The for-profit world has also Attributes that hospitals are looking Notable trends emerging that recognized that CMOs can for in a contemporary CMO will impact the hiring of CMOs make a difference

The Chief Medical Officer: Now Mission Critical To Your Hospital's Future

By Thomas J. Lynch, Jr.

romotion of quality medical care and patient safety have Medical Officer is leading the charge P to see that this happens. I see the taken on a sense of urgency for our nation’s hospitals. An article CMO as the lightning rod for any- in the June 26, 2003, New England Journal of Medicine reported thing to do with patient care. The that clinicians failed to pro- vide appropriate care in “The CMO is the ‘go-to’ person’ when nearly half of all cases. Astounding! Public it comes to quality and patient safety.” accountability for what hos- pitals do to patients is now front and center in today’s headlines CMO is the “go-to” person when it comes to quality and patient safety.” about our healthcare system. It is no wonder that patient safety The responsibility for the quality of and quality care have become the overriding concern of our care delivered to patients rests with the hospital Trustees. Board of Trustees. Traditionally, the With the publication of the Institute task has been performed by the med- of Medicine’s report, “To Err is ical staff who, in turn, assigns the day- Human,” which cited 98,000 preventa- to-day oversight to the various chairs ble deaths each year, and numerous or chiefs of services. This “world other reports in the media about med- order” for overseeing the delivery of ical errors, Boards want to be assured quality care will not likely change. that someone is focused on clinical What is changing is the CMOs’ role. outcomes at all times. It is not surpris- Boards and CEOs are placing renewed ing, therefore, that the Chief Medical emphasis on the CMOs’ responsibility Officer is becoming the focal point in in assuring that patients are safe and the campaign to address this problem. quality outcomes are happening. They Roger Scoville, Chairperson of the are expecting the CMOs to be sure Board of Trustees at Newton- that patient safety and quality assur- Wellesley Hospital, a 253-bed com- ance systems are in place and working. munity teaching hospital in Newton, They also expect the CMOs to be Massachusetts, agrees, “Our Trustees readily available to support the medical are focused on ensuring that patients and nursing staffs in their efforts to receive the right care at the right time ensure quality patient care. and at the right place. Our Chief Thomas J. Lynch, Jr. Michael Sack, President and CEO of Hallmark Health, a 368-bed, leading continued - Phillips DiPisa recruits leaders for healthcare and life sciences organizations along the East Coast and throughout the Midwest. This article is part of a continuing series. community-based healthcare system patient safety issues. They will north of Boston, sees the CMO as continue to carry a full load of vital to improving the quality of care. other important duties such “We have set high standards and as: expect our CMO to spearhead our drive to provide the safest environ- • Be the conduit between the ment and the highest level of quality medical staff and hospital care because we know he is personal- administration. ly and professionally the best person solve the cost-quality equation. to facilitate and to gain support as • Assist the elected medical staff Patrick Muldoon, President and we change our operating systems.” leaders in carrying out their duties Chief Executive Officer of UMass and responsibilities. “Physicians in HealthAlliance in Leominster, Recently, Applied Management private practice are facing additional Massachusetts, has recently under- Systems, a national healthcare con- time constraints as they see reim- taken a search for his health system’s sulting firm, published its top ten bursements decline and demand for first CMO. He said an understand- trends for the year 2010. First and quality accountability increase,” says ing of the relationship between cost foremost was a “Focus on Patient Jerrold Maki, Chief Administrative and quality was an important factor Safety.” Among the other top trends Officer of Bon Secours Richmond in the selection process. “Our mis- were the arrival of the electronic Health System, a four-hospital sys- sion is to provide the best care possi- medical record (which helps support tem in Richmond, Virginia. “We ble for our patients. This can only be higher quality care) and pay-for-per- expect our CMOs to help our hospi- done if we use our resources wisely. formance – an incentive-based pro- tals’ medical staff leaders carry out There is a direct relationship to the gram that will reward physicians and the duties