A health care community suc­cess­fully blend­ing col­lab­o­ra­tion and in­no­va­tion

Nashville’s health care in­dus­try has grown ex­po­nen­tially over the last few years by do­ing busi­ness locally, na­tion­ally and glob­ally and es­tab­lish­ing a rep­u­ta­tion for in­no­va­tion.


The Nashville area boasts more than 250 health care com­pa­nies, of which more than 56 are cor­po­rate head­quar­ters and 16 are pub­licly traded. In ad­di­tion, more than 300 pro­fes­sional ser­vice firms lend their ex­per­tise to Nashville’s health care in­dus­try.

“It starts with the unique cul­ture we have in Nashville,” said Wayne Smith, chair­man of the board, pres­i­dent and chief ex­ec­u­tive of­fi­cer of Community Health Sys­tems, an op­er­a­tor of gen­eral acute care hos­pi­tals with 135 af­fil­i­ated hos­pi­tals in 29 states. Smith is also the cur­rent chair­man of the Nashville Area Cham­ber of Com­merce.

“Com­pa­nies here have an in­ter­est in help­ing other com­pa­nies de­velop,” Smith said. “It’s not that we’re not com­pet­i­tive; we are. But, the com­pa­nies here are col­le­gial, and we col­lab­o­rate to im­prove and grow our in­dus­try as a whole. That ben­e­fits

“As a community, we must work to­gether to find ways to pre­vent ill­ness and keep peo­ple health­ier. We must also find ways to boost ef­fi­ciency and im­prove pa­tient out­comes across the board.” BILL CAR­PEN­TER Chair­man and CEO Life­Point Hos­pi­tals®

ev­ery­one – our busi­ness, our em­ploy­ees, the com­mu­ni­ties we serve around the coun­try.”

Com­bin­ing many large and es­tab­lished com­pa­nies with in­no­va­tive star­tups, Nashville has a his­tory of health care man­age­ment that goes back five decades, said Bill Car­pen­ter, chair­man and chief ex­ec­u­tive of­fi­cer of Life­Point Hos­pi­tals

,a hospi­tal com­pany oper­at­ing 56 hospi­tal cam­puses in 18 states.

“We have a legacy and an amaz­ing col­lec­tion of health care com­pa­nies in hospi­tal man­age­ment, health in­for­ma­tion tech­nol­ogy, dis­ease man­age­ment, life sciences and many other sec­tors,” Car­pen­ter said. “We have a deep bench of tal­ent and a broad net­work of ad­vi­sors that can sup­port com­pa­nies of all sizes.”

For nearly 20 years, the Nashville Health Care Coun­cil has been the cat­a­lyst for col­lab­o­ra­tion and cham­pion of the en­tre­pre­neur­ial spirit that char­ac­ter­izes the Nashville health care community.

“The Coun­cil brings us to­gether to con­sider in­dus­try-wide is­sues and op­por­tu­ni­ties,” Smith said. “We can talk about the things that mat­ter to all of us and work to­ward com­mon goals.”

Car­pen­ter said the need for col­lab­o­ra­tion and in­no­va­tion will in­crease in the com­ing years.

“We are in a pe­riod of change and un­cer­tainty in health care,” Car­pen­ter said. “Health re­form is lead­ing most of this

change and driv­ing a new fo­cus on im­prov­ing qual­ity of care and re­duc­ing costs. As a community, we must work to­gether to find ways to pre­vent ill­ness and keep peo­ple health­ier. We must also find ways to boost ef­fi­ciency and im­prove pa­tient out­comes across the board.” “These are ex­cit­ing times,” Car­pen­ter added. Nashville’s health care in­dus­try is one of the most di­verse sec­tor clus­ters in the na­tion. In ad­di­tion to tra­di­tional provider or­ga­ni­za­tions, such as hospi­tal com­pa­nies and am­bu­la­tory groups, Nashville is home to in­sur­ers, tech­nol­ogy, care man­age­ment com­pa­nies and a va­ri­ety of sup­port and en­tre­pre­neur­ial ven­tures.

“In Nashville, and thanks in part to the lead­er­ship pro­vided by the Nashville Health Care Coun­cil, a unique col­lab­o­ra­tive spirit ex­ists,” said Richard M. Bracken, chair­man and chief ex­ec­u­tive of­fi­cer of HCA. “There is a pro­gres­sive and re­spon­si­ble recog­ni­tion that a diver­sity of or­ga­ni­za­tions will be es­sen­tial for the con­tin­ued pos­i­tive growth and ef­fi­ciency of the health care in­dus­try.”

