And when it does, people listen. Which could explain why David Blumenthal, M.D., the national coordinator for health information technology, was voted the most powerful physician-executive in America by Modern Physician
and Modern Healthcare
readers when, in his previous life, as founder of what is now called the Mongan Institute for Health Policy at Massachusetts General Hospital in Boston, Blumenthal had only made it as high as No. 30 in 2005.
Whoever has occupied the national coordinator's office has always maintained a high position on the list, and Blumenthal is no exception, being voted to the No. 12 spot last year. But, most likely thanks to the American Recovery and Reinvestment Act of 2009, or stimulus law, and its provisions to provide billions in subsidies for physician and hospital purchases of IT systems, Blumenthal and his post have been elevated to the top spot on the 50 Most Powerful Physician Executives in Healthcare
His predecessors, David Brailer, M.D., and Robert Kolodner, M.D., reached No. 4 (2006) and No. 16 (2007), respectively.View a photo gallery of this year's 50 Most Powerful
But the size of one's budget does not always equal the amount of his or her influence. Last year's most powerful physician-executive, Carolyn Clancy, M.D., director of the Agency for Healthcare Research and Quality, heads one of the least-funded branches of HHS. While her budget increased because of the stimulus law, Clancy dropped to No. 3 this year.
For the second year in a row, the No. 2 spot has been occupied by a female executive. This year, it's Food and Drug Administration Commissioner Margaret Hamburg, M.D., making her first appearance on the list. Last year's second-place finisher, Christine Cassel, M.D., president and CEO of the American Board of Internal Medicine, fell to No. 13.
Although readers voted before President Barack Obama signed the healthcare reform legislation into law, the federal government's influence dominated the voting with the top six spots being occupied by Washington officials: Blumenthal, Hamburg, Clancy, National Institutes of Health Director Francis Collins at No. 4, Centers for Disease Control and Prevention Director Thomas Frieden, M.D., at No. 5, and U.S. Surgeon General Regina Benjamin, M.D., at No. 6. Barry Straube, M.D., chief medical officer for the CMS as well as director of the CMS' Office of Clinical Standards & Quality, finished at No. 9. If the vote were taken tomorrow, it's highly likely Institute for Healthcare Improvement President and CEO Donald Berwick, M.D., reportedly Obama's choice for CMS administrator, would have placed higher than No. 32.
Like Hamburg, it was the first time on the list for Collins, Frieden and Benjamin. It's Straube's second time on the list; he was No. 49 on the 2008 list
Five men have made it to the list all six years a vote has been taken: Gary Gottlieb, M.D., president and CEO of Partners HealthCare System, Boston, at No. 21 this year; William Jessee, M.D., president and CEO of the Medical Group Management Association, Englewood, Colo., No. 33; Michael Maves, M.D., executive vice president and CEO of the American Medical Association, Chicago, No. 40; Edward Murphy, M.D., president and CEO of Carilion Clinic, Roanoke, Va., No. 24; and Patrick Quinlan, M.D., CEO of Ochsner Health System, New Orleans, No. 14.
No women have been on all six lists, but two on this year's ranking—Clancy and Robert Wood Johnson Foundation President and CEO Risa Lavizzo-Mourey, M.D., No. 34—have been selected five times.
While a companion reader poll, Modern Healthcare's annual 100 Most Powerful People in Healthcare ranking, is typically dominated by those wielding political or economic power, this poll was open to physician candidates only. And although in his current position Blumenthal enjoys both political and economic leadership, he notes that it's his status as a physician that helps channel his influence.
“My personal experience has been that I've found my background as a physician extremely useful—not just as a physician—but as a physician that used an” electronic health record, he says. “I find I connect better with an audience because I've been there, I've done it, I struggled with it.”
How many billions of dollars Blumenthal will award in financial incentives for EHR investments and how he will do it is still being determined as the CMS continues to codify what it means by “meaningful use,” the test by which a physician's or hospital's use of IT deserves to be subsidized. So Blumenthal says the original range included in the proposed meaningful-use rule—$14 billion to $27 billion—represents the current best estimate.
Often overlooked, Blumenthal says, is the $2 billion allocated to build an infrastructure that will allow “information to flow with the patient and follow the patient through the healthcare system.” This includes building regional extension centers and health information exchanges as well as workforce training. “We're not just trying to put in new technology,” he says. “We're trying to make healthcare practice change for the better.”
