Latest / Becker’s Healthcare - Clinical Leadership Podcast / Dr. James F. Kravec, Market Chief Clinical Officer at Mercy Health Lorain and Youngstown

Transcript

Dr. James F. Kravec, Market Chief Clinical Officer at Mercy Health Lorain and Youngstown · Becker’s Healthcare - Clinical Leadership Podcast

0:00
Imagine this. You're at the Hyatt Regency Chicago
0:03
immersed in insightful discussions with the health care
0:06
industry's top leaders.
0:07
Welcome to Becker's 12th annual CEO
0:10
and CFO roundtable from November 11th to 14th,
0:15
2024.
0:16
Picture yourself networking with over a 1000 executive
0:19
level attendees,
0:20
collecting business cards and forging valuable connections.
0:24
Feel the excitement as you engage in 4
0:26
days of sessions featuring 400
0:29
elite health system speakers.
0:31
Envision yourself diving deep into critical topics like
0:35
rural health care, digital transformation,
0:38
health equity, and c suite diversity.
0:41
Now imagine being inspired by our celebrity keynotes,
0:45
pro football hall of famers Troy Aikman and
0:48
Emmett Smith, 43rd president George w Bush, and
0:52
author and journalist Jenna Bush Hager. Their stories
0:55
will leave you motivated and energized.
0:58
Don't miss this unparalleled
1:00
opportunity. Get registered today. Visit beckershospitalreview.com
1:05
and click on the events page to find
1:07
the conference website. That's the beckershospitalreview.com
1:11
events page. See you in Chicago.
1:15
Welcome to the Becker's Healthcare Podcast.
1:18
My name is Paige Twenter. I'm an assistant
1:20
editor here at Becker's Healthcare.
1:22
I'm thrilled today to interview doctor James Kravec.
1:25
On the podcast today.
1:27
I'm really excited. But before we dive in,
1:30
I'd love to have, doctor Kravick introduce himself
1:33
and tell us about his background.
1:37
Well, thank you for having me on the
1:38
podcast today. My name is doctor Jim Kravick.
1:42
I'm an internal medicine physician.
1:45
By background,
1:46
I'm born and raised in Youngstown, Ohio in
1:49
Northeast Ohio.
1:51
I went through my training as an internal
1:53
medicine physician, and about 10 years into my
1:55
career
1:56
as a program director of a residency, as
1:59
a core faculty member of a residency, and
2:01
as a hospitalist and outpatient physician kinda combination,
2:05
I switched
2:06
into add on,
2:07
some part time
2:09
administrative roles,
2:10
and then I became more full time administrative,
2:13
although I still see some patients on an
2:15
in a part time role.
2:17
I serve as chief clinical officer
2:19
for Mercyhealth in Lorraine in Youngstown. So I
2:22
have 5 hospitals that I oversee
2:24
in in Lorraine,
2:26
Oberlin,
2:27
Warren, Boardman, and Youngstown, Ohio.
2:30
And I also serve as a medical director
2:32
for graduate medical education for our our system,
2:35
which is Bon Secours Mercy Health.
2:39
Right. So focusing first,
2:43
in the c suite,
2:45
can you kind of, you know, talk a
2:47
little bit about the
2:49
potential evolution or the evolution you're already seeing
2:51
among chief medical officer roles as well as
2:54
chief clinical officers?
2:57
You know, probably back in the mid 2000
2:59
tens, a new term came to be in
3:02
the physician leadership role, and it was a
3:04
chief clinical
3:06
officer. If you look back historically, the CMO,
3:09
chief medical officer, historically had been
3:12
over the 4 walls of a building, you
3:14
know, the lead physician of 4 walls of
3:16
a building.
3:17
And that person led by influence. They were
3:20
usually more a senior
3:22
physician
3:22
leader in the community.
3:25
Yeah. And and that was they they really
3:27
just had they they were more of the
3:28
esteemed member of the medical staff.
