Looking for some prominent physician leaders? Chances are they work in Washington.
Physicians employed by the federal government or public health advisory organizations dominate the latest list of the 50 Most Influential Physician Executives in Healthcare
, as voted by readers of Modern Healthcare
and Modern Physician
. Such clinicians squeezed all but one privately employed physician from the top 10 of this year's ranking.
At the head of the pack is one of Washington's newest clinician leaders, Dr. Richard Gilfillan, who was named acting director of the Center for Medicare & Medicaid Innovation at the CMS in September 2010.
“It recognizes the optimism and excitement out there for the opportunity that the Affordable Care Act gives us to work together and innovate to improve healthcare,” Gilfillan told Modern Healthcare about his lead rank. “In my own case it's the result of folks seeing that there is a great opportunity to make our healthcare system better.”
The Patient Protection and Accountable Care Act clearly contributed to the dominance of publicly employed clinicians in the rankings, especially with its emphasis on quality, safety and prevention, on which many of the top 10 focus. But as much as the publicly employed clinicians relished the recognition of being among the most influential physicians in the nation, the obvious link of their new dominance to the controversial law also creates some discomfort.
“This is not government doing this to the healthcare world,” Dr. Donald Berwick, CMS administrator and No. 2 on the list, says in an interview about his agency's efforts to implement the law. “The improvement is a matter of partnership and collaboration, a public-private relationship. We've got to do this all together.”
Berwick also stressed Gilfillan's experience with public-private partnerships and his “capacity for bridging between the worlds of public and private healthcare financing and delivery.”
For his part, Gilfillan downplayed the significance of his ranking ahead of Berwick, who heads an $800 billion agency responsible for implementing much of the nearly $1 trillion healthcare law. Instead, he emphasized the promise of innovation to control spiraling public and private healthcare costs and improve patient outcomes.
In the seven months since Gilfillan was named to his newly created post, his most significant accomplishment was helping to launch the Partnership for Patients initiative in April, he says.
“Right now, that is the flagship of the effort that the innovation center is working on,” Gilfillan says of the $1 billion patient-safety and cost-control initiative. “We thought that the opportunity and the No. 1 need was to make sure that we focused on improving the safety for people who are receiving care.”
Another Washington official in the top 10 was Dr. Carolyn Clancy, director of the Agency for Healthcare Research and Quality, who retained her 2010 rank at No. 3. Like most federal healthcare agencies, AHRQ is assisting in the new patient-safety initiative. The agency's contribution to the campaign includes a series of patient-safety tools and products it helped to develop.
Clancy is followed in the rankings by Dr. Regina Benjamin, U.S. surgeon general. Like Berwick, Benjamin sought to downplay the political conflict in which the law remains embroiled, even as she praised the promise of its various components.
“I've been promoting prevention, and while I tend not to use the job for political things—I don't get involved in advocating for a particular bill or anything—the Affordable Care Act did establish a national prevention council, and this is the first time that anything like that has happened,” Benjamin says. “And it fits right in with my prevention goals and objectives.”
The National Prevention, Health Promotion and Public Health Council was created by the reform law to coordinate the prevention efforts of 17 federal departments and agencies and produce a national prevention strategy.
The No. 5 physician leader is another federal illness prevention guru: Dr. Thomas Frieden, director of the Centers for Disease Control and Prevention.
“The CDC has a fundamental role in prevention,” Frieden says in an interview about his agency's recent efforts to help reduce bloodstream infections in hospitals by 60%, which it estimated will save 27,000 lives and cut $2 billion in medical costs.
Such efforts to reduce hospital infections were praised by Berwick, who expressed little surprise in the findings of an April Health Affairs study that concluded one in three hospital patients is the victim of a medical error and 90% of such errors go unreported. Berwick had found similarly higher-than-anticipated rates of medical complications in his earlier research.
“He included injuries that would be classified as somewhat more minor, although you wouldn't want one,” Berwick says of the study led by Dr. David Classen, a professor at the University of Utah School of Medicine and an expert in infectious disease. “So the harder you look, the more you find.”
Another leading prevention focus of the CDC is cutting the nation's rates of cardiovascular disease, including the 1 million heart attacks and 700,000 strokes that occur nationally each year.
“The most important thing the healthcare system should do, in terms of prevention, is control blood pressure,” Frieden says, noting that among those suffering from hypertension, only 46% have their blood pressure under control. It's a number Frieden says his agency is working to increase.
Frieden also touted the benefits of the 2010 healthcare law, including its provision of community transformation grants, which fund local initiatives on diabetes prevention and prescription drug abuse prevention.
“The pendulum swung drastically toward more use of prescription opiates with the idea that we were underdosing people and now it is clear that it needs to swing in the other direction while still ensuring that anyone with pain—such as those with cancer in palliative care—get adequate pain control to be pain-free,” Frieden says. “But there is a big problem with how opiates are being prescribed today in this country.”