of their offices so that we investment we make and the out- hospitals for quality care and continue to have effective, voluntary comes we get. The CMO will be improved outcomes. Each of these medical staff organizations.” critical in our effort to achieve this.” trends will be a major focus for the CMO. He/she will be expected to • Provide direction and assistance to According to James Butterick, MD, champion these causes. clinical departments and hospital CMO at Cape Cod Hospital in administrators in evaluating new Hyannis, Massachusetts, “Being the The for-profit world has also clinical programs and technology. CMO today is much more complex. Clearly our focus is on quality, more recognized that CMOs can • In some community hospitals, they than ever before, but that has not make a difference. will serve as a liaison with tertiary or diminished our other duties. We academic medical centers to ensure have to be very good at prioritizing Tenet Healthcare, the Tennessee- their hospitals gain maximum bene- our time. We need to use our powers based, for-profit hospital chain, fit from the affiliation. of persuasion to be effective.” recently announced the appointment of six new CMOs to ensure quality • Be a key player in interacting with So, what are the attributes and patient safety at all the compa- health insurance companies, man- hospitals are looking for in a ny’s hospitals. They will be prime aged care plans, and employers. contemporary CMO who can movers in implementing Tenet’s play all of these roles in this comprehensive “Commitment to • Be a “medical strategist” from a increasingly complex Quality” initiatives, a program business perspective. They will need environment? designed to bring about significant to address the issue of rising finan- improvements in quality of care and cial tension between hospitals and First of all, they are not necessarily patient safety, nursing practice, med- their medical staffs and help find looking for a doctor with a newly ical staff governance, and other common ground where both can minted MBA. While an MBA is important areas related to the deliv- benefit. nice to have, hospitals first and fore- ery of quality patient care. most want their CMOs to be clini- • Champion the efficient use of cally credible, especially with their All of this is not to say the CMOs resources. They need to be the “math medical staff. Usually a physician will only concentrate on quality and professors” who lead the effort to with real patient care experience is a systems that are efficient and ciency performance, and vary high quality – the combina- provider compensation accordingly. tion is powerful!” The CMO will need to understand An understanding of medical the managed care environment and management information is be able to interface with this market essential; one does not have to force payor. Ten years ago this was a be a former Chief Information greater driving force for CMOs than requirement. Scott Bullock, Officer. However, an effective CMO it is today. He/she must have a President and CEO of needs to be comfortable with and strategic business sense – or at least MaineGeneral Health in Augusta know how to use data and technolo- an appreciation and understanding and Waterville, Maine, believes, gy to make his/her case. Accurate of the market forces effecting future “Every CMO needs to have prac- and persuasive data usually win the healthcare services and demands. ticed medicine at some point in day with physicians. Pay-for-performance and consumer- his/her career. The ability to under- driven healthcare will likely modify stand and speak the language is The ability to relate to nursing is a the “buying” habits of tomorrow’s imperative. But most importantly, must. After all, most of the care purchasers of healthcare. The federal knowing what constitutes quality delivered is by nurses. The CMO government is embracing the con- care and being able to recognize will need to partner with inferior care are the crucial factors.” his/her counterpart in nurs- ing, the Chief Nursing “Boards and CEOs Policemen need not apply. Hospitals Officer. Maureen Buckley, are not looking for enforcers – this RN, PhD, Vice President of are placing renewed approach is usually a dead end, Patient Care at Penobscot except in extreme cases. They are Bay Medical Center in emphasis on the CMO’s seeking a facilitator. Someone who Rockport, Maine, says that can, through his/her power of per- the key to successful CMO suasion, use of data, facts, and diplo- and Chief Nursing Officer responsibility in assuring macy, reach the desired result – relationships is communica- namely, a quality outcome. tion. “My CMO and I that patients are safe debrief at least three times Integrity is a must; without it the per week. The