3:31
As the CMO role changed, they also found
3:34
a need for a chief clinical officer. Chief
3:36
clinical officers don't just have 4 walls of
3:39
a building.
3:40
They tend to have maybe multiple hospitals,
3:44
a medical group that's employed,
3:46
an accountable care organization,
3:49
responsibility for graduate medical education,
3:52
responsibility for recruitment and quality. So, really, you
3:55
know, the other term sometimes for chief clinical
3:57
officer is the chief physician executive.
3:59
So sometimes those were used interchangeably.
4:02
But I I I find the chief clinical
4:04
officer role is a newer role, and it
4:07
really encompasses
4:08
the entire breadth of
4:10
leadership
4:11
of a health system
4:12
rather than the four walls of a cyst
4:14
of a of a building of a hospital.
4:18
And what does that look like,
4:21
for you, you know, that
4:23
full clinical outlook,
4:25
outside the four walls of a system?
4:27
Yeah. Yeah. I think I think it's interesting
4:29
because as you think think of the CMO
4:31
or the CCO
4:33
of today
4:34
versus the CMO of the past. Right? So
4:37
we focus on a lot of things such
4:38
as hospital strategy,
4:40
hospital clinical strategy, working with the hospital president,
4:43
working with finance and nurses, the strategy team.
4:47
I focus on physician relationships and advanced practice
4:49
clinician relationships,
4:51
between the credentialing and the medical executive process,
4:54
but also working with,
4:56
recruitment and how do we grow our medical
4:59
staff and how do we grow our employed
5:01
physician group.
5:03
A lot of clinical operations,
5:04
things like, you know, when when we talk
5:06
about our star ratings and our leapfrog ratings,
5:09
how do we have less
5:10
CAUTIs and CLABSIs
5:12
and less c diff,
5:15
cases and decreased blood
5:17
transfusion utilizations
5:19
and on all that? And then and case
5:21
management throughput, how do I focus on, length
5:24
of stay and making sure that patients are
5:27
have have less time in the emergency department,
5:29
increase,
5:31
experience of care? But and when I think
5:33
about that, that's one component of it. Then
5:35
the other component is I I really see
5:37
the role of the chief clinical officer as
5:40
the lead physician communicator
5:42
talking about, you know, we just finished our
5:44
pandemic for a couple years, and and I
5:47
I served as the spokesperson for the clinical
5:49
roles,
5:51
for clinical evolution of of COVID and how
5:54
we've communicated that, working with health departments, working
5:57
with our
5:58
university partners and medical schools. But I I
6:01
see that really in 2024
6:03
as the role of the chief clinical officer
6:05
as opposed to what it was in the
6:06
past.
6:09
And what role are you envisioning for 2034?
6:15
You know, I think as we
6:17
continue
6:18
to
6:19
gain knowledge on the business side for physicians,
6:22
I see the physicians being more in involved
6:25
in the finance of MepHealthcare.
6:28
You know, it's it's easy
6:30
to manage a medical staff when you have
6:31
to and if you had unlimited money. It's
6:34
easy to run strategy with unlimited money.
6:37
But as margins have become thinner and thinner,
6:39
as we have worse
6:41
payment models through insurance companies, and as we
6:44
have higher salaries,
6:45
our margins are smaller and smaller, so we
6:47
have to be smarter with our decisions.
6:49
And I think having physicians with that knowledge
6:52
of the business of medicine
6:54
is is only is where we're gonna see
6:56
this role go in the next 10 years.
6:57
Really
6:58
focusing on
6:59
not just clinical quality that's given that's expected,
7:03
but also how do you balance that with,
7:05
you know, the return on projects and the
7:08
finances and the amount of money you spent
7:10
on on this and that in the hospital.
7:12
I I see that role going,
7:14
in that direction over the next 10 years.
7:18
With margins getting thinner and thinner,
7:21
chief clinical officers, chief, medical officers need to
7:24
be more financially nimble.