Two highly-re­spected aca­demic health sci­ence cen­ters an­chor Nashville’s health care in­dus­try: Me­harry Med­i­cal Col­lege and Van­der­bilt Univer­sity Med­i­cal Cen­ter, known for their ter­tiary care clin­i­cal ser­vices and re­search.

Dr. Wayne J. Ri­ley, pres­i­dent and chief ex­ec­u­tive of­fi­cer at Me­harry Med­i­cal Col­lege, be­lieves health care for ev­ery­one in the United States is des­tined to im­prove.

Founded in 1876, Me­harry is well-known for train­ing African Amer­i­can physi­cians, den­tists, bio­med­i­cal sci­en­tists, health care ad­min­is­tra­tors and health pol­icy ex­perts. It is also the na­tion’s largest pri­vate, in­de­pen­dent his­tor­i­cally black aca­demic health cen­ter ded­i­cated to ed­u­cat­ing mi­nor­ity and other health pro­fes­sion­als.

“I en­vi­sion a health care sys­tem that will continue to evolve for the bet­ter – first by fo­cus­ing on en­sur­ing ac­cess for ev­ery­one who needs health care ser­vices and then, by con­tin­u­ing to find bet­ter ways to de­liver ev­i­denced-based care ef­fi­ciently and ef­fec­tively,” Ri­ley said. “We know that preven­tion is key to good health, so I would en­vi­sion a fu­ture where more and more of us take ad­van­tage of prac­tices that we know work to­ward good health, such as eat­ing a well bal­anced diet, ex­er­cis­ing, min­i­miz­ing stress, avoid­ing tobacco use to name a few.”

Mar­ket­ing in­no­va­tion

In­no­va­tion of­ten be­gins with univer­sity re­search, and the Van­der­bilt Univer­sity Cen­ter for Tech­nol­ogy and Com­mer­cial­iza­tion has found a way to take in­no­va­tive re­search from the univer­sity and pre­pare the re­sult­ing in­tel­lec­tual prop­erty for the mar­ket­place.

Van­der­bilt’s Cen­ter for Tech­nol­ogy also works with lo­cal and re­gional en­trepreneurs, in­vestors, ex­ec­u­tives and other busi­ness lead­ers to ad­vance tech­nolo­gies in sec­tors such as broad drug de­liv­ery, health care man­age­ment and other in­for­ma­tion tech­nol­ogy sys­tems, said As­sis­tant Vice Chan­cel­lor Alan Bent­ley.

“Health care in­no­va­tion na­tion­ally is prob­a­bly the sin­gle most im­por­tant el­e­ment con­tribut­ing to re­duc­ing health care ex­pense and im­prov­ing pa­tient care,” Bent­ley said.

Right now, the Cen­ter for Tech­nol­ogy is work­ing with in­vestors to po­si­tion some of its med­i­cal cen­ter in­for­ma­tion sys­tems for broad com­mer­cial­iza­tion. For one project, the cen­ter has en­gaged a lo­cal en­tre­pre­neur to cre­ate a com­pany to de­liver a nanosponge drug de­liv­ery sys­tem de­vel­oped in the Van­der­bilt Depart­ment of Chem­istry by Dr. Eva Harth and col­leagues.

Bent­ley said he an­tic­i­pates sim­i­lar part­ner­ships be­tween Van­der­bilt re­searchers and the Nashville area health care community will be com­mon­place in the com­ing years.

“The Van­der­bilt re­search community is such an in­no­va­tive bunch, there are nu­mer­ous op­por­tu­ni­ties to part­ner locally to de­velop high im­pact health care prod­ucts,” Bent­ley said

And, once those innovations be­come busi­ness mod­els, Nashville community groups like the En­tre­pre­neur Cen­ter and the Nashville Cap­i­tal Net­work are in place to nur­ture star­tups into suc­cess­ful ven­tures.

“Nashville is home to a num­ber of new and long­time en­trepreneurs in health care. At the En­tre­pre­neur Cen­ter, we con­nect these in­no­va­tors with crit­i­cal re­sources to ac­cel­er­ate busi­ness cre­ation and growth. We are the ‘front door’ of Nashville for all types of en­trepreneurs, cre­at­ing both a phys­i­cal and vir­tual place for pro­vid­ing re­sources, mak­ing con­nec­tions, seek­ing ad­vice and launch­ing a busi­ness,” said Michael Burcham, pres­i­dent and chief ex­ec­u­tive of­fi­cer of the The En­tre­pre­neur Cen­ter.

