciliations, to fall risk assessments, to education for patients and their caregivers."
Clinicians employed by myLaurel conduct the home care, but they are Ochsner-credentialled providers, Davies explains, which allows them to have full access to the health system's electronic medical record.
To be enrolled in the Acute Care at Home program, patients must be stable and able to be treated safely in the home, according to Davies.
"A cornerstone of the program is appropriate acuity," Davies says.
Patients are transferred to the Acute Care at Home program from the emergency department, hospital observation units, and inpatient units.
Acute Care at Home patients are being treated for several medical conditions, Davies explains.
"For the conditions we are managing, the most common are infections, including urinary tract infections," Davies says. "The second most common condition is congestive heart failure. After CHF, we are treating pulmonary conditions such as chronic obstructive pulmonary disease as well as upper respiratory infections. We also treat patients for electrolyte issues and renal issues."
Benefits of the Acute Care at Home program
The main benefit of the Acute Care at Home program is that patients get to receive care in the home, which is an appropriate care setting for these patients, according to Raymond.
"People are eligible because they are stable enough to not be hospitalized, but they do need more than just intermittent care that would require travel to and from a clinic or other care setting on multiple visits," Raymond says. "It's the right care in the right place. These patients get to be home, where they and their caregivers are more comfortable."
Secondarily, the Acute Care at Home program is beneficial because it meets an acute need for a patient at a lower cost than hospital inpatient care, Raymond explains.
"This program is currently available to patients that we share in the total cost of care in some way," Raymond says. "This allows us the freedom to try different models of care while always keeping the patients first. Another benefit is that it frees up beds inside the hospital for those that need that level of care or intervention, and it avoids delaying that care by having better access."
The Acute Care at Home program exemplifies value-based care, according to Raymond.
"The goal of value-based care is to provide high quality care at a lower cost with a great experience," Raymond says. "This checks all of those boxes. People are getting great care at an appropriate cost in their home. Value-based reimbursement allows us to do this."
The Acute Care at Home program is reducing total cost of care by avoiding hospital admissions and readmissions, Raymond explains.
"Hospitalizations are some of the costliest events in healthcare for not only the payer, but also the patient through deductibles and coinsurance," Raymond says. "Reducing hospitalizations has a direct and noticeable impact on the total cost of care."
This HealthLeaders podcast focuses on several infection prevention topics, including respiratory virus season, emerging pathogen considerations, and healthcare-acquired conditions.
Health systems and hospitals are entering the respiratory virus season with little guidance from local and federal public health agencies, according to the executive medical director of infection prevention and control at UChicago Medicine.
Infection prevention and control staff are the first line of defense for infectious diseases and infections at health systems and hospitals. They help health systems and hospitals manage interventions such as masking and promote best practices in areas such as healthcare-acquired conditions.
Coming out of the COVID pandemic, there are a lot of questions about the role of masking and other interventions for respiratory viruses such as restricting visitors in hospitals, says Emily Landon, MD, executive medical director of infection prevention and control at UChicago Medicine.
"For a long time, we had a lot of rules that we had to follow from our local public health agencies and the Centers for Disease Control and Prevention," Landon says. "Most of those rules sunset before this year's respiratory virus season."
In the absence of guidance from public health agencies, it is challenging to know when to require masks at healthcare settings, but it is clear that masking helps prevent transmission of respiratory viruses, Landon explains.
"What type of mask you wear helps determine whether or not you are going to be protected," Landon says. "If you want to be protected from a sick person near you, then you need to wear a tight-fitting, N95 mask. If you want to help prevent yourself from giving someone else COVID or influenza, you can do that safely by wearing a surgical mask."
Emily Landon, MD, is executive medical director of infection prevention and control at UChicago Medicine. Photo courtesy of UChicago Medicine.
UChicago Medicine has created a "masking ladder" to manage the wearing of masks during this respiratory virus season.
"We have a team of people including ambulatory staff, people from occupational medicine, people from pharmacy, and people from infection control, and we huddle every Thursday for about 15 minutes," Landon says. "We use a set of metrics to determine how we move up and down the masking ladder."
