The hospital Chief Medical Officer’s (CMO) role in health care performance is perpetually changing. The constant transition frequently leads to uncertainty concerning the role’s function, making it difficult to assess performance and contribution to value delivery. In the era of metrics and improved analytical decision-making, it is important to develop, track, and display metrics around performance. As roles and performance expectations change, metrics constructed for performance assessment need modification to adequately reflect these changes.
The Changing Environment
The last 10 years have seen the proliferation of electronic medical records, as well as the related development of outcome- and value-based health care delivery models and the associated reimbursement constructs, including ACOs, value-based purchasing, clinically integrated networks, and bundled payments. Many operational and regulatory changes, including quality assurance, compliance monitoring, hospital acquired conditions, and ongoing/focused professional practice evaluation require CMO involvement. The changes necessitate ongoing role development from facilitation, negotiation, and consensus building to include increasing responsibility for operational management and growing involvement in recruitment, hiring, and management of physicians.
The CMO has been described as the Influencer in Chief, functioning to facilitate change and build resilience. To be effective, the CMO must not only perform as a leader within the hospital C-suite, but must also mentor leadership capacity among the medical staff. CMOs are frequently involved with organizational cultural change, including the transition from volume to value. Focus on value creation may bring about increased scrutiny on CMOs to ensure return on investment.
Essential roles that a highly effective CMO plays include: promoting safety, developing medical staff relationships, providing an interface between health care system and hospital administrative personnel and medical staff, developing mechanisms to provide/track/improve clinical care delivery, facilitating patient satisfaction, engaging/aligning physicians with system initiatives, recognizing and enacting changes in overall health care delivery, and facilitating dispute resolution. Many of these skills are developed over time and are facilitated with clinical practice and resulting relationships. Skills can also be enhanced with specific course work, both online and in person, through a number of professional organizations.
Founded in 1924, Baptist Health System is a multistate integrated health care organization headquartered in Louisville, Kentucky, with hospitals and care sites throughout Kentucky and in Indiana and Illinois. The system comprises eight owned and one managed hospital with 2,700 licensed beds, ambulatory facilities, and a multi-specialty medical group providing more than 300 points of care. The provider network encompasses more than 3,000 health care providers — employed, contracted, and independent. Each hospital has its own Chief Medical Officer. The Baptist Health Medical Group, composed of employed health care providers, and Information Technology, a department supporting Baptist Health System services, have a CMO and Chief Medical Informatics Officer (CMIO), respectively.
CMO Current Roles and Responsibilities
In July 2017, twelve Baptist Health CMOs participated in an internally developed survey to establish their backgrounds, current duties, and desired/anticipated future duties. These include the nine hospital CMOs, the Baptist Health Medical Group CMO, the system CMIO, and one hospital that also has a specialty services CMO and chairs the physician leadership group. Clinical background varied significantly: internal medicine (most common), obstetrics/gynecology, cardiology, pulmonology, and family medicine. There are no specific training requirements to be a CMO. Educational experience varied significantly, including on-the-job training (most frequent), prior physician leadership roles such as Chief of Staff, course completion through organizations including the American Association of Physician Leadership and The Advisory Board, shadowing the previous CMO, and a corporate physician leadership development program.
CMOs perform many duties as part of their role. Historically, even hospitals that were part of a larger organization typically operated individually (under a holding company model) and only recently have begun working more collectively under the auspices of a system (under an operating company model). One consequence of the independently operated hospital structure has been that CMO duties have often been developed locally or individually. The figure above reflects the top ten duties identified by Baptist Health CMOs in the survey. The CMOs’ most frequently identified duty was interface work between clinical and system/hospital administration. The next most common duties were recruiting/retaining physicians and quality/case management. The remainder covered a wide breadth of topics and serve to further illustrate the variation in duties expected/performed by the CMO.
Behavioral competencies identified by the Baptist Health CMOs that help them be successful included: negotiating skills, diligence, persistence, excellent communication, and having an ability to listen. This is an important area and certainly can be developed further.
Evolution of care delivery has seen consolidation of health care systems resulting in recent dramatic increases in system size, scale, and scope. Accordingly, the evolution of the CMO’s role involves increased system-level activity. The CMO must be familiar with the many facets of care delivery and provide clinical context. This can be accomplished at the individual hospital level; however, it must be orchestrated with the system as a whole. Although there is certainly no consistency in this particular area, hospital CMOs are more frequently taking on some system roles to coordinate care.
CMOs often serve as executive sponsors for system endeavors. As an example, at Baptist Health, system clinical service lines link physicians of similar specialties to focus on quality, efficiency, and value. In this role of executive sponsor, the CMO will ensure that roadblocks to success are removed/minimized, that continuous improvement is occurring, and that goals are achieved. The service lines report to the Physician Cabinet, which comprises physician leaders in titular positions, including medical staff Presidents, Presidents-elect, and all CMOs from across the Baptist Health System. Cabinet members are responsible for policy development and physician leadership in care delivery.
CMO Future Roles and Responsibilities
Baptist Health System CMOs were also queried about how their role may change in the future. Common responses included: developing a strong relationship with the medical staff, driving physician engagement, advancing physician leadership, and taking part in strategic decision-making. The survey indicated that CMOs anticipate they will increasingly add health care system roles. For example, one Baptist Health physician CMO serves both as CMO and hospital President at the same facility. Ongoing CMO role definition will likely involve system-level input.
Evolution of the hospital CMO may include promotion to health care system Chief Medical/Clinical Officer. The Chief Clinical Officer role has little consistency from system to system; however, it more frequently involves end-to-end patient management and implies oversight outside of the hospital environment into medical group clinics and post-acute environments such as home health.
Improving safety, quality, and the patient experience are at the heart of the business of health care and must be the primary focus for hospital CMOs and coordinated for the system by the Chief Clinical Officer. Additional duties for the Chief Clinical Officer vary but frequently include facilitating physician leadership, reducing unnecessary clinical variation with standardization/systematization, creating a high-reliability organization, managing departments including information technology or pharmacy, creating value, and promoting process improvement through Lean, Six Sigma, and change management.
Chief Medical Officers have varied backgrounds, as illustrated above. Physician hospital leadership selection has historically been by the hospital administrator, often based on specific training or achievements, as well as on the doctor’s relationship with the medical staff and ability to interact well with administration. A CMO’s effectiveness, therefore, has been more by perceived achievement or demonstrated executive suite achievement rather than by specific measurable individual accomplishments. The evolution of the CMO role will rely on more system involvement in strategy development/deployment, value creation, and assumption of additional duties. The hospital CMO’s scope of activities may increasingly include system-level duties, with an overall goal to reduce unnecessary clinical variation.
As health care delivery moves inexorably toward creating more value for the customer (to include both the patient and the payer), so must CMO activities. To remain relevant in the face of change, the physicians who fill these roles must be able to adapt and be nimble in their ability to transform to meet the needs of the organization as it serves the patient.