HealthTrust CMO Michael Schlosser spends eight days a week helping clinicians use evidence to make informed decisions about products and procedures
Michael Schlosser
In January 2015, HealthTrust appointed Michael J. Schlosser, M.D., FAANS, as the organization’s first chief medical officer (CMO). Dr. Schlosser is a board-certified neurosurgeon whose clinical practice focused primarily on complex spine surgery and surgical neuro-oncology.
“Adding a full-time CMO is a continued investment in advancing a clinical agenda that supports our member providers and the outcomes so critical to their success,” said HealthTrust President and CEO Ed Jones, at the time. “The CMO will also bring a new level of expertise to clinical value analysis – increasingly a critical part of the way medical supplies and, in particular, physician preference items, are selected and sourced.” Schlosser was also charged with expanding opportunities for physician engagement in purchasing decisions through leadership of the HealthTrust Physician Steering Committee.
Born in Detroit, Mich., and raised in Tucson, Ariz., Schlosser previously served in leadership roles at TriStar Centennial Medical Center in Nashville, including chief of staff and chief of surgery. Prior to accepting the position of CMO for HealthTrust, he worked as medical director for Parallon Supply Chain Solutions
Journal of Healthcare Contracting: Can you share a day – or a week – in the life of the chief medical officer of HealthTrust?
Michael Schlosser: My typical week involves one or two days of travel. This might be for a customer-facing event where I’m presenting on HealthTrust’s clinical agenda – how we’re incorporating physicians and evidence into our processes, what we’re doing with clinical outcomes data, and how we’re driving toward an evidence- and data-based approach to device utilization. I might also be meeting with physician leaders and hospital and supply chain executives to help them develop processes for driving better value from medical device utilization in their facilities.
Another one or two days per week I spend working within the GPO, both with national contracting teams focused on physician preference item agreements and the custom contracting group for medical devices. In 2015, my team launched the HealthTrust Physician Advisors program, giving these contracting specialists access to physician subject matter experts. We also have a robust clinical evidence team to research products and procedures. My role is to support these clinical assets and ensure they’re better used in HealthTrust’s contracting processes.
For the remainder of the week, I’m generally working with HealthTrust’s InVivoLink team and HCA’s supply chain. InVivoLink is a registry that captures detailed information about patients undergoing orthopedic and spine procedures, and the implants and approaches used in the operating room, and links that to the outcomes of those surgeries. We’re implementing InVivoLink at many HealthTrust member facilities based on the particular outcomes they want measured and dashboard views that will best engage and support their physicians.
More broadly, we’re optimizing the InVivoLink tool to support the new Comprehensive Care Joint Replacement Program of the Centers for Medicare & Medicaid Services, which may soon be forcing bundled payments on 75 markets across the country. Everyone is scrambling to figure out what they’re going to do when that program launches, possibly as early as Jan. 1, 2016. InVivoLink is positioned to play a key role by providing real-time cost-per-case data as well as tracking key clinical outcomes, helping organizations manage the critical aspects of bundled episodes of care.
With the HCA supply group, the focus currently is on engaging physicians around a supply chain agenda for 2016 that will address physician preferences and utilization of various products. We’ll be using evidence-based approaches that include the launch of physician-led committees, best practices, and optimized order sets and protocols.
I think that all might add up to more than five days, but I would never be happy if I wasn’t busy.
JHC: As HealthTrust CMO, what are some of the key strategic areas of focus in the year ahead?
Schlosser: We’re going to spend a lot of time in 2016 focused on how to support supply chain organizations, and contracting and purchasing departments, to be successful working under the growing number of value-based payment models (bundled payments being the most common). As more care is delivered in a value-based or risk-sharing format, there will be greater need for those in supply chain to have an evidence-based and outcomes-focused approach to device decisions.
One category of products on our radar is the rapidly expanding field of biologic products approved through the FDA regulatory process for human cells, tissues, and cellular and tissue-based products (HCT/P), so we can start understanding where these products are adding value and where they’re just adding costs. Cells harvested from amniotic fluid, for example, might be applied to burns and wounds or injected into tendons or the spine without ever having demonstrated efficacy, or even safety, for any of those indications. HCT/P manufacturers look to the market to generate some of that data, but isn’t keeping pace with utilization.
Our objective is to stay ahead of these new technologies and help our members understand the clinical and economic impact. Another example is a collaborative effort we have with invasive cardiologists in the HealthTrust Physician Advisors program to evaluate how absorbable coronary stents should be deployed to create the most value for patients. Clinical evidence also needs to be regularly amassed and examined for a whole host of med/surg products, including sutures, endomechanical products and hernia meshes.
JHC: Prior to becoming CMO for HealthTrust, you were medical director for Parallon Supply Chain Solutions, assisting in the development of evidence-based and physician-led approaches to hospital supply decisions. How have your responsibilities changed since becoming CMO of HealthTrust?
Schlosser: At Parallon I was tasked with creating different structures to engage physicians in supply decisions regarding the adoption of new technology within individual HCA facilities and, on a regional basis, spine and orthopedic devices. Since becoming CMO of HealthTrust, my responsibilities have expanded to include physician engagement in contracting at the GPO level, and utilization up to the IDN or national level, on behalf of the HealthTrust membership.