“Nashville is home to a num­ber of new and long­time en­trepreneurs in health care. At the En­tre­pre­neur Cen­ter, we con­nect these in­no­va­tors with crit­i­cal re­sources to ac­cel­er­ate busi­ness cre­ation and growth. We are the ‘front door’ of Nashville for all types of en­trepreneurs, cre­at­ing both a phys­i­cal and vir­tual place for pro­vid­ing re­sources, mak­ing con­nec­tions, seek­ing ad­vice and launch­ing a busi­ness.” Michael Burcham Pres­i­dent and CEO The En­tre­pre­neur Cen­ter

Tack­ling community is­sues

Sup­port from lead­ers in the Nashville health care in­dus­try gives the Coun­cil the clout it needs to tackle big is­sues in the community, ex­em­pli­fied in the Coun­cil’s role in an award-win­ning project by Nashville Pub­lic Tele­vi­sion.

As Nashville’s busi­ness community has thrived, the health of its chil­dren has not. The city ranked 48th in the na­tion for chil­dren’s health—from obe­sity to in­fant mor­tal­ity—and the state over­all didn’t fare much bet­ter. In 2009, Nashville Pub­lic Tele­vi­sion spear­headed a part­ner­ship among Nashville health care or­ga­ni­za­tions and community part­ners to con­front the crip­pling ef­fects of poor child­hood health in the re­gion.

The Coun­cil was on board im­me­di­ately, said Beth Cur­ley, pres­i­dent and chief ex­ec­u­tive of­fi­cer of Nashville Pub­lic Tele­vi­sion. Coun­cil mem­ber Health­ways, the largest in­de­pen­dent global provider of well-be­ing im­prove­ment so­lu­tions, was also an ini­tial key sup­porter. The Coun­cil and its mem­bers con­tin­ued to play a ma­jor role, build­ing and par­tic­i­pat­ing in a coali­tion that brought the project to fruition.

Ti­tled “Chil­dren’s Health Cri­sis,” the project’s first phase

con­sisted of seven doc­u­men­taries aired over three years. Each episode ex­am­ined a dif­fer­ent is­sue, from child­hood obe­sity to men­tal health to ado­les­cent sex­u­al­ity.

Other el­e­ments of the project in­cluded 18 health spots for chil­dren and par­ents dur­ing day­time chil­dren’s tele­vi­sion pro­gram­ming, as well as 81 health up­date spots dur­ing prime time. It fea­tured call-in pro­grams, weekly on-air re­ports and an ex­ten­sive web­site.

“We’ve doc­u­mented great suc­cess with in­no­va­tive ini­tia­tives that sup­port the doc­tor-pa­tient re­la­tion­ship and bet­ter align health care re­sources.” HERB FRITCH Pres­i­dent HealthSpring

The project lived off the air, too. In­for­ma­tion was dis­trib­uted to area schools, community cen­ters and health-care providers with trans­la­tions in four lan­guages other than English. Nashville Pub­lic Tele­vi­sion held a se­ries of Fam­ily Health Nights at Nashville schools. In 2011, more than 550 fam­i­lies at­tended lit­er­acy and nu­tri­tion work­shops in­volv­ing games and healthy food.

Throughout the process the Coun­cil as­sisted with the project by pro­vid­ing in­put on con­tent, iden­ti­fy­ing health care ex­perts and as­sist­ing with stag­ing events, said Daniel Tid­well, vice pres­i­dent of de­vel­op­ment and mar­ket­ing for Nashville Pub­lic Tele­vi­sion.

“They have re­ally been one of our most ac­tive and in­volved part­ners,” Tid­well said. “They have done a great job in help­ing us get the word out about it and help­ing us con­nect with the health care community.”

The se­ries won the 2011 Midsouth Re­gional Emmy Award for Community Ser­vice. In 2010 it won two Emmy Awards in 2010 for best top­i­cal doc­u­men­tary and best pub­lic af­fairs doc­u­men­tary. Other awards in­clude the 2011 Amer­i­can Academy of Pe­di­atrics Friend of Chil­dren Award, 2011 and 2012 Ten­nessee Com­mis­sion on Chil­dren & Youth Mak­ing KIDS COUNT Me­dia Award and 2010 Na­tional Ed­u­ca­tional Telecom­mu­ni­ca­tions As­so­ci­a­tion awards for best long-lead promo and Sci­ence/Na­ture doc­u­men­tary.

