The Modern Physician 2001 Physician Executive Award of Excellence honors rising physician executives who have demonstrated vision, leadership and business acumen and who are positioned to be in the top tier of tomorrow's medical leadership ranks.
The three recipients of this year's award share a common vision of excellence in patient care, whether fighting off a corporate takeover, streamlining the operations of an emergency department to provide better care to its community or healing the wounds between a health system and its physicians.
Nominations were open to those who have served at least three years as physician executives and who spend 75% or more of their workweek on activities involving administrative and clinical management.
A panel of prominent physician leaders (see page 36) selected the winners on the basis of visionary leadership, outstanding problem-solving skills and leadership in the development of an organization.
The 2001 Award of Excellence is co-sponsored by the American College of Physician Executives. Winners will be recognized April 24 at the ACPE Institute in Orlando, Fla.
Profiles by Elizabeth Thompson Beckley, Rebecca Lentz and Joseph Conn
Keith Wilson, M.D.Physicians practicing amid the turmoil of the Southern California market--indeed, almost anywhere--would love to have the crystal ball that Keith Wilson, M.D., appears to possess.
In 1999, Wilson, an OB/GYN practicing in Costa Mesa, Calif., was able to steer his medical group away from an impending sale by former owner MedPartners to the now-defunct KPC Medical Management. With near-missionary zeal, he rallied 120 physicians to purchase and manage the group themselves.
The success of the new version of Talbert Medical Group, of which Wilson is president and chief executive officer, is not assured. But Wilson's colleagues insist that his forthright integrity, common sense and unyielding commitment to put physicians in charge have created an environment where a bright future can exist.
Eighteen months after Talbert ventured forth under the leadership of Wilson, 44, and his all-physician board, the group has shown it can do more than just survive. Some say it is thriving, attracting new members and doctors while operating in the black and providing quality care. The group did suffer some losses in the first half of last year, but Wilson says it has operated in the black every month since June 2000.
He estimates that by the end of 2001, revenue will be about $84 million with a net profit in excess of seven figures.
Despite outsourcing some of the group's former providers, Talbert has maintained a physician retention rate of 96%. At eight medical sites in Orange and Los Angeles counties, Talbert doctors now serve more than 80,000 patients, a 25% increase from the 63,000 treated when the new management took over.
For Wilson, the group's economic success and the improved quality of medicine go hand in hand. His passion for clinical medicine drives him to convince others of the importance of physician control of the business of medicine.
Wilson's initial exposure to medical management came in 1991 when he joined FHP, an HMO physician network and early incarnation of Talbert, where he quickly became chair of the obstetrics department.
Recognizing his discomfort with a big piece of his new job, namely budgeting and management, Wilson began a rigorous 250-hour curriculum offered by FHP in conjunction with the business school of the University of California at Irvine.
Additional business-related CME courses through the American College of Physician Executives helped prepare him for the journey ahead.
His biggest challenge on that path? Getting doctors to think beyond the immediate and recognize the need for change--"to think in terms of what can be as opposed to what is," he says.
"We didn't see any value added in being managed by an MSO or PPMC," Wilson says. "The margins are so thin that the 'taxation' by someone else's structure would actually guarantee failure.
"That was the motivation to create our own internal management. We have the intellectual capacity and expertise."
Each of the physicians paid $5,000 per unit for up to five units of the firm, with the eventual buy-in reaching $1.2 million.
"We have an efficient model in that we have no money leaving our system--we either provide incentives for our doctors or invest in patient care," Wilson says. "By being a stable provider, we've been able to grow just by being here."
Talbert board member Wesley Mizutani, M.D., says Wilson always focuses his decisions on what is best for the company even though it means making unpopular decisions at times. He often depends on a small group of supporters to help sell such decisions.
"I must say that it was Dr. Wilson who encouraged me to seek a physician board position with Talbert," Mizutani says. "It was also through his influence that I became treasurer."
Wilson's ability to rally attention and support is rare, agrees Thomas Collins, president and CEO of Memorial Health Services, a five-hospital system that uses Talbert providers. "Often you see doctors who think they only win when the hospital loses. Dr. Wilson doesn't have this historic perspective. He's a constructive, decent human being with integrity."
"It's a long process, a huge cultural transformation," says Marcia Manker, chief operating officer of Orange Coast Memorial Medical Center, who has worked with Wilson for nine years. "Certainly the job is not done, but at least Dr. Wilson has set the course for the group to succeed in a very tough market."
Wilson is soft-spoken and humble when describing his achievements but assertive in crediting others. "The doctors, the board that supported it all, as well as the senior management team--a lot of people made sacrifices."
Steven Davidson, M.D.Steven Davidson, M.D., likes to make a point: "Most folks in medicine, as we advance in our field, become more and more specialized in a vertical fashion. We know more and more about less and less until, eventually, we know everything about nothing."
