Maureen Bisognano, who succeeded Berwick as president and CEO of the Institute for Healthcare Improvement and comes in at No. 37, said the healthcare system's woes create “the most pressing time for innovation,” adding that the current models aren't working. “Although the division has the potential to hold us back, I am heartened by local and regional improvements.”
Berwick has taken the IHI's “Triple Aim” strategy of improving population health, improving the healthcare experience and lowering costs per capita with him to the CMS, but Bisognano said the two of them don't discuss that.
“We don't talk about work for a number of different reasons,” she said. “I admire his vision and commitment to improve care. I think the direction he's taking CMS—especially with the Center for Innovation—is helpful because it's creating the forward thinking that we need.”
Dr. Gary Kaplan, chairman and CEO of the Virginia Mason Hospital & Medical Center in Seattle, said healthcare is an extremely complex industry and his concern is that the federal government may wind up tinkering with isolated changes that are not connected to a central vision.
“There is certainly a lot of activity in Washington and still a fair amount of uncertainty,” said Kaplan, who is No. 33 on this year's ranking. “But the train is moving down the track in regards to reform and the hospital and health system executives have an important role to play.”
He said Virginia Mason has had success adopting manufacturing principles to healthcare and working with area employers on employee problems that add up in terms of cost and lost productivity. “I think the reform law dialogue has been a catalyst, but we've known for some time that healthcare needs to be better in terms of quality and safety—and it needs to cost less.”
Chris Van Gorder, president and CEO of Scripps Health and No. 18 on this year's ranking, reiterated that government is the largest payer most providers have. He said the uncertainty over what this payer will do next is leading many organizations to innovate and redesign—and that's a positive development. “When everyone else thinks the sky is falling, I'm running around the country saying, ‘I've never been more bullish on healthcare,'” Van Gorder said.
Kevin Lofton, president and CEO of Catholic Health Initiatives, Englewood, Colo., and No. 45 on the list, said providers, payers and the business community have to realign incentives so everyone benefits by a community's improvement in health. He said it's his sense is that dysfunction in Washington is serving as a catalyst for those outside of government to act.
“Personally, I'd rather not have the government step in and do that. The provider community should take the lead,” Lofton said. “We need to step up.”
Rulon Stacey, president and CEO of Poudre Valley Health System in Fort Collins, Colo., and chairman of the American College of Healthcare Executives, said providers need to identify what they can do to reduce costs and improve quality—and then do it before waiting to be told.
“I think we spend too much time worrying about what the government is going to do,” said Stacey, a first-timer to the list who holds the No. 88 spot. “We're going to wish Congress well while we drive variation out of our organization. It's one thing I can change and will change.”
Stacey explained how, if an organization performs a procedure 10 different ways, “by definition, nine are inferior. When you identify best practices, you drive people to do the things the right way,” he said. “I don't need Congress' permission to do that.”
Teri Fontenot, president and CEO of Woman's Hospital in Baton Rouge, La., and chair-elect of the American Hospital Association, said performance reporting is prompting hospitals to improve faster than any government program she's ever seen.
“I'm a firm believer in transparency and disclosure, and that can have more impact on performance improvement than any payments or penalties,” said Fontenot, No. 79 on the list and also a first-timer.
She added that the AHA looks to the government for funding and stability, and she said it still looks at the passage of the Affordable Care Act as a positive move. “I know that it's still pretty controversial, even among our members,” she said. “The American Hospital Association really views it as the first step in getting people affordable care.”
Dr. Robert Wah, No. 12 on the ranking, is the nation's former deputy national coordinator for health IT and the new chairman of the American Medical Association's board of trustees—another organization that was bashed for supporting the reform law. He said the AMA wants the government to fix the Medicare payment formula, reform medical malpractice liability and change antitrust laws to allow more physician collaboration.
“As a practicing physician, what I see is a time of great opportunity. I always see change as opportunity, and I never like to miss an opportunity,” said Wah, also chief medical officer for IT company Computer Sciences Corp. “It's quite an exciting time.”