Chief medical officers have an extremely tough job these days. No longer are they mere figureheads, owing their position largely to being noncontroversial and easy to work with.
Instead, they are expected to bridge the gap between the clinical and the financial. And that's impossible without the backing of a strong CEO. No two senior executives' fates are more closely tied together.
Mark Kestner MD, now a consultant with Guidon Performance Solutions, has been CMO at many stops over the years, and he bears the scars. Included among them was a stint as CMO at Alegent Health in Omaha, where an attempt to standardize clinical work patterns and establish operational efficiency ended with a physician revolt and the resignation of both the CEO and CMO (Kestner).
Alegent, given the predominance of fee-for-service reimbursement, was ahead of its time, Kestner says. Now that reimbursement is truly being shifted toward performance measures. And now that hospitals are being penalized for readmissions, the message is a little easier to deliver, he says. Still, the transition is slow, because physicians don't often recognize that the change is permanent.
"In most communities, the hospital is the common space for people to establish their relationships. And if there was a governance of physician practices, it was generally generated outside a hospital. Does that structure serve us going into the future?"
In short, he says, no.