The South Whidbey Record article of Dec. 20, titled “Hospital eyes new addition to administration,” fails to accurately describe how a successful, modern hospital should function, and I feel obligated to provide insight to try and correct the misstatements, mischaracterizations and misrepresentations of the relationship between the hospital’s medical staff and the hospital’s administration.
First, it is important to understand that there are two distinct “chains-of-command” in every hospital, the medical staff and the hospital administration, and WhidbeyHealth is no exception. The members of the medical staff are all healthcare providers (physicians, nurse practitioners, and physician assistants) who provide medical and surgical care directly to patients in the hospital district. Both the Centers for Medicare and Medicaid Services (CMS) and Washington state law have language stating that medical staffs must be organized, integrated, and function under governing-authority-approved medical staff bylaws to provide credentialing, privileging and peer review. See RCW 7.71.050.
The hospital administration manages the facilities, purchases equipment, hires and fires employees (including most members of the medical staff), manages the finances and deals with the day-to-day operation of the hospital. Both groups report to the board of commissioners. The head of the administration is the chief executive officer, Mr. Ron Telles, who is the board of commissioner’s only employee. The CEO has other members of the senior administration who report to him (chief financial officer, chief operations officer, chief quality officer, chief nursing officer, etc). All of these positions are appointed (hired) by the CEO.
The head of the medical staff in the hospital is the chief of staff (CoS). The CoS is nominated and elected by his or her peers on the medical staff. The medical staff is self-governing and independent from the hospital’s administration deliberately in order to reduce the potential conflict of interest between patient care (providers) and profit (administrators). Under the CoS are the other officers that make up the medical executive committee (MEC), consisting of the chief of medicine, Dr. Rosa Rangel, MD, the chief of community clinics, Ms. Kristine Young, C-PA, the chairperson of the credentials and bylaws committee, Ms. Michelle Aube, CRNA, the chairperson of the peer review committee, Dr. Jeremy Idjadi, MD, the chief of surgery, Dr. Robert Johnson, MD, and the chief of staff past, Dr. Nick Perera, MD. The MEC has three main functions: the first priority is to ensure proper patient care through monitoring of standards-of-care; the second is to ensure medical care providers are qualified and competent before being granted hospital privileges to care for patients; and the third is to ensure those providers adhere to all standards of conduct and to provide them training and/or discipline if they do not.
The Dec. 20 article claims that a newly appointed chief medical officer (CMO) would be brought on to “lead the medical staff.” That statement is simply wrong. The person who leads the medical staff has been (and will continue to be) the chief-of-staff, currently Dr. Doug Langrock, MD. The idea that an officer of administration, rather than an officer of the medical staff, would lead the medical staff ignores the checks and balances and the intentional separation of business and health care functions required by law.
A CMO is an administrator hired by the CEO to facilitate dialogue between the medical staff and the administration with the common goals of improving patient care, increasing efficiency and maintaining regulatory compliance. He or she is almost always a physician who brings a medical provider’s perspective to administration meetings. A CMO is also usually a member of the medical staff and must therefore meet the requirements of medical staff membership (i.e. maintain clinical competency). However, the CMO works below, and answers to, the CEO, as do all other members of the hospital administration. One need only Google the expected qualifications for a CMO to see that this role is primarily administrative, generally requiring a masters of health administration as a fundamental requirement.
Also contrary to what was stated in the article, there would be added cost in employing a CMO. When Ms. Clark stated there would not be added cost because “the surgical services medical director and the medical quality director positions would be eliminated,” she failed to mention that those two positions have been appointed to the same individual by the administration as a part-time position in addition to his full-time position as an employed surgeon. If this individual is appointed to the CMO position, the hospital will have to hire another surgeon to fulfill the vacancy since the CMO position will be a full-time job. Whatever this individual is being paid for his part-time director positions is almost surely far less than what he would be paid to be CMO. And the “employee health medical director” is an ancillary duty assigned by the CoS to the chief of medicine. So it appears that there would be no cost savings, only additional administrative overhead.
Dr. Rob Johnson, MD
WhidbeyHealth Medical Staff