Ad­dress­ing im­por­tant lo­cal is­sues with a com­bi­na­tion of tele­vi­sion pro­gram­ming and other outreach is gen­er­at­ing buzz among sta­tion man­agers and pro­duc­ers in the pub­lic tele­vi­sion community.

“It’s on the radar screen,” Cur­ley said. “Peo­ple are talk­ing about it at a num­ber of other sta­tions and try­ing to fig­ure out what they can do.”

But the best news, said Coun­cil Pres­i­dent Caro­line Young, is the im­pact on chil­dren’s health. Ten­nessee now ranks 39th in child well-be­ing. “All of these ef­forts are slowly, but steadily mov­ing the nee­dle,” Young said. “More Nashvil­lians un­der­stand the need to cre­ate a cul­ture of health and well­ness.”

In­still­ing pos­i­tive life­long health habits in kids is the only way to truly change over­all health in the United States, said Coun­cil mem­ber Scott McQuigg, chief ex­ec­u­tive of­fi­cer of HealthTeacher, which pro­vides a com­pre­hen­sive on­line health ed­u­ca­tion cur­ricu­lum used in pub­lic schools, af­ter-school and home school pro­grams in the United States and in­ter­na­tion­ally.

“Our coun­try des­per­ately needs con­sumers to take more re­spon­si­bil­ity for their health,” McQuigg said. “The costs of poor health choices among adults are be­com­ing in­sur­mount­able.”

“Suc­cess­fully teach­ing young peo­ple the in­trin­sic value of health to­day will pro­vide a gen­er­a­tional shift in health and well-be­ing that will pay div­i­dends for our com­mu­ni­ties and coun­try to­mor­row,” McQuigg added.

Ag­ing pop­u­la­tion in­flux

In­dus­try lead­ers are also fo­cus­ing on Nashville and the na­tion’s ag­ing pop­u­la­tion, which will continue to need a higher level of health care.

“The ris­ing num­ber of se­niors is a global trend and not lim­ited to the ag­ing of the baby boomer gen­er­a­tion in the United States,” said Herb Fritch, pres­i­dent of HealthSpring, a health plan de­liv­er­ing qual­ity health care, pri­mar­ily through Medi­care Ad­van­tage and other Medi­care and Med­i­caid prod­ucts.

“Ad­vances in sci­ence, tech­nol­ogy and medicine mean peo­ple to­day are liv­ing longer,” Fritch said. “How­ever, as we age we be­come more sus­cep­ti­ble to chronic ill­nesses like high blood pres­sure, di­a­betes, and heart dis­ease.”

HealthSpring works with physi­cians and pa­tients to de­velop per­son­al­ized care plans that com­bine reg­u­lar med­i­cal care with pre­ven­ta­tive ser­vices and dis­ease man­age­ment. The ap­proach has re­sulted in an av­er­age 80-90 per­cent com­pli­ance with ev­i­dence-based medicine prac­tices com­pared to a na­tional av­er­age of 40-50 per­cent, Fritch said.

“We’ve doc­u­mented great suc­cess with in­no­va­tive ini­tia­tives that sup­port the doc­tor-pa­tient re­la­tion­ship and bet­ter align health care re­sources,” Fritch said.

Fritch main­tains that pi­o­neer­ing new pro­grams and strength­en­ing ex­ist­ing ones fo­cused on de­liv­er­ing bet­ter health out­comes, re­duced costs and higher pa­tient sat­is­fac­tion is vi­tal for keep­ing se­niors healthy in a fu­ture with a larger num­ber of older Amer­i­cans are expected to cel­e­brate their 100th birthday.

When the sit­u­a­tion calls for acute care fol­low up, skilled nurs­ing and home health pro­vide the most cost ef­fi­cient set­tings for the ma­jor­ity of cases, said Steve Flatt, pres­i­dent, Na­tional Health­Care Corp., one of the na­tion’s old­est long-term health care com­pa­nies, oper­at­ing 130 health care fa­cil­i­ties in 11 states.

“As we move to a world of bun­dled pay­ments and cap­i­tated pay­ment for the care of de­fined pop­u­la­tions, we want to be po­si­tioned to work with physi­cians and hos­pi­tals to meet the clin­i­cal and fi­nan­cial tar­gets for ef­fec­tive, qual­ity care of an ag­ing pop­u­la­tion,” Flatt said.