7:26
Is is that what I'm
7:28
hearing or I wanna make sure I'm understanding
7:30
properly.
7:31
Yeah. You no. That's that's I think that's
7:33
true. Because, again, we
7:35
you might say, as the lead physician, your
7:38
job is to focus on quality.
7:41
Well, that's true
7:43
and focus on physicians. That's true. But you
7:45
have to understand the finance component.
7:48
We can say I need 5 more quality
7:50
leaders, and I need to pay this, and
7:52
I need this person, this this new service
7:54
line and and whatnot.
7:55
But the reality is it's all tied to
7:57
the finance of the hospitals and the finances
8:00
of medicine. And if those don't match up,
8:03
then we're not working we're working in silos.
8:05
You have to be aligned
8:07
with the finance
8:08
on everything we do on the physician strategy,
8:11
the quality strategy, the recruitment.
8:13
It has to has to come together. Because
8:15
if it doesn't,
8:16
it's really not gonna succeed.
8:20
And with that forecast, do you have,
8:24
recommendations
8:24
or action items you recommend
8:27
for your peers across the US, you know,
8:30
other clinical officers, other medical officers?
8:34
You know, as as I
8:36
think about my role as a chief clinical
8:38
officer,
8:39
you know, we should be
8:41
and we we we say use the the
8:43
term tied to the hip with the chief
8:44
nursing officer and really understand nursing and physician.
8:47
That's really important. And this doesn't minimize what
8:49
I'm about to say doesn't minimize that. But
8:51
you also have to be tied very closely
8:54
with your strategy team and with your finance
8:56
leaders.
8:58
And I think, you know, the the historical
9:00
CFO,
9:01
just like the historical CMO,
9:05
was very
9:06
focused and siloed.
9:07
The CFO focused on on money and on
9:11
the balance sheet and focused on
9:14
that part only. The CMO focused on quality
9:17
and that part only.
9:19
Reality is they're they're they're so intertwined.
9:22
And the finance physician finance leader needs to
9:25
understand
9:26
what it means to hit quality measures and
9:29
what it means to recruit and what it
9:30
means to have a good performer in the
9:32
operating room and where the but the physician
9:33
needs to understand
9:35
the cost of supplies and, you know, the
9:37
return on having a new physician or a
9:39
new service or a new robot. Those have
9:42
to be brought together. So I think working
9:43
with your finance lead is is so important.
9:47
And I can only imagine
9:49
the clinical efficiencies
9:52
or unlocked opportunities
9:54
there. You know, the more integrated CFO and
9:56
CMO and CCO
9:58
work comes together.
10:00
I I I think it is. And it
10:02
really it really makes
10:04
us work as a team. I I I
10:06
I remember meeting I had recently with our
10:07
our chief
10:09
finance officer and chief nurse, and we were
10:12
almost telling each other's story and and defending
10:14
their position because, you know, the finance person
10:17
was saying that you need that clinically. And
10:19
I was saying, yeah. But it's too expensive.
10:20
You know? And that and that it's
10:22
just you reach a success point when you're
10:23
fighting the other person's battles, and they're fighting
10:26
yours because you see their point of view
10:28
so much. And I think that's kind of
10:29
how that's that's a level of success, I
10:31
think, as you have these relationships.
10:35
That's funny.
10:36
We have a few minutes left. I really
10:39
wanna make sure I get to this, other
10:41
question I have for you.
10:45
At Mercyhealth and your practice, in the multiple
10:47
cities that you're working in in Ohio,
10:50
what's your most successful project or initiative from
10:53
the past few months? You know, can you
10:56
kinda dive into what you did and what
10:58
you've seen so far?
11:00
Yeah. We we spend a lot of time.