A collector of aphorisms--concise statements of truth--that he stores and feeds upon like a squirrel with acorns, Davidson has made an art, perhaps even a science, of taking the simple solutions such adages inspire and applying them to complex situations. It's a skill that has proved invaluable in his position as chairman of emergency medicine at 700-bed Maimonides Medical Center in Brooklyn, N.Y.
Since 1995, Davidson has managed a department of more than 270 employees with a $20 million budget while maintaining responsibility for all of Maimonides' emergency services, including physician, nursing and business services. Last year's ED volume of 20,249 patients contributed nearly two-thirds of Maimonides' total admissions from multiethnic neighborhoods. Of course, ensuring an efficient flow of those patients while maintaining standards of care requires more than just a pithy saying or quotation.
"Here in New York, the biggest challenge has been bringing a systematic approach to problem solving and integrating that effort among all the communities of interest," says Davidson, 51. Those include hospital groups-physicians, nurses, clerical staff, X-ray technicians and environmental services--as well as the residents and families of the city outside the ED's doors.
Davidson's specialty as a physician executive is breaking apart and analyzing systems in order to rebuild them more efficiently. He has been a fan of technology since he registered for his amateur radio operating license in 1964.
As chairman of Maimonides' technology and software standards committees, he pursues technological solutions to community problems.
He first came to Maimonides armed with an MBA from the University of Pennsylvania's Wharton School of Business and more than a decade serving as medical director for the Philadelphia Fire Department.
Once there, Davidson negotiated a contract that assured he would have both the authority and the accountability for clinical and financial performance. Yet he immediately set about building an interdisciplinary team that was equally committed to his lofty vision for implementing major ED improvements.
Among those are the installation of a highly automated ED information system, at a cost of about $1.6 million for the first phase of the project, and a new model of scheduling and budgeting for ED employees that best staffs the department's busiest times. "You need to look at everything you do and see what raw technology brings to the table," Davidson says.
"It allows you to work in a different way, to trust colleagues and co-workers in a different way. Instead of relying on hand-to-hand exchange, you communicate by way of a dynamic tracking board," where entire patient encounters are documented and managed.
Under his guidance, Davidson's emergency department has seen a 50% increase in patients served, a 50% decrease in delays and waiting time, a 65% decrease in patients leaving without service and a significant improvement in the hospital's community rating. "Davidson took all of the processes within the emergency department--from staffing to ancillary departments to workflow--and worked with the processes and resources he had," says Lisa Figueroa, M.D., chief medical officer of A4 Health Systems, the company that worked with Davidson to install the ED system. "The icing on the cake was to get this stuff automated. He took his vision and worked on it for about six years."
Sam Kopel, M.D., medical director of Maimonides, says Davidson's intelligence and intensity have not abated since he helped interview him six years ago. "He always has something pertinent to say and is jumping out of his chair to say it." More importantly, Kopel says, Davidson understands the underlying issues and he's "got the right ethic."
"His main forte these days is running the department, getting the data and moving the organization," Kopel says. "And he's got it--the ED runs completely differently than the rest of the hospital, with its own standards, rules and agreements. Everybody agrees to be reviewed. That's refreshing in medicine."
"It's important to develop an entire culture in emergency medicine that is self-renewing, self-improving and self-managing," Davidson says. To complement and continue his work as a teacher and mentor, Davidson has applied to set up an emergency residency at Maimonides.
"I am completely confident that will improve the academic ferment in the department," Kopel says. He adds that other departments, especially pediatrics, are picking up on Davidson's business style.
Davidson's desire now is to develop a discipline of clinical operations research that parallels the business school model of operations research.
Davidson says he still considers it a privilege to work with people and on people's behalf. "I can't imagine better times to have the opportunity to engage all the people we do in caring for patients and families and communities," he says.
Rodney Hochman, M.D.Rodney Hochman, M.D., didn't imagine himself the enemy when he joined eastern Virginia's largest healthcare system nearly three years ago.
The physicians didn't want to work with or in the hospitals, and tension was rife between doctors and hospital officials.
Hochman, chief medical officer and senior vice president of Norfolk-based Sentara Healthcare, knew in order to make peace with the physicians, he had to earn their trust by breaking bread with them. So he did, literally.
Hochman invited physicians to a dinner in Williamsburg, Va., and spent the evening listening as physician after physician outlined concerns and problems they had with the health system. Then he set about fixing it.
Sentara is a $1.3 billion-a-year healthcare system that includes a 300,000-enrollee HMO, 150-physician IPA, six hospitals and 10 nursing and assisted living facilities.
One of the first problems Hochman tackled was how the HMO paid physicians.
"We had a very complicated contact capitation formula," Hochman says. "After the fourth or fifth flip chart, I didn't know how we were paying them."
So he simplified how physicians would be paid under Sentara's HMO.
"We came up with straightforward rates with not a lot of complicated bells and whistles," he says. "It made a big difference."
Many of his colleagues would argue it is Hochman himself who has made the big difference since joining Sentara.
