A Good Friend at CMS

The Obama Administration is set to disclose that Donald M. Berwick is its pick for administrator of the Centers for Medicare & Medicaid Services, according to a report from the Bureau of National Affairs.

Members of ACPE are quite familiar with Don’s work and writing as a physician, CEO of the Institute for Healthcare Improvement, and one of the authors of the Institute of Medicine’s landmark reports calling for greater safety and efficiency in our nation’s health care system. I think Don is a great choice to lead the country’s largest source of funding for health care services. If he survives the confirmation process (never an easy task), here’s what we should expect, and why he’s up to the challenge.

First and foremost, Don knows that the health system should be designed with patients and consumers as the primary focus. He’s written and spoken eloquently about his personal experiences with mistakes and poor communication among members of the health care team during his wife’s serious illness a few years ago. He’s made the impact of errors and poor communication very real to care givers and health care leaders through the voices of Americans who have lost children and spouses from medical error to the attention of the health care industry by allowing them to share their stories with us. Hearing their stories and their determination to prevent similar tragedies from happening to others should make us no less committed to a safer health system. Look for CMS to have a relentless focus on health system safety.

Consistent with his focus on consumers, watch for a spotlight to be shown on the cost of care. These federal funds for Medicare and Medicaid come from our taxes. We have every right to demand that CMS funds are being spent for essential services, delivered efficiently. Recent articles on communities that have BOTH high quality and low cost are worth re-reading. If you haven’t looked at the Dartmouth Atlas recently, you might want to see how your region or community compares to the best cost performers – and ask yourself why. Overuse of medical services will be a hot topic.

Now that insurance reform changes have been passed, I expect the next large change to come in how physicians and hospitals are paid. Many health policy experts have pointed out the flaws in the fee-for-service system when quality, safety, and lower costs are the goal of a nation’s health system. Based on his experience as a pediatrician, IHI’s experiences with promoting greater efficiency , and imagining an idealized design in which a system is perfectly designed to achieve the results it gets, we should be prepared for a transition to bundled payments, and/or capitation for large populations. This means that another wave of integration between physicians and hospitals will occur.

Recent reports suggest discussions have already begun across the country as balance sheets of independent group practices deteriorate in the recessionary economy, and health systems are seeking clinical leadership to deliver lower cost care with high quality. Add to this equation the preference of young physicians for employment by a large organization, and we’ve already got momentum for change in the alignment of hospitals and physicians.

Finally, Don has the characteristics of a “Level 5 Leader”, as described by Jim Collins in this best selling business book, Good to Great. Noting the common leadership traits that make these leaders highly successful, he describes men and women who understand from personal experience what’s happening at the front lines of their businesses or industry, like most physicians in leadership roles. They “turn information into information that cannot be ignored”. They’re ambitious for their enterprise (not themselves). They’re quick to give credit to everyone but themselves when everything is going well, and take personal responsibility when things aren’t going well. They lead with questions, not answers.

Please join me in asking what we can do to help Dr. Berwick transform our health system to one that’s more responsive to patients’ concerns about quality, safety, and cost. This is the time to use what we’ve been learning about leadership, influence, reliability and teamwork. The next few years are going to be exciting ones for all of us!

Physician Leadership: The Next Generation

I’ve had a couple of really great weeks.

I had lunch the other day with several physicians who are here in Tampa for the Certified Physician Executive tutorial. Almost all of them were in their thirties. Last week I was at a meeting with CMIOs, many of whom were in the same age group. This is a very energetic and determined group of physicians who have a whole different set of challenges than many of us have had, or are currently dealing with. I left these two separate meetings with optimism for the future of health care and a determination to make ACPE a place where they can get the help they’re seeking. Here’s what I heard.

Many of these physicians already have advanced degrees in management. They’re very articulate in defining leadership and management challenges in health care. They decided during their medical training, or before, that they wanted to be in leadership or management roles. All of them are familiar and facile with information technology as a means to improve health care. Some of them were tapped for IT roles because of the perception that they’re “technodocs”. Direct, one-on-one patient care is not their preferred career path. They want to maintain both a clinical role, and a significant leadership or management position in whatever organization they’re working with.

They note that the health care industry is extremely hierarchical. Leadership positions are usually given to physicians who are much older than themselves. They’re being pulled into leadership roles primarily because they have IT skills, and because they really enjoy the opportunity to improve a system. Unlike many mid-career or older physicians who describe being pushed into management roles somewhat reluctantly, this group is very excited about shaping the next generation of health care.

They’re interested in learning how to position themselves in the eyes of system leaders and board members as potential senior leaders – even as physicians who are still early in their careers. Because they’re young, many older physicians feel they can use their personal connections with senior leaders or board members to make life difficult for them when change management issues are not to the liking of senior colleagues. Their spouses sometimes ask them if their CMIO role will lead to anything else after the IT implementation is completed, or whether their system leadership opportunity ends with that job. I think that’s a very fair question, and one that deserves an answer.

If you’re in a high level senior leadership role at your organization, would you do anything different if you knew that the youngest physicians making an impact in your organization might be impatient for more significant leadership opportunities? Have you mapped out a career path with them that fills their needs for a satisfying career in health system leadership? What would you tell them about positioning themselves for those higher level roles if they’ve already gotten their MBA or MMM, and if you’ve been noticing how quickly and elegantly they’re able to define a thorny issue in your organization compared to older physician leaders without that leadership and management training? If you thought that one of the youngest physicians on your staff was the best leader for key organizational roles in quality, IT, safety, operations, or even the CMO role, would you discount their suitability because of their age? Can we create organizational structures for the health care systems of the future that are less hierarchical, more teamwork oriented and less age-dependent?