11:01
I spend a lot of time on recruitment
11:03
of physicians
11:04
and planning from 1 to 3 to 5
11:07
to 7 years down the road. And and
11:09
and, you know, the 1 to 2 years
11:10
is easy. I I talk to physicians while
11:12
they're in residency or if they're in practice
11:15
and then working with them coming over to
11:16
Mercyhealth in Lorraine or Mercyhealth in Youngstown. But
11:19
as I as I look down the road,
11:21
we're working on building residency programs.
11:24
You know, how do we start a family
11:26
medicine residency program? How do we start internal
11:28
medicine residency program to build our pipeline?
11:31
That's gonna take 3 to 5 to 7
11:34
years to see the the the fruits of
11:36
our labor. And so as I look at
11:38
that, that that success of of building these
11:41
new programs is something I'm so proud of
11:44
because, you know, we're gonna kinda feel that
11:45
in in a couple years. But, you know,
11:48
in 2030,
11:49
when we have our graduates of our new
11:51
residency program, the work we're doing now in
11:53
2024 will be will be just tremendous. So
11:56
that that's probably one of the biggest, areas
11:58
of,
11:59
work that's made me proud over the last
12:00
couple of years.
12:04
My last question for you,
12:07
what's a really large
12:09
challenge you're expecting to face in next year?
12:13
You know, I think if I look at
12:14
the work that our primary care physicians
12:16
do,
12:18
there is a lot of
12:21
clicking in electronic medical records,
12:24
a lot of,
12:26
outside pressures on primary care physicians,
12:30
answering questions, coding queries about the accountable care
12:33
organization,
12:35
or working directly with patients through their portals
12:39
or communication, their MyChart, and whatnot.
12:42
And the document documentation
12:45
requirements
12:45
are so heavy. My wife's a primary care
12:47
physician. I see firsthand the time that she
12:50
spends at home
12:52
after seeing a full day of patients and
12:54
you spend eat dinner for an hour and
12:55
you come home and turn the computer back
12:57
on and work for 3 to 4 more
12:58
hours every night.
13:01
And I think that is the challenge that
13:03
we feel both at in my organization and
13:05
really across the country in primary care. That
13:08
needs
13:09
fixed. That needs fixed because that's gonna burn
13:11
out, primary care physicians,
13:14
and that will be a problem. So we
13:15
we have a lot of ideas and a
13:16
lot of things that we're working on, but
13:18
that's a big problem I see.
13:21
And not one easily
13:23
fixed probably?
13:26
No. It's gonna it's it's gonna take resources.
13:28
And then and you might say that resources
13:29
and maybe a person to help them within
13:31
basket or person help with communication.
13:33
Or as a technology such as artificial intelligence
13:36
to help write notes or
13:38
or check charts or whatnot. But it it
13:40
it has to be addressed because,
13:42
you know, I've talked to my colleagues in
13:44
other health systems and other parts of the
13:45
country. It's the same
13:47
problem they're dealing with in primary care. And
13:49
probably as you talk to other guests, if
13:50
you ask that same question, you're probably gonna
13:52
get a similar answer.
13:53
It's the the the moral injury of those
13:55
in primary care is so
13:58
challenging because the work does not end.
14:01
And electronic medical record with all of its
14:04
positivity,
14:05
it has made it very, very easy for
14:07
patients to get ahold of their doctors at
14:09
any time, and that's a challenge for primary
14:12
care doctors.
14:14
Not to end on a sour note or
14:17
ending on a problem, but we are at
14:19
time. I just wanna say, doctor Kravec, thank
14:22
you so much for joining me today. I
14:23
really appreciate your, you know, your time ensuring
14:26
your sharp insights with me and our audience
14:28
listening today.
14:30
For our audience, you can catch more of
14:32
doctor Kredick at our upcoming clinical leadership forum
14:35
at the Becker CEO and CFO roundtable, which
14:38
is taking place November 11th through 14th in
14:41
Chicago. We do have limited space available,
14:44
and contact us to learn more. Thank you
14:46
again, doctor Pradak.
14:48
Thank you. Have a wonderful day.