COMMENTARY

COVID-19 Spawns an Important New MD Job Title

Bernard Godley, MD, PhD; Christine Mackey-Ross, RN

Disclosures

June 11, 2020

The coronavirus pandemic has caused a massive rewrite of the way we deliver healthcare in the United States. Perhaps most consequential among many changes has been the remarkably rapid pivot to telehealth.

Bernard Godley, MD, PhD

Regulators and payers have relaxed patient privacy and reimbursement policies that had inhibited the use of telehealth, dramatically altering the playing field. We can safely assume that the widespread use of telehealth will outlive the pandemic and become a fixture of patient/provider interactions.

As a result, it's critical to develop a new job title that will integrate telehealth into health system operations and maximize its still untapped potential. As the healthcare system moved away from the transactional model of care and toward the experiential model, a new title was created: Chief Experience Officer.

Another new title was created for leaders guiding their systems from volume- to value-based delivery: Chief Transformation Officer. The Chief Medical Information Officer role was created to drive integration of EMRs and other digital platforms in support of system transformation.

Now an additional title is likely to become common in the C-suites of many hospitals, health systems, and large medical groups post-COVID-19. This title is so new that there is as yet no name for it. Our proposal: Chief of Distance Care Delivery. It might more simply be called Chief of Telehealth, while CMO for Telehealth or Chief Digital Care Officer are other options.

Post-COVID-19, convenience and lower cost will continue to drive the expanded use of telehealth. As the crisis subsides, regulatory and reimbursement organizations will require that policies be enacted to bring quality, safety, privacy, and other benchmark standards in line with those of traditional delivery methods.

An emerging leadership position will have to be assigned to oversee what could become the primary method of providing ambulatory care, along with artificial intelligence–driven interfaces and remote patient monitoring technology. What would be the duties of this role, and who would qualify?

Briefly stated, the Chief of Distance Care Delivery (CDCD) would conceptualize, implement, and maintain high-quality telehealth services across the hospital, health system, or group. In academic environments, the role also might entail an outcomes research component.

Key to the role would be developing and overseeing quality, patient experience, and safety care measurements and protocols. Similar to other dyad structures, the role may evolve to have an administrative and/or nursing partner as telehealth becomes a major source of revenue, potentially overwhelming traditional ambulatory care delivery in some settings.

Joseph Kvedar, MD, president of the American Telemedicine Association and professor of dermatology at Harvard Medical School, has personally observed how health systems, physicians, and patients have rapidly embraced telehealth. He notes that at the Brigham and Women's/Massachusetts General Hospital–affiliated Partners Healthcare System, a network of about 7000 physicians, there were only 1600 virtual patient encounters in February 2020. In April 2020, that number had jumped to 242,000.

In 2018, 18% of physicians treated patients through telehealth, according to a national survey conducted by Merritt Hawkins (an AMN Healthcare company) on behalf of The Physicians Foundation. In an April 2020 survey, Merritt Hawkins and The Physicians Foundation found that the number of doctors treating patients through telehealth had increased to 48%.

"Patients love the telehealth experience, and physicians have come around to its benefits," Kvedar told us in a recent conversation. "There's no doubt that the expanded role of telehealth is going to stick."

Christine Mackey-Ross, RN

Though exceptions are possible, the role would most likely be filled by a physician leader, according to Kvedar. An advanced clinical perspective would be required, as the CDCD would be responsible for assessing which services can be safely and effectively delivered through telehealth and which cannot. A command of data, medical training, and experience would be essential to both conceptualize the program and ensure its clinical effectiveness.

Somewhat surprisingly, Kvedar suggests that the CDCD would not necessarily be a change agent.

"At this point, the key players have embraced telehealth concepts and technology. You don't have to convince them to change," Kvedar said. "Now the position is more operational than inspirational. How do you integrate telehealth into all the necessary patient record touchpoints? What is the right balance between your brick-and-mortar resources and your virtual resources? How do you address all the reimbursement, patient privacy, and related challenges?"

Candidates for the role would not be abundant, as a specific background would be required. An experienced and respected leader with ambulatory care experience would be needed—someone who understands the practicalities of face-to-face patient encounters. Physician leaders with emergency medicine or primary care backgrounds might have an inside track, given their experience coordinating multiple specialty referrals.

Some home healthcare experience would be useful, while a thorough understanding of current telehealth technology and apps available on various platforms would be essential. The CDCD would need experience and aptitude in collecting and analyzing patient data, with a focus on outcomes research and safety, as well as knowledge of the regulatory environment. When serving at academic medical centers, scholarly output may be required. A deep IT background may not be necessary, as the technical aspects of implementation will fall to others. More important will be vision, commitment to quality, and the ability to lead.

"The position doesn't require a heavy technical background and it would be a mistake to make that the main qualification," Kvedar said. "You have to understand how the technology affects the user—whether the physician or the patient—and you need to be conversant enough with it so that you can't be fooled by people who know more. But as someone who is or has been an active practitioner, your main focus should be smoothly integrating telehealth into overall operations."

Success would be measured the same as in any service line, by evaluating gains in quality and safety metrics, outcomes, variations in care, market share growth, efficiencies, cost comparisons or cost per unit of service, and patient experience. The CDCD would typically report to the Chief Medical Officer (CMO) and would interact with the Chief Medical Information Officer (CMIO), the Chief Quality Officer, Chief Experience Officer, Chief Transformation Officer, and various ambulatory specialty care leaders within the hospital, system, or group.

Compensation probably would be at the Associate CMO/CMIO range, somewhere between $250,000 and $390,000, depending on experience, medical specialty, and clinical full-time equivalent.

Together, these leaders would develop the strategies, systems, staffing configurations, technical solutions, and outcomes metrics necessary to guide us from what remains a largely volume-oriented, transactional model of care that is behind the virtual curve, to the value-based, patient-oriented, technically advanced model to which we all aspire.

This, of course, is the optimistic view, but given the inspiring way healthcare professionals nationwide have responded to the current crisis, we're confident we can get there.

Christine Mackey-Ross, RN, is executive lead partner with AMN Healthcare Leadership Solutions.

Bernard Godley, MD, PhD, is lead physician executive of AMN Healthcare Leadership Solutions.

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