The role of Dr. Francis Collins, as director of the National Institutes of Health, continues to garner national attention, landing him at No. 6 on this year's ranking. In an interview, Collins credits his continued high ranking (he was No. 4 last year) to the NIH's role as the largest supporter of biomedical research in the world.
“This is a time that the science is moving forward at a breathtaking pace and revealing the molecular causes of diseases—rare diseases, common diseases, neglected diseases, diseases of the developing world—we've never been on such a fast course of discovery as we are right now,” Collins says. “That is exhilarating to preside over and to try to nurture.”
The latest NIH focus—and possibly one of the reasons its work is of particular interest to this year's 50 Most Influential voters— is efforts to spur dissemination of medical research and development of clinical applications faster than the average 17 years it takes most research to move into widespread clinical practice.
Like many Washington officials, Collins addresses the current political focus on exploding debt and the deficit by emphasizing that his agency provides a “wise investment.” For the NIH, that means research that in turn spurs products and jobs in the private sector from companies seeking to apply those scientific findings.
“And that is not a partisan statement but something that has been agreed upon by people of all political persuasions,” Collins says.
Dr. Margaret Hamburg, commissioner of the Food and Drug Administration, also is among the top 10, although she fell from No. 2 last year to No. 7 in this year's ranking. But that's certainly not because the role of her agency has diminished.
“FDA is a hugely important and unique public health agency,” she says. “We're a science-based, science-driven regulatory agency with a public health mission.”
Hamburg says she has tried to strengthen the FDA's role in regulating medical products and food safety by recruiting experts that can stay abreast of medical technology that is increasingly complex and on which a growing proportion of the public relies.
“And we also have to really transform ourselves to operate in an increasingly globalized world,” Hamburg says of efforts to expedite the availability of medical innovations developed overseas and to keep dangerous foreign products away from U.S. patients.
Another Washington physician whose role was elevated by the 2010 healthcare law is Dr. Harvey Fineberg, president of the Institute of Medicine, who is ranked No. 8. His organization was authorized under the law to develop key recommendations for the design of the essential benefits package, or the components of the various insurance policies offered under the state insurance marketplaces that the law will launch in 2014.
“It both defines what everyone should be entitled to receive and also should help establish standards for deciding over time what is or is not included in an essential benefits package,” Fineberg says.
Even the Joint Commission, an independent, not-for-profit accreditation and certification organization, saw significant effects from the healthcare law because several components have similar goals as the Joint Commission's core mission of reducing healthcare facilities' complication and accident rates. Dr. Mark Chassin, president of the Joint Commission, holds the No. 9 spot, down from No. 7 last year.
An example of Joint Commission efforts that echo goals in the healthcare law is its ongoing push for hospitals and other facilities to adopt simple initiatives that could have widespread complication-reduction impacts, such as hand-washing. “We're helping hospitals and doctor's offices to solve health and safety problems whereas we only previously helped identify those problems,” Chassin says.
The commission's Center for Transforming Healthcare also will participate in the new patient-safety initiative by identifying and testing solutions for preventing patient injuries, he says.
Dr. Delos “Toby” Cosgrove, president and CEO of the Cleveland Clinic, rounded out the top-10 leaders. His organization also had a headline-grabbing role in development of the reform law when it repeatedly received praise from President Barack Obama and other supporters of the law during the legislative battle to enact it as a model of the type of high-quality, low-cost medical-care providers that the law would spawn.
Only two physicians have been included in all of the seven annual rankings: Dr. Gary Gottlieb, president and CEO of Partners HealthCare System in Boston, and Dr. Edward Murphy, president and CEO of the Carilion Clinic in Roanoke, Va.
Murphy, who is ranked No. 17 and will step down at Carilion in June, urged the federal officials implementing various components of the healthcare law to ease its impacts on healthcare providers through “sustainable clarity” and by allowing enough flexibility for clinicians to determine how to reach the goals of the law. Specifically, he urged them to finalize the law's regulations and interpretations as quickly as possible, as opposed to allowing endless appeals and revisions.
“That all creates limbo that makes it difficult to plan how you are going to move forward,” Murphy says. His second recommendation was that the government aim to hold providers accountable for results “but give them lots of flexibility to innovate.”
That approach would speed up the healthcare system's numerous needed improvements, he says.
Partners HealthCare's Gottlieb, who is No. 18, up from No. 21 last year, emphasizes the responsibility on physician leaders to participate in the redesign of healthcare to improve quality and cut costs.
“Nobody is better positioned than physicians in leadership positions to be both empathetic to the needs of patients and families and to understand ways in which the delivery system does great stuff and ways in which the delivery system is challenged and could be more effective,” Gottlieb says.
It's a sentiment echoed by Berwick.
“There's a lot of questions out there about how healthcare can be sustainable and how much it can improve and how we're going to get out of the American healthcare dilemma, the cost and quality problem,” Berwick says. “Clinicians know that they have the answer: that's to make care better.”