"He's cool under fire. He's very collaborative, and he's willing to share authority and credit with others," says David Bernd, CEO of Sentara. He recruited Hochman, 46, from the Health Alliance of Greater Cincinnati. "I think the key is open and frank discussions with physicians and having them in leadership positions."
The system employs 158 physicians, with about 140 in primary care. About 2,000 physicians are in the HMO, and Hochman spent countless hours talking to them during his first weeks on the job.
But he never got the chance to ask physicians with whom he spoke what needed fixing within the hospital system. He couldn't get a word in edgewise because providers were "pretty upset with our HMO and how it related to them. I said:
'We have to fix this before we get to anything else. They won't let us get beyond that.'"
He revamped the health plan's board, filling half the seats with physicians; developed leadership councils made up of physicians who meet to discuss best standards, best practices and best protocols for each specialty; and let the groups manage their own clinical agendas. The medical directors at each hospital in the system report to Hochman.
"When you're really honest with physicians, and you lay out what's going on, they really do get in there and get behind you," Hochman says.
Irving Pike, M.D., a Virginia Beach gastroenterologist, says "all physicians in the community . . . view Rod as a champion for clinical excellence."
With that fire still smoldering but no longer engulfing his time, Hochman turned his attention to how physicians felt about the health system and its components. He wanted to find ways to make working within the hospitals easier and more pleasant.
One of his first moves was to pitch his idea of an electronic intensive care unit to physicians. "They gave us a big thumbs up," he says. "This is something that made a lot of sense to all of us."
The eICU system allows intensive care physicians to continuously monitor ICU patients from remote locations. The system allows intensivists to work with patients' attending physicians.
Hospital officials say the collaboration resulted in a 22% reduction in mortality within the first six months. The average length of stay in an ICU dropped from 2.7 to 2 days.
Other results included a stroke aspiration pneumonia rate of 0.8% compared with the 2.67% goal. Post-heart attack beta blocker usage was 98.1%, three percentage points higher than its target of 95%. The system's mortality rate for strokes was less than 8% compared with the national average of 30%.
Hochman also addressed the system's medical groups and how they worked together and within the system. Like many other systems, Sentara had purchased primary care groups but had never dealt with the tension those purchases created. Some physicians didn't want to be part of the group anymore, Hochman says.
The solution was to arrange for "soft landings" for those doctors who wanted out, he says. He didn't want to just dump them, leave them to flounder on their own and risk alienating them further from the system. "We said: 'Let's help you out with that. We don't want to lose you in the community.'"
Hochman says he's not done. The next steps include more focus on quality, service and excellence, he says, and making "our hospitals more efficient, safer places that doctors like working in.
"We've been lucky. We started with a good product. It's been around for a while . . . It was the right environment."
Panel of judgesDavid Nash, M.D., is the Dr. Raymond C. and Doris N. Grandon professor of health policy and medicine at Jefferson Medical College of Thomas Jefferson University in Philadelphia. He founded and directs the office of health policy and clinical outcomes at Jefferson University Hospital. He received the Clifton Latiolais Prize from the Academy of Managed Care Pharmacy and was named an honorary distinguished fellow of the American College of Physician Executives. He earned< his medical degree from the University of Rochester (N.Y.) School of Medicine and Dentistry and his MBA from the Wharton School at the University of Pennsylvania.
Major Gen. Leonard Randolph Jr., M.C., is deputy Air Force surgeon general with responsibility for directing the Air Force Medical Service, a system of 77 medical treatment facilities serving 2.5 million beneficiaries. He oversees clinical quality management, strategic management, information systems management and readiness planning and training. He entered the Air Force in 1970 while attending Meharry Medical College in Nashville, Tenn. He has commanded hospitals at George Air Force Base and the medical center at Travis Air Force Base, both in California, and was acting commander at Wright-Patterson Medical Center in Ohio. He is a distinguished fellow of the American College of Physician Executives and is a chief flight surgeon.
Lily Jung, M.D., is the medical director of Madison Clinic, an affiliate of PacMed Clinics, in Seattle. A neurologist, she is chairwoman of PacMed Clinics' compensation committee, as well as a member of PacMed's medical staff executive and credentialing committees She is a member of the American College of Physician Executives' strategic planning of graduate program in medical management team. She earned her medical degree from Northwestern University Medical School in Evanston, Ill., and her master's degree in medical management from Tulane University School of Public Health and Tropical Medicine in New Orleans.
Scott Young, M.D., is executive vice president of St. Mark's Health Care Foundation in Midvale, Utah. A family practitioner, he helped design, create and implement the foundation, which is a not-for-profit organization dedicated to improving the health and wellness of Utah residents. Prior to joining the foundation, he served as the director of clinical services for the St. Mark's Family Medicine Residence. He also is chairman of the St. Mark's Hospital Department of Family Medicine and a founding member of Intermountain Health Care's Utah Valley Family Practice Residence Program. He was one of two recipients of Modern Physician's 2000 Physician Executive Award of Excellence. He earned his medical degree from the University of Oklahoma.