Better outcomes? The role of the "Chief Outcomes Officer"

As we continue to challenge the status quo and the current path of pediatrics, its important that we think of how to transform outcomes not balance sheets. I would argue that we need less pediatric CEO's and more pediatric COO's, Chief "Outcome" Officers.

I see a concerning trend in pediatrics where physicians are overly focused on revenue generation than impacting better outcomes.?? I see more MBA’s, more “pediatric CEO” offerings, and more executive development than I see how to drive outcomes, population health and ensuring our mission as pediatricians is being met.? We want better outcomes for kids, right?

The reality is that pediatricians are suffering to meet the needs of their practices. My perspective is not to deny that primary is hard or that the revenue focus is not one of choice but necessity. However, I do believe that if we are to transform pediatrics and primary it won't be by hoping payment reform will save us. We must think much harder about driving outcomes that demonstrate our value to patients, families and maybe some day the insurers.

If you don’t see this trend, just ask a pediatrician to demonstrate their outcomes?? How they know they are offering great care??? Is it RVU’s, HEDIS metrics, or investing in the hoops of becoming PCMH certified.?? Sadly, we all know these metrics say next to nothing about quality or outcomes. How many will show you how few of their asthmatics get admitted, their kids go to the ER less, and the number of positive developmental screenings they have uncovered? This travesty is not only on pediatric primary care, but in my practice as well. As a pediatric er physician, I have no way to point to you my outcomes nor can I point you to outcomes metrics that are measured or compared across the country. We do have patients per hour, RVU's per hour, wait times and percent of children we admit. We pay plenty of attention to this data, but where are the real outcomes? I find this mind blowing in medicine.

Pediatric healthcare is at a crossroads, often driven by a business model that increasingly prioritizes volume over value. The RVU wheel in pediatrics is not just inefficient; it is counterproductive. We are caught in a cycle of administrative expansion, where the focus on increasing Relative Value Units (RVUs) overshadows the mission to improve patient outcomes. Pediatric care needs leaders who champion innovation over operational metrics, leaders who are driven by the outcomes of their young patients rather than the bottom line.? We pediatricians need to challenge each other to not be defensive but rather to be open to asking ourselves “are we on the right path?”??

Physician entrepreneurs in pediatrics bring a critical perspective to this challenge. They combine clinical expertise with a visionary approach to address systemic problems that are unique to pediatric healthcare. Unlike traditional executives with MBA backgrounds who may excel in scaling businesses and managing via excel spreadsheets these physician leaders understand the intricacies of pediatric care from the inside out. They think more about system design, aligning patient needs with care delivered and pulling patients into care more than pushing them out.

Consider the "Chief Outcomes Officer" as the antidote to the pervasive issue of treating healthcare like a conveyor belt or money stream. In the realm of pediatrics, where the stakes include the health and future of children, we cannot afford to prioritize quick fixes over sustainable health outcomes. Physician's who focus on the outcomes can be uniquely positioned to drive change that aligns with the long-term health needs of children, integrating innovative technologies and therapeutic approaches that support holistic care.? These physician are also not opposed to risk based contracts as they know their outcomes are excellent and continually improving.??

For example of how outcomes first thinking could change pediatrics, pediatric healthcare innovation might reimagine the use of electronic medical records (EMRs) in ways that genuinely enhance patient care. Currently, EMRs often serve more as burdensome data entry systems rather than tools that facilitate better health outcomes. If pediatrician innovators were at the helm of EMR transformation, all this data collected would be used by the practice to drive patient care.? How many asthmatics? Who is missing their well child checks?? How many of our kids are on controller medication for asthma??? How are our patients with obesity doing?? Can you we use data analytics to see if our care is working and effective? Are we getting kids better or just enhancing RVU's?

Moreover, the experiences that pediatricians bring—such as breaking difficult news to families, handling the complexities of pediatric chronic diseases, or managing acute emergencies—can fuel their drive to innovate. These are not merely professional experiences; they are profound human encounters that underscore the urgency of improving pediatric healthcare systems and technologies.? Bad outcomes are the worst in pediatrics and the hardest on the pediatricians, the families and our patients.? Improving outcomes not driving revenue should be our path and will improve our own satisfaction as well.? Burnout will not be solved by debating how much we get paid, should get paid or if we get paid.? Doing the right thing rarely aligns with the RVU in my experience and the RVU's never seem to drive career satisfaction.

We need to foster an environment where more pediatric physicians feel empowered to step into outcomes based innovation. Where we define, measure, and continually seek to improve the outcomes we want to achieve. This involves providing platforms for sharing ideas, accessing startup capital, and encouraging collaborative ventures that bridge the gap between medicine and technology.? We need to stop bashing innovators or seeing them as evil.? Those who are threatened by changing the status quo, which obviously ain’t great, are the biggest challenge to transforming pediatrics toward outcomes. Are we willing to ask the real question? Is our care really as good as we think it is?

Let's give thanks for the pediatric physician innovators, challengers and those willing to take risk. We need more pediatricians to lead change and not simply hold onto the status quo.?Let’s take the blinders off and move away from our focus on “how to generate more revenues” and advocacy for more pay while our patients outcomes suffer. ?lt's time to champion a shift towards innovation-led pediatric care that promises a healthier future for all children.

Outcome centered will move us back to delivering great care, fostering relationships, ensuring continuity and reaping the rewards of a career in pediatrics.?? If you chose one of the lowest paying specialties for the money, I feel bad for you.?? My bet is you chose it for the mission, the rewards of child’s hug and the thanks of a parent who sleeps better at night because of the trust they have in you as their child's pediatrician.

We can be the change we want to see.

Note:?As a reminder this newsletter is written from my experience and perspective.?The newsletter does not imply or relay the opinions of others.??The intent is to offer an avenue for dialogue and discussion around important topics in healthcare and healthcare innovation from one doctor’s perspective.??I am a physician and so can only write from my perspective.?If you are clinician, provider, nurse or whatever my goal is to enable you to agree or disagree and have not intention to suggest or imply that only the physician perspectives matter.??They do matter but as part of a larger dialogue that can foster better health outcomes.?