Becker's Hospital Review

13 CEO / STRATEGY urban settings is a top priority, and the lack of interest and creativity to maintain it is strikingly stark. As a realistic expectation for 2023, it would be encouraging to at least have an injection of energy, innovation and mission-first thinking toward a problem that grows like a snowball, seemingly bigger, faster and more insurmountable year aer year. Look at what Mark Cuban was able to accomplish within one year to democratize prescription drug pricing. Remember how humble and small the origins of that effort were. Recall how he — albeit being a billionaire — has put profit secondary to social mission. ere's no one savior that will curb hospital closures in the U.S., but it would be a good thing if 2023 brought more leadership in problem-solving and matching a big problem with big energy and ideas. 5. Which hospital and health system CEOs will successfully redefine the role? Many of the largest and most prominent health systems in the country saw CEO turnover over the past two years. With that, health systems lost decades of collective industry and institutional knowledge. eir tenure spanned across numerous milestones and headwinds, including input and compliance with the Affordable Care Act, the move from paper to digital records, and major mergers and labor strikes. e retiring CEOs had been top decision-makers as their organizations met the demands of COVID-19 and its consequences. ey set the tone and had final say in how forcefully their institutions condemned racism and what actions they took to address health inequities. To assume the role of health system CEO now comes with a different job description than it did when outgoing leaders assumed their posts. Many Americans may carry on daily life with little awareness as to who is at the top of their local hospital or health system. e pandemic challenged that status quo, throwing hospital leaders into the limelight as many Americans sought leadership, expertise and local voices to make sense of what could easily feel unsensible. e public saw hospital CEOs' faces, heard their voices and read their words more within the past two years than ever. In 2023, newly named CEOs and incoming leaders will assume greater responsibility in addition to a fragile workforce that may be more susceptible to any slight change in communication, transparency or security. ey will need to avoid white-collar ivory towers, and earn reputations as leaders who show up for their people in real, meaningful ways. Healthcare leaders who distance themselves from their workforce will only let the realistic, genuine servant leaders outshine them. In 2023, watch for the latter, emulate them and help up-and-comers get as much exposure to them as possible. n Cap hospital CEO pay at $800,000, physician says By Molly Gamble C ontroversy driven by bonuses paid out to MetroHealth System's former CEO has intensified criticism of hospital CEO pay at large, with one former MetroHealth physician calling for it to be capped at $800,000 — twice as much as the U.S. president earns. "A MetroHealth physician friend of mine says that we need to view health care as a public service rather than as a profit- oriented industry. Makes sense," Kenneth Frisof, MD, wrote in a letter to the editor of Cleveland.com, an affiliate of The Plain Dealer newspaper. "And, as part of that, let's cap hospital system CEO salaries at $800,000, twice the salary of our most powerful public servant, the president of the United States." Since 2001, U.S. presidents have earned a $400,000 annual salary with an additional expense allowance of $50,000. Dr. Frisof previously practiced as a family medicine physician with Cleveland-based MetroHealth before retiring. He said he is upset by recent events related to executive pay at the county-owned, safety-net health system. President and CEO Akram Boutros, MD, was fired Nov. 21 after the board received findings of a probe into compensation issues involving more than $1.9 million in supplemental bonuses. The system's board chair said that between 2018 and 2022, Dr. Boutros authorized the compensation for himself, without disclosure to the board. Dr. Boutros alleges board retaliation. He also filed a lawsuit against the board and board Chair Vanessa Whiting, alleging violations of Ohio's Open Meetings Act and the board bylaws. The lawsuit asks the court to nullify Dr. Boutros' termination for cause. Misappropriations of pay in any health system C-suite tend to ignite criticism of executives' earnings industrywide, particularly when health systems are looking to cut costs amid thinning margins and front-line employees seek raises. Earlier in the pandemic, as hospitals and lawmakers urged federal authorities to investigate travel staffing agencies for price-gouging, some travel nurses reciprocated and said such scrutiny should actually be redirected toward health systems' executive pay. Some argue that competitive compensation packages are needed to attract and retain top executive talent, the scope and responsibilities of leading a modern-day hospital or health system are larger than ever, and the skills and talent to lead such organizations are specialized and niche. Regardless of whether one sees executive pay as appropriate or too high, its variation across settings is real. A 2022 analysis by the Lown Institute of more than 1,000 hospitals found the gap between hospital CEO pay and average worker pay varied widely, with some CEOs paid twice the rate of other workers, while the highest paid received 60 times the hourly pay of general workers. Hospitals in urban settings and those that held teaching status were associated with higher executive hourly compensation compared to general worker wages. Across all industries, CEO pay has catapulted in recent years. From 1978 to 2021, CEO pay based on realized compensation grew by 1,460 percent. In 2021, the average CEO earned $27.8 million. Setting an all-time record, CEOs in the U.S. earned 399 times more than the typical worker in 2021, CEO pay continues to spike, according to a report from the Economic Policy Institute. n

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