An in­crease in the U.S. el­derly pop­u­la­tion com­bined with an in­flux of Med­i­caid pa­tients due to the pass­ing of the Ac­count­able Care Act means manag­ing the rev­enue cy­cle is go­ing to be more im­por­tant than ever, said Scott Mer­tie, pres­i­dent of Kraft Health­care Con­sult­ing, an af­fil­i­ate of Kraft CPAs which is one of the largest in­de­pen­dent cer­ti­fied pub­lic ac­count­ing firms in Mid­dle Ten­nessee. His prac­tice spe­cial­izes in all as­pects of re­im­burse­ment and com­pli­ance re­lated to Medi­care and Med­i­caid.

“Providers al­ready strug­gle with Medi­care and Med­i­caid rates, as well as an in­crease in com­pli­ance,” Mer­tie said. New health care laws will not likely al­le­vi­ate that strug­gle, he added.

“They are go­ing to have to learn to op­er­ate their or­ga­ni­za­tions by manag­ing pa­tient care with lower re­im­burse­ment rates while car­ing for more pa­tients.”

Mer­tie said the best way he can as­sist his clients is make sure they’re in­formed about reg­u­la­tions that af­fect them di­rectly, as well as in­di­rectly over the long term.

Tech­no­log­i­cal ad­vances such as the MISTY™ care man­age­ment plat­form for health care providers, pay­ers and care­givers will help pa­tients with chronic con­di­tions, many who are older, said Scotte Hud­smith, pres­i­dent and chief ex­ec­u­tive of­fi­cer of Parental Health, which de­vel­oped and de­liv­ers MISTY™.

Es­tab­lished in 2009, Parental Health set out to de­sign a pro­gram specif­i­cally to sup­port Med­i­caid and Med­i­caid Ad­van­tage. Be­ing part of the Coun­cil was a help in get­ting his new con­cept off the ground, Hud­smith said.

“Start­ing Parental Health in this community has al­lowed us to tap into a vast knowl­edge base of how care is pro­vided to pa­tients with chronic con­di­tions,” he said.

Be­cause the same pop­u­la­tion is re­spon­si­ble for most of Medi­care and Med­i­caid spend­ing, ef­fi­ciently manag­ing their com­plex care is para­mount. The Cen­ters for Medi­care and Medi­care Ser­vices states that its pri­mary ob­jec­tive is to im­prove ac­cess, out­comes and qual­ity while re­duc­ing cost.

“Ap­prox­i­mately 5 per­cent of the mem­bers in Medi­care and Med­i­caid con­sume the ma­jor­ity of the cost,” Hud­smith said. “If a plan can man­age those costs proac­tively, the sys­tem over­all can save an enor­mous amount of money, while im­prove ac­cess and qual­ity of care. “

“Physi­cian ex­ec­u­tives and CMOs should be at the fore­front and in­te­grally in­volved with non­physi­cian lead­ers of most or­ga­ni­za­tions that will ex­cel in the fu­ture.” LYNN MAS­SEN­GALE, MD Ex­ec­u­tive Chair­man TeamHealth

Tech­nol­ogy in num­bers

In­creas­ing num­bers in the ag­ing pop­u­la­tion is just one of many im­pend­ing changes re­lated to health care de­liv­ery in the United States.

Thanks to health care re­form, health sys­tems will also see an in­crease in the in­sured pop­u­la­tion, as well as more par­tic­i­pants in in­di­gent care pro­grams na­tion­wide, said Ge­orge Lazenby, chief ex­ec­u­tive of­fi­cer, of Emdeon, the largest health care fi­nan­cial and clin­i­cal net­work in the na­tion – con­nect­ing 1,200 pay­ers, 500,000 providers, 5,000 hos­pi­tals, 81,000 den­tists and 60,000 phar­ma­cies – and pro­cess­ing more than six bil­lion health care in­for­ma­tion ex­changes per year.

“The one thing that is clear about the fu­ture of health care is that we have to im­prove our ef­fi­ciency to re­duce the costs of our health care sys­tem,” Lazenby said.

That is where tech­no­log­i­cal im­prove­ments as­so­ci­ated with de­liv­er­ing data and ex­chang­ing in­for­ma­tion come into play.

