The ACO will place greater emphasis on clinically driven improvements and, in turn, physician alignment, says Alfred Purcell, board chair of Heartland Health, an integrated healthcare system in St. Joseph, MO, with a 357-bed acute care facility. "As CMS and the nation move toward ACOs, it's going to require an enormous amount of collaboration and looking at how we can manage those with the physician in the middle," he says. With 125 employed physicians and another 125 physician referrers, Heartland has much collaborating to do.
That's why when the previous CEO—a 25-year, well-loved Heartland veteran—retired, Purcell and his fellow board members agreed a physician in the top slot could go a long way toward cementing relationships with those 250 doctors. "We wanted to make sure that physicians were clearly at the table with respect to outcomes for our patients," Purcell says. "We felt we needed to have a leader who really fully got that."
The "getting it" factor helps; but there are challenges for the physician CEO.
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A physician's experience doesn't typically include administrative training or finance. It doesn't often teach the skills to write a business plan or understand the intricacies of large hospital systems. Being CEO requires a unique way of thinking. "If you're clinician, it's very one-to-one," Bolster says. "You have the person who has the problem, you collect the data, it's right there
in front of you. Can you move away from that?" Only the doctor who can flip that switch—or who gathers the strongest individuals together into solid teams—makes a sound leader, he adds.