synergy we and quality outcomes CMO is out of a job. He/she must have developed, as a result, be viewed as a champion of the hos- has been invaluable in our are happening.” pital’s values and focused on its mis- efforts to deliver quality sion. Any actions that prove self- care.” serving compromise the CMO’s cept of pay-for-performance. In May ability to get the job done. The CMO will need to have full of 2005, the Centers for Medicare & knowledge and an appreciation of Medicaid Services announced its An appreciation of how hospitals how hospitals and doctors are paid. rate increase for fiscal year 2006. operate is expected. Bertine With the arrival of the pay-for-per- Acute care hospitals that have Colombo McKenna, PhD, Executive formance model, this will take on an agreed to submit data on ten quality Vice President and Chief Operating added dimension. The Leapfrog measures will receive a 3.2% increase Officer at Bassett Healthcare, an Group, sponsored by the Business in their payment rates, while hospi- academic rural health system in Round Table and consisting of 170 tals that do not will get a 2.8% Cooperstown, New York, says, “The influential companies that buy increase. CMO role has become the opera- healthcare coverage, is encouraging tions person’s best friend. By estab- its members to include language in lishing a link between operations, their employer health plan contracts quality, and safety, the CMO can be that clearly differentiate among an effective partner in establishing providers based on quality and effi- In addition to these attributes, • Barriers to hiring CMOs, while there are some notable trends weakening, remain. Medical staffs emerging that will impact the can resist the idea of someone hiring of CMOs. They are: “looking over their shoulder” who is paid by the hospital. Dollars can • Hospitals are seeking full-time also be a roadblock. CMOs can CMOs. No practice is required or command substantial compensa- expected. The job today is so tion, as noted earlier. demanding and complex, little time is available to see patients. There • Boards now see patient safety and are exceptions to this, and some quality care as their number one will argue you need to practice at focus. Stewardship is not just a the same time. The tilt is toward financial responsibility. Too many full-time. embarrassing headlines about sub- standard care have shaken the vol- • Competitive compensation is a unteer trustees. After all, in most must. Just like Chief Executive cases, they are trying to make a Officers, Chief Financial Officers, contribution to their community by Chief Operating Officers, etc., the serving on the Board. If their hos- market is determining the salary pitals are not providing the best and benefits. CMOs’ compensation care possible, they ultimately bear is often in the same category as the responsibility. these other “C” suite occupants. It was not long ago that the hiring of a CMO was driven by • The trend is to go outside the business interests and the demands placed on hospitals by managed organization. In the past, hospitals often identified their CMOs inter- care plans. In the future, the driving forces will be quality nally. While some hospital cultures outcomes, patient safety, and pay-for-performance. Hospitals are still prefer finding their CMOs from within, the trend is towards realizing CMOs have become critical to their mission of providing external candidates. CMOs often quality care. The CMO will become as integral to the success of come with an MBA and managed care experience. They are called the hospital as the other members of the senior leadership team. upon to make tough decisions that Can you afford not to have one? may alienate some of their col- leagues. This can be paralyzing for As a senior consultant at Phillips, DiPisa & a CMO who has come up through Associates, Tom Lynch conducts executive the ranks. leadership searches for the firm’s healthcare clients. He is the former Chief Operating • Managed care has become a Officer at Caritas St. Elizabeth’s Medical breeding ground for CMOs. Center in Boston and Newton-Wellesley During the 1990s, numerous physi- Hospital in Newton, Massachusetts. Tom cians took on roles with managed possesses more than twenty-five years of care companies. This has provided management and leadership experience these doctors with a better sense of within healthcare settings. the “business of healthcare” and importantly a different perspective c 2006 on quality outcomes. Many of these Phillips, DiPisa & Associates. All rights reserved. doctors are looking to return to the provider side – to have a real Phillips, DiPisa & Associates impact on outcome. 62 Derby Street, Hingham, MA 02043 Phone: 781-740-9699 Fax: 781-740-9064 PhillipsDiPisa.com