The bottom rung of the masking ladder is when staff wear masks when they are sick. The next rung of the masking ladder is called the yellow level, according to Landon.
"At the yellow level, we know something is coming such as seeing a new variant or seeing more cases of influenza," Landon says. "At the yellow level, staff still wear masks when they are sick, but we also tell people that respiratory virus season is heating up and they should be more careful, they should stay home if they are sick, and they should get tested if they feel sick."
The next rung on the ladder is the orange level.
"When we start seeing higher respiratory virus numbers in our community and among staff at our care settings, we switch to the orange level," Landon says, "which requires all staff members to wear masks when they are in direct patient care."
The top rung on the ladder requires universal masking, including for patients.
"If we see widespread problems such as lots of people being admitted to the hospital with respiratory viruses or lots of staff sick in multiple areas of the hospital," Landon says, "then we would consider universal masking, including for patients."
So far during the early days of this year's respiratory virus season, UChicago Medicine has been able to limit infections in healthcare settings, according to Landon.
"We track hospital-acquired COVID, influenza, and RSV at the University of Chicago, and we have been successful in preventing patients from getting sick in the hospital just by requiring masks for staff members when we see infections in healthcare workers," Landon says. "You can get by using fewer masks than you did during the COVID pandemic, but masking has the benefit of patients not getting sick from healthcare workers."
UPMC's CMIO, a HealthLeaders AI in Clinical Care Mastermind program participant, provides advice on adopting AI tools.
Health systems and hospitals need to understand the outcomes and goals they are trying to accomplish with AI, says Robert Bart, MD, chief medical information officer at UPMC.
"We are past the time that people are saying they want to use AI because it is AI," Bart says. "You need to make sure as you are examining the use of AI in your health system that it drives the type of clinical outcomes you are trying to achieve. In addition, AI models should have the scale that your organization needs."
HealthLeaders is conducting its AI in Clinical Care Mastermind program through December. The program brings together nearly a dozen healthcare executives to discuss their AI strategies and offerings. As part of the program, each of the panelists are talking with HealthLeaders about the use of AI in clinical care.
Bart says the process for identifying the desired goals and outcomes of an AI tool depends on the problem you are trying to solve.
"You want to identify your goals and desired outcomes early on when you are evaluating whether you want to adopt an AI tool, whether it impacts clinical care, the efficiency of care delivery, or other aspects that a health system has targeted," he says.
Health systems and hospitals also must have appropriate AI governance, so that they not only are evaluating AI when it is adopted but also reviewing how AI models are functioning.
"The thing about AI is that the algorithms are always learning," Bart says. "You need to go back and re-examine the algorithms at intervals after you have started using them. You need to make sure that an algorithm provides the type of guidance or insights that were intended at the outset."
UPMC has established an AI governance council to make sure that the health system is leveraging AI appropriately and in a safe manner, Bart says. The council has a dozen members and includes clinicians, technologists, as well as diversity and equality staff.
"We have governance to make sure we are understanding the algorithms, understanding the use cases, and understanding the test data that the algorithms were generated on," he says. "All of those things go into making sure we are leveraging AI in a safe manner to enhance care delivery."
Diversity and equality are also key issues for AI governance.
"There are some concerns that AI has algorithms that create segmentation of the patient population inappropriately," Bart says. "We want make sure that AI can be leveraged for all of the patients we serve at UPMC."
Robert Bart, MD, is chief medical information officer at UPMC. Photo courtesy of UPMC.
Clinical care AI models at UPMC
UPMC was an early adopter of predictive algorithms, launching these AI tools about six years ago.
"We have been using AI for predictive algorithms related to length of stay and risk for readmission or hospitalization," Bart says. "We have been trying to predict and understand those types of parameters for patients."
The health system is using the technology to be more proactive in care delivery.
"Where we identify patients who are outliers such as high risk for hospitalization or readmission after hospitalization, we are trying to put in interventions to mitigate their risk of hospitalization or readmission," Bart says.
