Roundtables

important. We're behind other in- dustries because we saw medicine as special. Doctors had judgment and didn't need standards. It's a welcome change to hold doctors to standards like in other industries and have them prove the work they do. However, this policy lags behind technology by 10 to 15 years. We can tell how well doc- tors perform from EHR data but the current require- ments are based on claims data. ese reporting require- ments need to catch up to technology so we're measuring things that matter. Dr. Shabot: I'm in favor of quality re- porting requirements. Any CMO will tell you there are some requirements that are not well thought out and com- ply- ing with those does not ensure the best care for the patient. An example is a finally retired core measure that required community-acquired pneu- monia patients to receive antibiotics within four hours of arriving in the ED. For patients with pneumonia, that's a good thing. e problem was that we were doing diagnostic testing and getting X-rays and lab work back, and complet- ing that within four hours was challenging, especially with other emergency patients arriving in the ED at the same time. e net effect was that many patients who ultimately didn't need antibiotics were getting them anyway, forced by compliance with that measure. e reporting mea- sures, along with transparency about them, are important. I also think the reimbursement reduction for excess readmissions is fair; oth- er CMOs might disagree. At Memorial Hermann, we're different from most hospitals and systems in that we started a campaign to reduce readmissions eight to nine years ago, long before it became a national quality measure. We identify patients at high risk for readmission and have case manager assigned to make a time- ly follow-up physician appointment, and follow up with them at home to make sure they are taking their medications and doing well. To do this well, you need to have started long before readmission reduction became a requirement. Dr. Slonim: Anytime we're faced with new reporting requirements, it fo- cuses a large segment of our industry on specific bodies of work. Unfortu- nately, the number of new regulatory requirements becomes burdensome if not organized effectively. In addi- tion, there is an opportunity cost that accom- panies new mandates. More measures means less time in the day to manage other important elements of patient care that are operative in our hospitals. I believe that there needs to be a balance between the things we have to do in quality improvement and the things we know we need to do to help our hospitals provide better care. Q: what is the best decision you've made as CMO in the past year? e worst? Dr. Arredondo: e best was the a decision to retain and continue sup- port of a surgical specialty program that had been a collaboration between an inde- pendent physician group and PHS. is program had been in place for many years and, though the long- term financial implications were not entirely clear due to the complexities involved, we committed the resources to retain the program. is entailed some difficult negotiations and a will- ingness to com- mit, but in the end, the value to the community will be worth the work. e worst was the decision (or lack thereof ) not to move more forcefully and expeditiously with the scenario described above. Fortunately, this will play out well and we will preserve the program. Dr. Mossallam: Fourteen months ago we created an internal physician ad- visory service here to perform second- ary physician reviews for appropriate patient status [to better ensure that the patient is either an inpatient or out- patient (observation)]. We're signifi- cantly ahead of the pack on this. We've also refocused on resource utilization, which has been helpful. When we had to start rethinking re- admission resources, there were a few problems when we directed resources not to where the problem was and had to redirect our efforts. It really is about engaging the right people to do the right work, the people who have the skill set you need. Dr. Orr: All CMOs should take stock of the information they have available. ey should make a list of all the data sources they have, clinical data, claims data, health risk assessments, etc., and start getting feeds from them either manually or automatically. en the information can be used to make deci- sions. Sometimes it's also a matter of getting the right people from different silos come in and meet once per week and make sure everyone is on the same foot. en, once CMOs have the information they need to go ou t and com- municate and make sure the organization is all on the same page. Dr. Shabot: e best decision we made was to set a goal of becoming a high reliability health system and "The best decision we made was to set a goal of becoming a high reliability health system." -Dr. M. Michael Shabot, CMO, Memorial Hermann Health System Five CMOs Discuss Challenges, Changes and Advice 5

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