“Any im­prove­ments that lead to higher lev­els of ef­fi­ciency will be achieved by the in­creased avail­abil­ity of rel­e­vant data for de­ci­sions within the work­flow,” Lazenby said. “Tech­nol­ogy will clearly play a sig­nif­i­cant role in this go­ing for­ward.”

In­vest­ment in new care mod­els, es­pe­cially health care in­for­ma­tion tech­nol­ogy will ac­cel­er­ate as health care com­pa­nies align their pro­cesses with the re­quire­ments of health care re­form, said Claire Mi­ley, a health care reg­u­la­tory lawyer and mem­ber at Bass, Berry & Sims PLC, which rep­re­sents 16 pub­lic health care com­pa­nies, more than 150 health car­ere­lated busi­nesses and is one of the 10 largest health law firms in the United States.

“Health care tech­nol­ogy, es­pe­cially health in­for­ma­tion tech­nol­ogy, is the un­der­pin­ning of the new co­or­di­nated care mod­els cre­ated by health re­form,” Mi­ley said.

In ad­di­tion to the changes brought on by health care re­form, hos­pi­tals and other health care providers face Medi­care re­im­burse­ment costs be­gin­ning in 2012 if they fail to in­vest in health care tech­nol­ogy that com­plies with gov­ern­ment man­dates for “mean­ing­ful use,” Mi­ley added.

Cen­ters for Medi­care and Medi­care Ser­vices de­fines mean­ing­ful use as the ap­pli­ca­tion of cer­ti­fied elec­tronic health records tech­nol­ogy in ways that can be mea­sured sig­nif­i­cantly in qual­ity and in quan­tity.

Do­ing busi­ness in the birth­place of for-profit health care and work­ing with some of the world’s most so­phis­ti­cated health care com­pa­nies, Mi­ley said she ex­pects to par­tic­i­pate on the cut­ting edge of in­dus­try in­no­va­tion in the area of health care tech­nol­ogy.

Ex­ec­u­tive physi­cians at fore­front

New fed­eral reg­u­la­tions, evolv­ing de­mo­graphic dif­fer­ences and changes in so­cial pop­u­la­tions will con­trib­ute to the in­creas­ing im­por­tance of the chief med­i­cal of­fi­cer and ex­ec­u­tive physi­cian in the com­ing years.

As ex­ec­u­tive chair­man at TeamHealth, one of the largest providers of out­sourced physi­cian and clin­i­cal staffing so­lu­tions for hos­pi­tals in the United States, Dr. Lynn Massin­gale said the com­pany is fo­cused on ini­tia­tives that im­prove qual­ity in a mea­sur­able way, re­duce un­nec­es­sary costs and en­hance the pa­tient ex­pe­ri­ence in emer­gency ser­vices, hospi­tal pro­grams, anes­the­sia and ur­gent care.

Whether it’s a chief med­i­cal of­fi­cer fo­cused on clin­i­cal is­sues or a physi­cian ex­ec­u­tive with broader ex­ec­u­tive man­age­ment du­ties, physi­cian lead­ers will need to de­velop req­ui­site skills be­yond their med­i­cal cre­den­tials to be ef­fec­tive as high-level cor­po­rate ex­ec­u­tives, Massin­gale said.

Kim Har­vey Looney, a health care reg­u­la­tory prac­tice leader at Waller, a na­tional law firm, shared, “The in­creased em­pha­sis on qual­ity will re­quire the physi­cian/CMO to be more proac­tive. While qual­ity stan­dards are not new, the physi­cian/ CMO will be spend­ing more time mak­ing sure that new qual­ity met­rics are in place be­fore there is a prob­lem. The im­por­tance of tak­ing a proac­tive ap­proach is un­der­scored by developments such as the Hos­pi­tals Read­mis­sions Re­duc­tion Pro­gram which will re­duce Medi­care pay­ments for hos­pi­tals viewed as hav­ing ex­cess pa­tient read­mis­sions as well a re­cent pa­tient care mea­sures en­dorsed by the Na­tional Qual­ity Forum.”

“Physi­cian ex­ec­u­tives and CMOs should be at the fore­front and in­te­grally in­volved with non­physi­cian lead­ers of most or­ga­ni­za­tions that will ex­cel in the fu­ture,” Massin­gale said.

Physi­cian lead­ers will face in­creased staffing chal­lenges, said at­tor­ney Jay Hard­cas­tle, part­ner and chair of the Health Care Prac­tice Group at Bradley, Arant, Boult, Cum­mings LLP.

“There may be a short­age of physi­cians in the com­ing

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