CMOs: You Are Not Alone

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The views and opinions expressed in this blog are mine personally and are not necessarily representative of current or former employers.

CMO’s, we need to get connected. How many times do we have some weighty, politically-laden decision before us, and we feel that no matter which way we turn, someone is going to get offended. I know as a Chief Medical Officer of six hospitals here in Austin, as well as two in El Paso, it can feel pretty LONELY in this position. And I’ve been doing this for over 25 years!! We know that the bottom line is to do what’s right for the patient, but even that path is not straight forward. (Or is it do what’s right for my CEO or for my largest admitter !). Many times I wish I could bounce my thoughts off someone else who is in a similar position, maybe someone who “feels the pain” , and could even share some of it.

Impending health care reform will likely change the very bedrock on which we stand— if I may be so bold as to think there is bedrock in the first place—maybe it’s more like “shake the sand” under my feet. Increasing data transparency is giving the knowledge-hungry consumer more information than they can process. And the information is not necessarily accurate, and rarely passes significance by scientific standards. Yet when has any of us ever considered scientific methodology when using consumer data to buy a computer or automobile.

Despite the mandates from Washington or our state capitals, the market continues to evolve rapidly. Issues such as risk-taking, physician employment, and the ideal health care model continue to confront us daily. At a time when hospitals and physicians need to work closer than ever before, these issues tend to fractionate us further. Just consider the issue of paying physicians for emergency on-call. The hospital has to pay physicians to see patients who don’t pay the hospital!! Fractionation is our biggest enemy, yet we feel powerless to change it.

As Chief Medical Officers, we are used to being cost-conscious….that’s a fundamental part of resource stewardship. But given the dire projections on Medicare spending and the deficit, I’m reminded of the old rock tune “You Ain’t Seen Nothin’ Yet”. We will be under financial pressure that we have never seen before in our careers. Some of our institutions may not make it.

Then there’s the usual issues on our plates: the MEC, physician credentialing, OPPE and FPPE, the Joint, core measure and Healthgrades performance, the fun of dealing with the disruptive or even impaired physician…..too many to count. But I bet of the top 10 issues on your plates, at least 8 of them are on mine too. All hospitals and medical staffs are unique, but the similarities abound. We all deal with the same problems in a random and somewhat haphazard way. For areas I have failed, there are many of you who have succeeded— and vice versa. How we can all benefit from the frank and honest discussions that we have faced. How useful would be a forum that we can bounce ideas amongst each other as colleagues Imagine the collective intellect and knowledge that we all bring to the table. Many of the answers are truly amongst us, we just don’t realize it yet.

For the most part as Chief Medical Officers or Medical Directors, we transcend issues of competition and market. We have a similar charge—the continued health and safety of the patient in an increasingly precarious environment. If we do well as medical leaders, the health of our communities will improve.

Although I have raised some big issues, I am very POSITIVE about health care and our roles to improve how care is delivered. I believe times like this have tremendous opportunity for us all.

Hence the BLOG. I do not even know where to begin. I seek your help and counsel…. Your problems and your solutions. I envision an ongoing dialogue, in a welcome oasis of professional solace and openness, where we can discuss our mutual issues and seek some mutual best practices….

Please respond on any issue you feel is important……ACO’s, Meaningful Use, Credentialing, Best Clinical Practices, Physician Leadership, Data Transparency….. the list goes on.

Let’s make something happen.. for our patients.

We need not share patient information, or anything that would constitute some HIPAA issue. Let’s get connected… and move ahead.

Steven M. Berkowitz, MD
Chief Medical Officer
Austin, Texas

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