Power is often measured by the resources people have at their disposalwith money, number of employees or even political influence often at the top of the list.
That theory, however, goes out the window with the person who was chosen the most powerful physician-executive this year by the readers of Modern Healthcare and Modern Physician: Carolyn Clancy, M.D., director of the Agency for Healthcare Research and Quality.
To the general public, AHRQ is an obscure agency buried deep within HHS. But in the healthcare industry, the agency has been recognized as the center of federal government efforts to improve patient safety and healthcare quality, and its approximately 300 employees have been able to show the rest of Washington how to do more with less.View a text list of this year's honorees
AHRQ is a unique organization because our goal is to improve the quality, safety, efficiency and effectiveness of healthcare, says Clancy, who finished 27th in last years voting and 10th in 2007. We dont provide care like the VA, we dont pay (providers) like the CMS, or regulate like other agencies of HHS. That makes us very good conveners and helpful partners.
AHRQ advocates have been lobbying for the agencys budget to be billionized, but for the past seven years or so its budget remained stagnated in the low $300 million range. Clancy has also seen her agencys budget get siphoned off to provide operating funds for the Office of the National Coordinator for Health Information Technology.
Recently, however, AHRQs budget has seen a surge. For fiscal 2009, almost $326 million had been requested, which would have equaled a 2.7% budget cut of $8.9 million. Instead, AHRQs 2009 budget was increased to just over $372 million, plus an additional $300 million was appropriated in the American Recovery and Reinvestment Act of 2009, which AHRQ will use to fund comparative-effectiveness research for a two-year period. Since 2005, AHRQs budget for such research equaled $15 million a year.
The AHRQ appropriation is part of a $1.1 billion comparative-effectiveness package, with another $400 million going to the National Institutes of Health and the remaining $400 million to be distributed by HHS Secretary Kathleen Sebelius. Clancy was named to a 15-person Federal Coordinating Council for Comparative Effectiveness Research that was created to help coordinate the research and guide investments.
In 2009, diagnosis, treatment and other healthcare decisions usually have two or more options, and theres not always enough good information to identify which is the best option for a particular person, Clancy says. Our translation of science into knowledge is too slow, and we can do better.
She adds that comparative-effectiveness research fits well into AHRQs mission of providing physicians with unbiased information backed by the highest quality of evidence possible.
Clancy says her clinical experience is helpful when having to brief the HHS secretary or other officials because she knows what its like to talk to patients, how proposed policies may affect clinician workflow and what its like when a mistake is made.
Clancy was appointed AHRQ director on Feb. 5, 2003, after several months of serving as interim director following the March 10, 2002, death of John Eisenberg. She stopped seeing patients in 2003 as well, but she says it had more to do with timing and logistics than her new workload.
I did it on Wednesday nights and that particular clinical session was canceled, Clancy says. I miss it enormously. I get a lot out of it, and I love to see patients. Im still exploring opportunities to fit into my schedule.
Clancy, who did not place on the inaugural survey in 2005, is the first woman to top the list. Only six other women made this years 50 Most Powerful list, including Christine Cassel, M.D., president and CEO of the American Board of Internal Medicine, who made her first appearance on the list and finished second.
Clancy is also one of only three government executives on the list. David Blumenthal, M.D., the national coordinator for IT, finished 12th; while Institute of Medicine President Harvey Fineberg, M.D., finished 48th. It should be noted, however, that the voting for this years survey took place before Blumenthals appointment, and his placement was due more to his former role as director of the Institute for Healthcare Policy at the Partners HealthCare System, Boston.
There were others also in a gray area of working for private organizations that have accrediting authority or have been given some degree of regulatory power by the government. In addition to Cassel, theres Mark Chassin, M.D., president of the Joint Commission, who finished third for the second consecutive year; Mark Leavitt, M.D., chairman of the Certification Commission for Healthcare Information Technology, who finished 32nd this year (up from 39th in 2008); and Thomas Nasca, M.D., executive director and CEO of the Accreditation Council for Graduate Medical Education, who made the list for the first time and finished 47th.
Unlike other appointees of former President George W. Bush, such as Robert Kolodner, M.D., who came in 38th last year, Clancy doesnt appear to be leaving her post at AHRQ any time soon. Its a political appointment, and I feel very privileged to be serving as its director, is all Clancy would say on the subject.
Clancys name had also been circulated as the possible replacement for longtime Joint Commission President Dennis OLeary, M.D., before the post was given to Chassin.
I felt extremely complimented when people mentioned my name, Clancy says, adding Im a big fan of Mark Chassin.
Chassin, a former commissioner of the New York State Health Department, notes that his position on the survey had more to do with the standing of the Joint Commission, and not necessarily for anything that he has personally accomplished.
I think its really a reflection of the importance and the level of influence that the organization I work for carries in healthcare today, and thats a sobering responsibility and one that I greatly value the opportunity to pursue, Chassin says, adding that its an exciting time to be working for improved patient safety and quality.
The days of denial are over, Chassin says. When I start talking about the Joint Commissions commitment to developing and bringing them more effective interventions, they want them yesterday.
His background as a physician has served him well in discussions with policymakers and legislators of all stripes, Chassin says, and he thinks its time for more physicians to take healthcare leadership roles. He believes that they probably will do so as more physicians become employees and fewer remain as independent entrepreneurs.
Discussions can get abstract or ethereal or bogged down in minutiae that has very little to do with taking care of patients, Chassin says. A physician can bring those discussions back down to earth and make sure the issue of patient care is not lost.