Emad Rizk, M.D., president of Broomfield, Colo.-based McKesson Health Solutions, who holds the No. 8 spot on the list, agrees. “This is not just technology adoption, it is significant change management and behavior modification,” says Rizk, who is making his third appearance on the list.
For Rizk, whose book The New Era of Healthcare: Practical Strategies for Providers and Payers was released last April, IT is just one tool that can be used to do what needs to be done to fix the nation's healthcare system. And what needs to be done, according to Rizk, is to better realign clinical outcomes, administrative processes and financial incentives.
He adds that, because there are so many small, interconnected components, it will be better if these changes occur locally. “My perspective of healthcare is that it's much more powerful to have local and regional changes than huge national changes,” Rizk says. “I believe that it's hard to do one piece at a time because there are so many intertwined pieces, and that—if you try to do one piece only—you suboptimize the results.”
Rizk envisions this being done through accountable-care organizations that create “vertical alignments” and regional alliances. “Hospitals will have increased purchasing of physician practices or will try, at least, to align as many physicians as possible with their system,” he says.
A physician-executive considered to be a prime mover in developing the proposed meaningful-use rule finished No. 11 on the list: Paul Tang, M.D., vice president and chief medical information officer, for the Palo Alto (Calif.) Medical Foundation. Tang has been elected to the list four times now, and this is the highest he has ever placed.
Tang stresses that he is just one among hundreds of volunteers helping to facilitate IT adoption and use, which he says “plays a critical, enabling role for health reform.”
While many have criticized the timetables in the proposed meaningful-use rules as “too aggressive”—along with those in the Health Information Technology for Economic and Clinical Health Act, which was incorporated into the stimulus law—Tang says the date everyone needs to focus on is 2017, when it's predicted Medicare will go broke.
“The meaningful-use framework was designed to align U.S. resources to focus on the health outcomes goals,” Tang says. “Although many may say the timeline is fast—and it is—the real deadline is not the 2014 HITECH deadline, it is the 2017 Medicare trust fund insolvency deadline. Now is the time to build the necessary infrastructure needed to reform the health system—before it's too late.”
Another reason to move quickly, Tang says, is that 2011 marks the start of the “age tsunami,” when the first round of baby boomers becomes Medicare-eligible. “This demographic is completely going to overwhelm the programs we have in place,” he says. A solution, Tang predicts, will be integrated personal health records that “empower patients and families to manage their own health.”
Tang says he is working on a clinical trial in which diabetic patients are using PHRs to track glucose readings, diet and exercise and they are shown how this affects the risks of having to go on dialysis, of losing a limb or having a heart attack. “Compare that to coming into an office and being talked at about something in a theoretical manner,” he explains.
One person tasked with giving meaning to meaningful use and pushing the Medicare 2017 insolvency date back is Straube, the CMO at the CMS. Straube notes that he finished No. 8 on the 100 Most Powerful ranking last year, “one notch above” Peter Orszag, director of the White House Office of Management and Budget, and behind such nonphysicians as President Barack Obama, HHS Secretary Kathleen Sebelius and U.S. Sens. Max Baucus (D-Mont.) and Chuck Grassley (R-Iowa).
“Where people end up is somewhat arbitrary,” Straube says. “I think that physicians bring a special skill or background that relates to having spent at least part—if not most—of their careers with people who receive healthcare and dealing with people who deliver it on the front lines of healthcare service. Having that perspective is especially valuable when decisions are being made.”
Straube's multifaceted job involves providing senior executive input on Medicare, Medicaid and the State Children's Health Insurance Program; representing the CMS before the OMB, Congress, the White House and “numerous outside stakeholders”; serving as director of the CMS clinical standards and quality office, what he describes as the nation's “No. 1 decisionmaking agency”; heading the federal government's health information services group, which works on collecting clinical quality data; and collaborating with quality-improvement organizations.
Straube says these efforts are channeled into focus areas such as reforming the payment system to promote better quality; promoting IT adoption and use; reducing healthcare disparities; and addressing complaints. “That's my day in a nutshell,” Straube says.
When Hamburg was nominated to lead the FDA, the choice was cheered by Sidney Wolfe, M.D., a physician who's director of Public Citizen's Health Research Group, a consumer advocacy group. But now Wolfe is becoming one of her sharpest critics.
