The Exec: Expect Increased Emphasis on Reducing Costs in 2023

Parkview Physicians Group CMO offers clinical care predictions for 2023.

This year, healthcare providers will be focusing on reducing costs while maintaining quality of services, says Thomas Bond, MD, chief medical officer of Parkview Physicians Group in Indiana.

Parkview Physicians Group is owned by Fort Wayne, Indiana-based Parkview Health, which features nine hospitals and a network of primary care and specialty clinicians. There are about 800 physicians and 300 advanced practice providers in Parkview Physicians Group.

Bond joined Parkview Health as a primary care physician in 1998. His current responsibilities include quality and safety, clinical integration, service excellence, and provider relations.

HealthLeaders recently talked with Bond about a range of issues, including clinical care predictions for 2023, the challenges of serving as CMO of a large physician group, and physician shortages.

This transcript has been lightly edited for brevity and clarity.

HealthLeaders: What are your clinical care predictions for 2023?

Thomas Bond: The biggest thing I see is that there is going to be an increased emphasis on cost, particularly in the ambulatory world. There is going to be continuing pressure on us to deliver high-quality services at a lower cost. I can't see government and payers continuing to shell out more money, so we are going to feel pressure on cost.

In our market, we will see more and more people going to the government health plans and less commercial coverage. That's going to put challenges on us. We will need to figure out how to deliver the same clinical quality and outcomes while being more efficient and cost-conscious in that delivery. We will need to think outside the box on how we can reduce cost.

HL: What are the primary challenges of serving as the CMO of Parkview Physicians Group?

Bond: The primary challenge is the sheer size of the group. It has gotten harder as one CMO to deal with all of our providers. We are looking at hiring more CMOs and dividing up the physician leadership hierarchy.

HL: How have you risen to the challenge of leading a large physician group?

Bond: I am trying to find physicians in the group who have leadership potential, then getting them the skills to advance their leadership. We try to find section chiefs and medical directors, which helps in physician leadership and hierarchy. It also helps facilitate our communication pathways to engage individual group members.

HL: What are the keys to success for physician leadership?

Bond: Change management and communication skills are key attributes. Change management is important because of the quickly changing conditions in healthcare.

Being a physician leader, you need to have credibility with your group and your operations team. We have administrators such as senior vice presidents and vice presidents, but physicians have greater trust in their physician leaders.

HL: What are the primary elements of physician engagement?

Bond: Trust, integrity, and follow-through are what physicians want. Physicians don't mind being told "no" as long as you follow through and let them know why. If you are not responsive or following up on things, that hurts your relationship with physicians.

HL: How has your clinical background as a primary care physician helped you serve as CMO of Parkview Physicians Group?

Bond: Being a family physician, you always have to work with different specialties. You have relationships and communication with specialists, so that has helped me establish camaraderie and understanding with many kinds of physicians.

HL: How do you establish and build relationships with physicians?

Bond: It is important to meet the providers, so I purposely round with every one of our physicians and advanced practice providers throughout the year. I make time to connect with clinicians, so I am not always coming to them with an issue. I don't wait for an issue to come up—I check in with the clinicians and see how things are going from their perspective and see whether there are things we need to do. I am purposely trying to keep communication open.

Thomas Bond, MD, chief medical officer of Parkview Physicians Group. Photo courtesy of Parkview Health.

HL: Are you experiencing any physician shortages?

Bond: We are seeing most of our physician shortages in primary care and neurology.

HL: How are you addressing those shortages?

Bond: We have been using a lot of locum tenens physicians. So, we are using contracted labor.

Recruitment and retention are also huge pushes for us. We are trying to be more creative in how we recruit—we are doing more searches than we have done in the past. We are getting more creative on work shifts.

In retention, we have established a mentoring and onboarding program for all of our providers. For the first year of employment, clinicians are assigned a mentor, which has helped reduce our turnover rate. We established this program four years ago, and our turnover rate has gone down. We are also working with the spouses of our clinicians to help them adapt to living in Indiana.

HL: You are involved in quality and safety work. What are the keys to success in quality-improvement initiatives?

Bond: A big key to success is getting physicians to buy into initiatives. A lot of times, our quality measures are determined by our payers. Sometimes, those payer metrics are not what we deem as quality, so we have to try to get physicians to understand the "why" behind initiatives and incentive dollars.

We also try to keep track of what is going on locally. For example, we are having a problem with obesity in our area, so we need to engage physicians in what they think is the solution for that and quality metrics we can put in place.

HL: What are the keys to success in patient safety initiatives?

Bond: You can talk about a patient safety issue, but if you do not have the numbers for your community, it is difficult to get buy-in for patient safety initiatives. For example, if you can show a high rate of wrong-side surgeries, that can give you the burning platform to prompt change. Sharing safety data is essential, and we have tried to have transparency on patient safety data.

HL: Give me an example of a patient safety initiative that you have been involved in.

Bond: We have tried to establish a just culture—if you see an adverse event, you are encouraged to speak up. If there is an error with a patient, there is not retaliation for reporting it. This has been a journey for us—we have been at it for about five years. It started off with just trying to increase reporting. We set reporting goals for departments because we knew that reporting was low. The next effort was trying to get leader feedback on adverse events within 24 hours. Then, in seven days, there had to be resolution, with a fix in place.

HL: How would you characterize your leadership style?

Bond: I am more of a servant leader. I do not see myself above my co-workers. I feel that we are all equals. My role is to help clinicians with barriers that are getting in their way and to help them be successful. I do constant rounding to let clinicians know that I am here to serve them.

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