"If you look at an ACO model, you are trying to avoid hospitalization, but there's no common point for physicians to congregate to have some organizational structure. Yet the hospital is de facto the entity where physicians participate in a legislative process. If your government isn't going to serve you well into the future, then you better have a backup plan."
He says he's learned over the years to find a way to respect that traditional legislative body, but to also bring in other allied medical providers to establish standards of care in a multidisciplinary fashion.
"We can set up a neutral ‘Switzerland' which aspires to standardized care, order sets, and competencies, which will report to a regional clinical council of some sort which can be made up of nurses, leadership, the CMO and medical staff leadership," he says.
"That allows you to continue to respect the organized medical staff for hospital-based operations because most boards have delegated organizing quality to the medical staff. You have to respect that legacy entity."
Beyond that, for most community hospitals, Kestner says, the CMO has to be in charge of evidence-based medicine. The CEO can't be in this role, he says, advocating for a clear separation of powers. Rather, the CMO needs to help facilitate the development of these muitidisciplinary teams, clearing the CEO to focus on business models.