Wolfe says Hamburg and the FDA are doing a good job enhancing food safety, “getting better” in the regulation of medical devices, but have been “reckless” in decisions to allow continued use of certain drugs whose risks, he says, outweigh their benefits.
“It's a disaster,” says Wolfe, who has appeared on the most powerful physician-executive list four times—but not this year— with his highest position being No. 8 in 2005.
The top female executive on the list who doesn't work for the federal government is Cassel, leader of the American Board of Internal Medicine, a credentialing organization, and its foundation.
“About one in every three physicians is an internist of some sort. It seems to indicate that it is not so much about me, but the work I'm privileged to do,” Cassel says, noting that her board certifies more than 200,000 physicians across 18 subspecialties.
Reed Tuckson, M.D., never made the list when he was senior vice president of professional standards at the AMA, but he's made it two years in a row since becoming executive vice president and chief of medical affairs for Minnetonka, Minn.-based UnitedHealth Group, finishing No. 28 this year, up from No. 35 last year. Tuckson joined UnitedHealth in November 2000 as senior vice president of consumer health and medical-care advancement, and his profile has steadily risen.
“I have a sense of being energized and engaged to gain a much greater appreciation of the causes of cost escalation in the healthcare delivery system,” Tuckson says. “The underlying challenges of getting after cost escalation and the related issues of improving quality and safety and preventing illness, these are the things we have to get at. That is the work that is so exciting for a person in a position like mine.”
This year tied with 2007 for having the most women on the list: eight. Along with Hamburg, Clancy, Benjamin, Cassel and Lavizzo-Mourey, other women on the list were Patricia Gabow, M.D., CEO of Denver Health, at No. 23; Barbara Paul, M.D., senior vice president and chief medical officer, Community Health Systems, Franklin, Tenn, No. 43; and Dexanne Clohan, M.D., chief medical officer at HealthSouth Corp., Birmingham, Ala., No. 47.
Cassel notes that, although they were “separated by a few years,” she attended medical school at the University of Massachusetts the same time as Clancy. “It is true that when Dr. Clancy and I were in medical school, we were in a small minority,” she recalls. “But I'm certainly seeing a number of women coming up through the ranks.”
More female physicians are holding executive positions in government and policymaking roles, but Cassel says the “academic world tends to lag behind” on this issue.
Next on the list behind Cassel is Oschner's Quinlan, at No. 14, who says the lack of gender balance on the most powerful physician-executive lists reflects “the rather lengthy period of time it takes to move up in a large organization.” He predicts the numbers will get progressively more balanced each year.
For Quinlan, it was not only his sixth time on the list, but his fourth time in the top 20.
“The bribes work,” jokes Quinlan, who claimed first place in 2007. “I think it really is recognition of what an institution does, what a team does, and I've been part of a great team in a great institution in a difficult environment.”
Quinlan says the seven-hospital Ochsner system differs from other hospital systems that employ physicians in that the New Orleans organization is “basically a medical group that happens to own and operate hospitals and a system.
“We're a group practice,” Quinlan says, calling his selection to the 50 most powerful list “an endorsement of our program, but—since it's a one-person award—I got it.”
Another regional healthcare leader with national recognition is Gary Kaplan, M.D., chairman and CEO of 289-bed Virginia Mason Medical Center, Seattle, who finished at No. 16 for his fifth appearance on the list and his fourth-straight showing in the top 20. Kaplan has gained recognition for applying the manufacturing industry's defect-reduction methods to healthcare. “It isn't impossible to get zero defects,” he says.
Earlier this year, Kaplan was honored with the MGMA's lifetime achievement award, and Jessee, the group's president and CEO, says Kaplan is an example of how local and regional healthcare leaders with vision can have national influence.
“He's obviously very well-known in Seattle, but he's also well-known on a national level,” Jessee says. “His vision on safety and efficiency has created a national reputation even though his work is on a regional level.”
Jessee, who has announced that he will retire in fall 2011, deflected any credit from himself for being one of the few individuals to make the most powerful list in all six years of its existence, and explains it has to do with how the MGMA's 22,500 members manage or lead 13,700 medical practices.
“In all candor, people don't really vote for me, they vote for the CEO of MGMA,” Jessee says, adding that it also reflects the trend toward larger medical practices. “Physicians are learning how important experienced practice managers are to their enterprise, and I'm the visible symbol of that. Most everyone on the list is on there by virtue of the position they hold.”
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