The health system is also using AI in pathology to identify disease states in tissue slides.
"The AI is prioritizing slides of tissue that might have areas of concern and need to be reviewed," Bart says. "It allows the pathologist to be more efficient with their time."
In a similar use case, UPMC is using AI in radiology.
"One of the AI tools we are using in the radiology space is related to stroke detection," Bart says. "For strokes, seconds and minutes make a difference for the brain in the type of care you are delivering. So using AI in image analysis helps improve the speed with which our neurologists and neurosurgeons can make decisions for patients who have brain tissue at risk."
As is the case with most health systems and hospitals that have adopted AI tools for clinical care, UPMC is using ambient listening AI technology to record conversations between clinicians and patients, then generate clinical documentation.
"We have been using AI to aid our physicians and advanced practice providers in improving the quality and efficiency of documentation," Bart says.
Compared to the other AI tools that the health system has adopted, the ambient listening AI technology has had the most profound impact on clinicians, according to Bart.
"We were one of the early adopters of ambient voice technology in documentation," he says. "Our deployment is broad compared to what I have seen in other health systems. The feedback that we get from the clinicians who have adopted this tool is very good."
For example, a family practitioner may see 20 patients through the course of a day in a clinic, then face "pajama time." They may finish their office day at 5 or 6 p.m., go home and see their family, then finish the documentation for the patients they saw over the course of the day.
"One of the things we have seen is that pajama time has decreased significantly; and for some clinicians, pajama time has gone away completely," Bart says. "For a clinician, it makes a huge difference if they can leave the clinic at 5 or 6 and have all of their documentation done as opposed to having to spend two hours in the evening catching up on documentation."
The HealthLeaders Mastermind program is an exclusive series of calls and events with healthcare executives. This Mastermind series features ideas, solutions, and insights on excelling in your AI programs. This clinical AI program is sponsored by Microsoft-Nuance, Rapid AI, and Ambience.
To inquire about participating in an upcoming Mastermind series or attending a HealthLeaders Exchange event, email us at exchange@healthleadersmedia.com.
Memorial Healthcare System’s new $1.7 million Care Coordination Center aims to eliminate gaps in patient navigation and care management.
The new Care Coordination Center at Memorial Healthcare System is expected to boost care quality and patient safety, the CMO of the health system says.
The South Florida health system invested about $1.7 million in the 3,000 square foot facility and equipment. The annual cost of operating the center is estimated at $3.7 million.
The Care Coordination Center has five primary capabilities, according to Aharon Sareli, MD, executive vice president and CMO at Memorial Healthcare System.
At Providence, AI governance addresses several issues such as safety and security of patients and their data.
Providence is taking a comprehensive approach to AI governance, the health system's chief clinical officer says.
"Our approach to the use of AI tools is methodical and anchored in our mission, values, and organizational vision and priorities," says Hoda Asmar, MD, MBA, executive vice president and system chief clinical officer for Providence. "While we believe AI advancements have the potential to elevate quality of care and allow our caregivers to perform at the top of their license, the safety and security of our patients and their data will always be our top priority."
HealthLeaders is conducting its AI in Clinical Care Mastermind program through December. The program brings together nearly a dozen healthcare executives to discuss their AI strategies and offerings. As part of the program, each of the panelists are talking with HealthLeaders about the use of AI in clinical care.
According to Asmar, Providence has established AI governance to get ahead of several issues raised by AI models,
"Providence proactively assembled an AI governance structure to ensure alignment around priorities and strategy, and ensure safety, privacy, security, equity, and the ethical use of AI," Asmar says. "This governance structure will evolve as our experience and knowledge around AI deepens."
The AI governance structure has several elements, Asmar explains.
"Providence has put together an AI guardrails workgroup led by our system's chief data officer; an Information Protection committee led by our chief information security officer; and a Data Ethics Council, led by our chief ethicist," Asmar says. "The work of these three teams feed into the Generative AI Leadership Council that oversees our responsible use of AI and advances our AI strategy."
The health system has also convened expert groups to manage AI governance, Asmar explains.
