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