Are the Best Hospitals Led by Physicians?

Posted on Mon, Feb 20, 2017
Are the Best Hospitals Led by Physicians?

Healthcare’s increasing complexity in this country and the growing emphasis on patient-centered care and efficiency in delivering clinical outcomes are forcing clinicians get better at balancing the competing imperatives of cost versus quality and technology versus humanity. Those challenges are preparing them to take on leadership roles—a good thing, say the authors of a recent op-ed published in the Harvard Business Review, who make a strong case that the best hospitals are led by physicians.

Many of the Top-Ranked Hospitals Are Led by Doctors

James K. Stoller, MD, a pulmonary/critical care physician at the Cleveland Clinic and chairman of the Education Institute; Amanda Goodall, PhD, senior lecturer in management at Cass Business School in London; and Agnes Baker, PhD, assistant professor at the University of Zurich, say there’s a correlation between physician-led hospitals and quality outcomes. Of the U.S. News and World Report (USNWR) 2016-17 Best Hospitals Honor Roll of this country’s top 20 hospitals, the five top-ranked hospitals—Mayo Clinic, Cleveland Clinic, Massachusetts General Hospital, Johns Hopkins Hospital and UCLA Medical Center— have physician CEOs and/or presidents. The authors also said the Mayo Clinic and Cleveland Clinic, ranked No. 1 and No. 2, respectively, have been physician-led since their inception about a century ago.

Dr. Goodall led a study published in 2011 that looked at CEOs of the USNWR’s 100 best hospitals in three key medical specialties: cancer, digestive disorders and cardiovascular care. The analysis found that hospital quality scores are approximately 25 percent higher in hospitals run by medically trained doctors than in hospitals run by professional managers who are not physicians. Research by Nick Bloom, Raffaella Sadun, and John Van Reenen published in 2014 found that hospitals with a higher percentage of clinically trained managers achieve higher quality scores.

Physician Leaders Have More Credibility With Other Clinicians

When asked why doctors make good hospital managers, Cleveland Clinic CEO Delos "Toby" Cosgrove, MD immediately answered, “peer-to-peer credibility.” Clinicians are more inclined to trust in a leader whose personal experience provides direct knowledge and insight into their challenges, motivations, and desire to put the needs of patients first. The authors assert that physician executives are more likely to have patient-focused strategies, and that if leaders understand based on firsthand experience “what is needed to complete a job to the highest standard, then they may be more likely to create the right work environment, set appropriate goals and accurately evaluate others’ contributions” and to “know what ‘good’ looks like when hiring other physicians.” Dr. Cosgrove also suggest that physician leaders are more likely to allow people to pursue innovative ideas and to tolerate “appropriate failure, which is a natural part of scientific endeavor and progress.”

Training Can Help Physicians Become Even Better Leaders

The authors argue that physicians traditionally have been trained in “command and control” environments as “heroic lone healers,” who are “collaboratively challenged.” But being an effective leader requires very different skills than those needed to be an effective doctor, including the ability to collaborate and to foster collaboration and teamwork among other clinicians. The op-ed mentions several examples of top-tier hospitals that engage physicians in leadership and management training, such as Yale Medicine and the Cleveland Clinic. Many healthcare institutions have in-house training developed by respected medical societies and business schools.


14 Envision EDs Recognized for Short Wait Times

Posted on Wed, Feb 15, 2017
14 Envision EDs Recognized for Short Wait Times

The national average for “door to diagnosis” in the emergency department is 22 minutes, but 14 of Envision Healthcare-staffed emergency departments beat that time by at least 18 minutes.

Becker’s Hospital Review’s annual list of hospitals with the lowest emergency department wait times included 59 facilities that reported wait times of four minutes or less, according to the “door to diagnostic evaluation” measure in CMS’ Hospital Compare's Emergency Department Care Measures dataset. Envision facilities made up 24 percent of the list.

Congratulations to the emergency medicine teams at the following Envision client hospitals:

  • Baylor Orthopedic and Spine Hospital at Arlington (Texas) — 3 minutes
  • Belton (Mo.) Regional Medical Center — 4 minutes
  • Coliseum Northside Hospital (Macon, Ga.) — 4 minutes
  • Denton (Texas) Regional Medical Center — 4 minutes
  • Fawcett Memorial Hospital (Port Charlotte, Fla.) — 3 minutes
  • JFK Medical Center (Atlantis, Fla.) — 3 minutes
  • Lafayette Regional Health Center (Lexington, Mo.) — 4 minutes
  • Lee's Summit (Mo.) Medical Center — 4 minutes
  • Medical Center of McKinney (Texas) — 4 minutes
  • Overland Park (Kan.) Regional Medical Center — 4 minutes
  • Poinciana Medical Center (Kissimmee, Fla.) — 3 minutes
  • Research Medical Center (Kansas City, Mo.) — 3 minutes
  • St. Lucie Medical Center (Port Saint Lucie, Fla.) — 4 minutes
  • TriStar Horizon Medical Center (Dickson, Tenn.) — 4 minutes

Wait times data was collected from April 2015 through March 2016. Hospitals with sample sizes of less than 100 and those with results based on a shorter period than required were excluded from the list.


Documentation Tip: Vascular Intervention

Posted on Mon, Feb 13, 2017
Documentation Tip: Vascular Intervention

Our recurring series of documentation tips for clinicians.

By Timothy Brundage, MD

“Peripheral Vascular Disease” is a huge, non-specific bucket. Operative notes need specificity for coding purposes.

Vascular interventionalists need to document three things for coding specificity:

1. Specific vessel(s) involved.

a. Anatomical name and laterality (R/L)

  • Artery
  • Vein
  • Previous bypass graft

2. Type(s) of lesion(s) identified and addressed.

a. Stenosis/blockage due to arteriosclerosis, embolus or thrombus. Note: the same area of blockage may have more than one etiology or two different lesions with different etiologies that are corrected in the same operation.

b. Detailed operative note with specificity is necessary for coding.
  • Example #1: The surgeon first removed an embolus from an artery and then they stent the stenosis where the embolus lodged. The embolus and its removal should be documented as should the arteriosclerosis and its stenting.
  • Example #2: The surgeon first stents an arteriosclerotic lesion proximally and then removes a thrombus distally. The surgeon should document a detailed procedure note that would include the specificity listed above in order to capture the accurate code.

3. Consequences of the blockages:
  • Claudication
  • Ulcers
  • Gangrene, dry/ischemic

Dr. Timothy Brundage is a hospitalist for EmCare at St. Petersburg General Hospital in St. Petersburg, Fla. Dr. Brundage earned his bachelor’s degree in chemistry and molecular biology at the University of Michigan, his M.D. at the Wayne State University School of Medicine and completed his residency in internal medicine at the University of South Florida College of Medicine. Subscribe to Dr. Brundage’s weekly documentation tips, or ask him about specific documentation issues, by emailing him at

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