"We have stood up four subject matter expert groups: clinical, patient and consumer, workforce and administration, and back office," Asmar says. "These groups identify and prioritize key use cases for their areas and leverage the guardrails, data protection, and other governance structures to guide work to develop and implement AI solutions."
Hoda Asmar, MD, MBA, is executive vice president and system chief clinical officer for Providence. Photo courtesy of Providence.
AI models at Providence
The health system is integrating AI tools into daily work to accelerate decision-making, simplify workflows, and reduce non-clinical task burdens.
This includes internally generated innovations that leverage AI to enhance patient experience and reduce clinician burnout, according to Asmar.
"Some examples include automating non-direct patient care tasks in the form of ambient documentation; clinical decision support by bringing together multiple information sources in a way that allows the clinician to easily analyze and make decisions; and employing predictive analytics that speed up access to just-in-time data and information," Asmar says.
An AI tool developed at Providence helps to manage patient messages sent to clinicians' electronic in-baskets.
ProvARIA (automated realtime in-basket assistant) organizes inbox messages to physicians and caregivers in the ambulatory setting based on acuity, urgency, and content. The AI model uses a natural language processing engine to organize the messages, and a tailored user interface integrated into the electronic health record.
"ProvARIA supports clinicians in responding to their in-basket messages by augmenting them and supporting them in understanding a patient in-basket message, triaging, and responding to the message more readily," Asmar says." ProvARIA has not only eased the way for our care teams but also improved the response time to patients by 50%."
AI's impact on Providence care teams
Some of the clinical AI tools being used at Providence are still new, and the health system is assessing how they are impacting care teams.
"Early indicators suggest these tools have a high level of engagement and satisfaction with the care teams by allowing clinicians to spend more time with their patients, reducing stress and administrative task burdens, and allowing clinicians to focus on what matters most to them and their patients," Asmar says.
Computer-assisted physician documentation and ambient technology, in which physician-patient conversations are automatically transcribed and uploaded directly to EPIC and Providence's EHR through tools such as Nuance's DAX, remove the technological barrier that typically inhibits personal connection in exam rooms and allows caregivers to deliver even better care, according to Asmar.
Providence has also introduced MedPearl, a clinician education and referral platform designed by clinicians for clinicians, which gives primary care providers advice on whether—and where—to send patients for specialty care, Asmar says. Generative AI is used to accelerate content creation and enhance the end user's search experience.
Another example of an AI tool that is having a positive impact on care teams is an AI-powered surgical scheduling tool, according to Asmar.
"Surgical teams have indicated improved role satisfaction as surgery scheduling is easier and more efficient, and this satisfaction is also shared by the surgeons and their office staff," Asmar says.
The HealthLeaders Mastermind program is an exclusive series of calls and events with healthcare executives. This Mastermind series features ideas, solutions, and insights on excelling in your AI programs. This clinical AI program is sponsored by Microsoft-Nuance, Rapid AI, and Ambience.
To inquire about participating in an upcoming Mastermind series or attending a HealthLeaders Exchange event, email us at exchange@healthleadersmedia.com.
Memorial Healthcare System's new $1.7 million center aims to eliminate gaps in patient navigation and care management.
The new Care Coordination Center at Memorial Healthcare System is expected to boost care quality and patient safety, the CMO of the health system says.
The South Florida health system invested about $1.7 million in the 3,000 square foot facility and equipment. The annual cost of operating the center is estimated at $3.7 million.
The Care Coordination Center has five primary capabilities, according to Aharon Sareli, MD, executive vice president and CMO at Memorial Healthcare System.
The facility will act as a transfer center, with access to real-time data across the health system's six acute-care hospitals. A team including nurses stationed at the center will be able to coordinate patient transfers both within the health system and from other facilities into the system.
Working through the Epic EHR platform, staff at the center can centralize bed placement. Staff at the center can also balance and manage capacity within each of the six hospitals and ensure that patients transferred into the health system are placed in the appropriate care setting.
Staff members at the facility will conduct virtual patient observation. The primary responsibility of virtual patient observers is to keep an eye on inpatients who are at risk of falls.