JHC: Where is the industry in terms of making “evidence-based decisions” about medical devices and equipment? Have we “arrived” at that point yet, or not? Why do you say that?
Schlosser: We’re in transition. We’re moving in that direction. We have the desire to use evidence-based approaches to decision-making around medical devices, but in many areas, we lack the right kind of data. We’re coming close with cardiovascular devices, where randomized controlled trials, national registries and other data sources provide 80 to 90 percent of the picture needed to understand how to tailor utilization to get the best outcomes. On the other end of the spectrum are spinal implants, where we have a very small percentage of the data we need due to the complexity of those procedures and wide variations in technique and surgical approaches, as well as the lack of randomized controlled trials and comparative effectiveness studies.
Step one to bridging that gap is collecting the right kind of information, such as the database we’re building with the InVivoLink tool. Once the data is collected, the right analytic approach is needed to make the data consumable and actionable. The next step is building the process for implementing those evidence-based decisions. This includes a collaborative approach with physicians, supply chain, hospital leadership and others on the OR team. The process needs to spell out the way decisions will get enacted upstream by the people who actually do the purchasing and write contracts, and the way the downstream effects of those decisions will be tracked in terms of patient outcomes.
In pockets around the country, there are hospitals and systems that are pretty far down this pathway to a value-based approach. But other organizations have not even started their journey. So there’s a lot of work to do before we’re at the point where we can say we’re truly making evidence-based decisions.
JHC: Do you make a distinction between evidence-based decision-making and clinical value analysis? If so, what is it?
Schlosser: To me, clinical value analysis is the process you use to operationalize evidence-based decision-making for devices and technology. It’s focused as much on how you implement and support an evidence-based approach as it is on the evidence and the decisions themselves.
JHC: On the HealthTrust website, you write: “Data and published evidence on their own will not provide us with all the answers. We must turn data into knowledge and then apply that knowledge to everyday practice.” Can you elaborate on this, and how it might play out in the typical hospital or IDN?
Schlosser: Data by itself does not give you answers. You have to make the data actionable, to actually change behavior and outcomes. Physician subject matter experts are needed to give the data context, for example to help understand the patients on whom data was collected and how that translates to everyday practice, and help you come up with best practices or guidance around that evidence. Is the data compelling and should practice patterns change, or is it biased and more study is needed before action is taken? That’s step one.
Step two is to turn that knowledge into practice. If the data is compelling, how do we communicate the results and implement change? This step involves looking at your physician leadership structure and communication plan. Both steps require a concerted effort and an implementation strategy.
JHC: You were chief of staff and chief of surgery at TriStar Centennial Medical Center. In the typical hospital, what are physicians’ primary misgivings about getting involved in product evaluation/selection? How can the supply chain director address those misgivings and enlist the support of his or her physicians and surgeons?
Schlosser: It’s less about misgivings than time constraints. Physicians have a lot on their plate and are constantly having to do more while getting reimbursed less, so asking them for their time is a challenge. One way to address that is to make their involvement valuable for them. If you’re a supply chain director asking physicians to attend a meeting to talk about value analysis, be sure it is well run and you have the right information on hand so it’s not just another meeting. Be respectful of their time.
You’ll also need to develop physicians’ trust that you will really include them in the process and listen to their advice, as well as follow through on decisions that are made. Unless you can build that trust, it can be hard to get physicians involved in evaluating products. Being willing to take action based on the outcomes of the meeting and provide follow-up in a timely manner will help build that trust.
JHC: My understanding is that physicians and surgeons can come to rely on medical device salespeople for knowledge and understanding of devices, equipment, etc. How important is that relationship between the clinician and the sales rep? Should the supply chain director leave such relationships undisturbed? Why or why not?
Schlosser: The relationship between clinicians and sales reps has become really important, and is probably the one that has the biggest impact on device choice and utilization. Studies looking at how physicians make decisions about which devices they will use reveal that sales reps are the first or second most influential factor. So it’s important for us to understand how those relationships are maintained and used to drive utilization.
I think supply chain directors need to break physicians of their habit of relying on sales reps as their source of truth on outcomes and clinical evidence. No one can deny that vendor-sponsored studies are biased, and that’s generally what reps are using as their sales tools. We would like to see HealthTrust, healthcare systems, supply chain, peer physicians or any combination of those folks become that source of truth. That still leaves sales reps with an incredibly important role supporting physicians in appropriate product use once their evidence-based decision has been objectively reached.
JHC: We see hospital systems acquiring physician practices. One would think that employed physicians would be more compliant with administration’s product decisions than independent physicians. Yet on our website, you point out that’s not the case. Why?
Schlosser: How physicians practice medicine – e.g., how neurosurgeons decide what implant they’re going to use and what approach they’re going to take – is a critical part of their identity as a physician. A signature on an employment contract is unlikely to change how they make decisions or cause them to turn over control of product choice to a hospital system. As we’ve seen with electronic health records and drug formularies, it really doesn’t matter what language is in the contract. Physicians are going to treat patients the way they think they should be treating them. That’s not to say that there’s not an opportunity to develop best practices tied to improved outcomes. But administrators need to take a collaborative approach to building and implementing them with physicians based on the best proven ways to treat patients, not tell them what to do once they’ve signed on the dotted line.