He says that connection has helped alleviate a number of crises brewing regarding physician compensation. The previous comp plan, in which every affiliated physician group would renegotiate the contract with Heartland from the ground up every couple of years, was causing a lot of angst, Laney says. So he blew that up and created a comp plan that does not require renegotiations, and has evergreen contracts that roll into automatic updates that are based on national benchmarks.
"They can look at their productivity and benchmarks, and they will know what their salaries are going to be," he says. "It really has created a much more positive environment, and got our docs focused on seeing patients rather than worrying about their contracts or benefits."
As far as managing those physicians, Heartland is under what Laney calls a "big push" to be more physician-led. That means administrative responsibilities for more doctors, each of whom is joined in responsibility for a certain process or department with a professional manager. Laney calls those two-headed administrative structures diads, which are appointed at the clinic and medical center administrative level all the way down to the service line level.
"Each has an office manager and medical director," he says. "This allows us to be physician led and professionally managed, so we get the best of both worlds."
There are no easy answers to CEO decision-making, but that's what makes the job so demanding—and rewarding, say the five CEOs we interviewed for this story. Harry Truman, a CEO himself, once said, "The buck stops here." He intended to convey to a skeptical public that he was in charge and paying attention. Today's healthcare CEO might modify that saying. The buck, indeed, stops at the CEO's desk, but like his or her subordinates, the CEO is accountable to them, too.
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Paul Kronenberg, MD
Years as CEO: 6
Operating entities: Crouse Hospital (466 staffed beds), Marley Education Center, Crouse HelpPeople Employee Assistance Program, Outpatient Surgery Center in Crouse Physicians Office Building, Madison Irving Same Day Surgery Center
Number of employees: 2,600
Greenville Hospital System
Years as CEO: 4
Operating entities: Greenville Memorial Hospital (762 licensed beds), Greer Memorial Hospital, Hillcrest Memorial Hospital North Greenville Hospital, Patewood Memorial Hospital
Number of employees: 8,000
Mark Laney, MD
St. Joseph, MO
Years as CEO: 1 (appointed 2009)
Operating entities: Heartland
Regional Medical Center (350 licensed beds), Heartland Clinic, Heartland Foundation, Community Health Improvement Solutions (health insurer)
Number of employees: 3,300
Years as CEO: 6
Operating entities: Divine Providence Hospital, Williamsport Regional
Medical Center, Muncy Valley Hospital, (292 licensed beds total), Susquehanna Health Medical Group, a multispecialty physician group, and Susquehanna Home Care & Hospice
Number of employees: More than 3,000