The facility will serve as a hub for virtual nursing. Through two-way communication tools at the bedside, virtual nurses can do some of the admissions intake for patients as well as discharge instruction and education. This frees up bedside nurses to do other patient care duties. The goal of virtual nursing is not only to be a satisfier for patients but also a satisfier for bedside nurses.
The facility will manage a centralized staffing pool for nurses, therapists, technologists, and other healthcare workers. That team will use Epic dashboards that have real-time information on high patient volume, then shift staff to areas with high need.
Sareli says the new center addresses a need to improve care management and coordination.
"It was essential for us to leverage technology, people, standard processes, and innovation to put together the Care Coordination Center to lock down multiple processes, including our capacity management for patients, patient transfers, virtual patient observation, and virtual nursing," he says.
Improving safety, care quality
The facility is expected to drive positive outcomes, Sareli explains.
"Ultimately, we not only want to improve patient experience but also improve quality and safety for our patients," he says.
"What we are looking to do is get the patient as quickly and efficiently as possible to the right care destination," he says. "For example, if a patient needs to be in the ICU to receive intensive care, we want to get that patient out of the emergency department as quickly as possible. Getting the patient into the right environment is always going to enhance patient safety and quality."
One critical function of the center, Sareli adds, is to track and improve the patient journey from beginning to end.
"When we look at throughput in our health system and the way patients transition from entry and exit at a hospital, anytime we can do anything to improve efficiency will improve quality and safety," he says.
Improving management of staffing will drive positive outcomes, according to Sareli.
"We have a relatively innovative strategy to have teams look at staffing," he says. "They can identify places in the health system that have increased patient volume and increased needs, then send more staff to the bedside in areas that need more staffing. This also contributes to patient safety and quality."
This also extends to virtual nursing.
"This capability is not replacing the bedside nurses, but the bedside nurses are better able to focus on delivering care," he says. "The virtual nurses can get the right intake information and give the right discharge instructions. This improves quality and safety."
Photo: Dashboards display real-time data at Memorial Healthcare System's Care Coordination Center. Photo by Michael Hopkins Photography.
RWJBarnabas Health executive says lawmakers should enact a permanent, annual inflation-based update to Medicare physician payments.
Congress should intervene to block a 2.8% physician payment cut in the 2025 Medicare Physician Fee Schedule, the CMO of a New Jersey-based health system says.
On July 10, the Centers for Medicare & Medicaid Services (CMS) issued a proposed rule for the 2025 Physician Fee Schedule that included a reduction in the conversion factor for physician reimbursement from $33.29 this year to $32.36 next year. The conversion factor is the number of dollars assigned to a relative value unit (RVU), which is a key element of physician payment by Medicare.
CMS issued the Final Rule for the 2025 Physician Fee Schedule last week, including the 2.8% physician payment cut.
Congress should adopt a proposal from the American Medical Association to enact a permanent, annual inflation-based update to Medicare physician payments, says Andy Anderson, MD, MBA, executive vice president and chief medical and quality officer at RWJBarnabas Health.
"An annual inflation-based update would provide predictability, and this increased certainty would enable more financial resources to invest into both physician practices and into the recruitment and retention of physicians who are in short supply," he says.
If the physician payment cut is allowed to stand, it will have a severe negative impact on health systems, hospitals, and physician practices, according to Anderson.
"Cutting physician reimbursement will put added financial strain on the healthcare industry and limit the ability to recruit and retain the best and the brightest physicians and staff," he says. "Pay cuts will increase physician burnout, put strain on physician practices, and impede the ability for healthcare organizations to shift to value-based care and focus on health and prevention."
This physician payment cut comes despite CMS estimating a 3.5% increase in the Medicare Economic Index, which is the government’s measure to gauge increases in the costs of physicians delivering care to Medicare patients. The 2.8% pay cut is unsupportable given the estimated increase in care costs, Anderson explains.
"A 2.8% pay cut is not sustainable given the ongoing increases in the costs of healthcare," he says.
