Clinical Leadership for Practicing Physicians
����������� Reform is the byword for all health care organizations, with emphasis being placed on �value.�� Most people outside of medicine believe hospitals and doctors have spent too much time focused on the business of medicine, and have not paid sufficient attention to the mission�the actual results from providing care to patients.
In conjunction with �value-based purchasing,� CMS has been giving more explicit directions to providers regarding how quality improvement activities, (QAPI in government speak), are to be done.� QAPI regulations have been in place for dialysis units for some time, and are now being instituted for nursing homes.[i] Hospital regulations are coming soon.
����������� So what does it mean to a practicing physician and the organizations with which they interact? Many hospitals are trying to meet requirements currently by relying on their chief medical officer and a small cohort of nurses, but CMS will require a formal structure that pushes �clinical integration.� But the practicing physicians on their staff have little to no training in how to interact with organizations. When I joined my medical staff in 1983, the surest way to be noticed and marked for leadership was to stand up and argue with the administrator. I�m not sure it has changed all that much in the 30+ years since. ��
����������� In my years of practice I have or continue to serve as medical director of dialysis units, a large multi-specialty medical group, and as chief of staff at a city-county hospital. Our push for clinical integration, begun in 2008, ultimately failed. I fear this has and will continue to have a negative impact on our ability to care for our patients. I also think the barriers encountered here are prevalent. Since I have written and spoken on issues I think are critical for success in our principal mission of taking care of the patient, I have posted these on this website. Take a look, and download what is of interest to you. Perhaps it will help you to be successful as we move into the brave new world of healthcare reform.