The pay cut will prompt healthcare organizations to make hard decisions, according to Anderson.
"Hospitals, health systems, and physician practices will have less resources available and will be challenged to provide needed services and access," he says. "Physician practices will have a harder time retaining staff, will have to cut services, and will be unable to purchase equipment and supplies."
Healthcare leaders should not think about technology first and the allure of AI, says Sutter Health's Kiran Mysore.
Sutter Health’s AI leader says clinicians may be too optimistic about what the technology can do, and they need to understand that there are right and wrong ways to use AI.
“AI is very complex,” says Kiran Mysore, MS, chief data and analytics officer at the northern California health system and a participant in the HealthLeaders Mastermind program on AI in clinical care. “It is rarely a turn-key solution, where you adopt a model and expect it to work.”
“It needs a lot of good, clean data. It needs a lot of talented and skilled professionals to make it work the right way,” he says. “It needs the right workflow integration, and it should impact the point of care. And it needs to be trusted and dependable, which means you must tune the models well so they can predict the right answers.”
Making a business case for hiring new infection preventionists starts with gathering data on the current state of infection rates and staffing concerns.
Infection preventionists have an expertise that is different from physicians and nurses.
They are trained in hospital epidemiology as well as sterilization and disinfection of reusable medical instruments, and they are valuable members of a CMO's clinical care staff.
An infection prevention and control executive at Boston Children's Hospital recently made a business case for hiring more infection preventionists and was able to gain approval to increase staffing by more than 50%.
"Infection preventionists add a lot of value," says Jennifer Ormsby, DNP, RN, senior director of infection prevention and control at Boston Children's Hospital. "They have an expertise that is very different from a nurse or a physician. They can improve patient safety and patient care."
Infection prevention and control programs at healthcare organizations are often understaffed, according to Ormsby.
"Nationally, infection prevention teams are understaffed," Ormsby says, "and the Association for Professionals in Infection Control and Epidemiology and infection preventionists across the country have been advocating post-COVID for C-Suite leaders to have more infection preventionists in their healthcare facilities."
At Boston Children's Hospital, there was a shortage of infection preventionists in ambulatory and procedural settings, and Ormsby led an effort to build a business case for increased staffing.
"Creating a solid business case to build your infection prevention program is key," Ormsby says, "especially when you are working with the C-Suite and advocating for additional resources."
Ormsby took a data-driven approach to building a business case for more infection preventionists. The process started with an assessment of the current state of the hospital's infection prevention and control program, including hospital-acquired infection rates as well as process measures such as hand hygiene, personal protective equipment audits, and the most recent accreditation survey results.
"I was able to present our current state, a bridge to the right size for our department, and right-sizing for our enterprise," Ormsby says.
Part of the business case was detailing overtime payments to the existing infection preventionist staff. According to Ormsby, the hospital was paying about $23,000 in overtime for the infection preventionist on-call staff member and $25,000 in overtime for contact tracing.
"My business case was sharing all the data, and the goal was to prevent infections and improve safety for our patients in procedural and ambulatory settings," Ormsby says. "If I didn't have the resources to be present in those locations to do observations and do quality improvement initiatives, I could not reduce infections."
Before presenting the business case, Ormsby had eight infection preventionists. After presenting the business case, she was able to hire four new infection preventionists and a manager of infection prevention.
Being fully staffed benefits the hospital and its patients because it allows the health system to help patients in all settings, according to Ormsby.
"Historically, the focus has been on inpatient settings as opposed to procedural and ambulatory settings," Ormsby said. "This is a challenge because more care is moving to the ambulatory setting such as day surgery. We need infection prevention staff members in those settings as well."
In addition to making a business case for more staff, there is a business case for limiting infections in healthcare settings, according to Ormsby.
"The business benefits of reducing infections for the organization include not getting reimbursement if an infection is identified as a hospital-acquired infection," Ormsby says. "Payers also can refuse to reimburse hospitals for surgical site infections."
Hoda Asmar, MD, MBA, is executive vice president and system chief clinical officer for Providence. Photo courtesy of Providence.
