Difficult Dilemmas for Chief Medical Officers: 30 Case Studies

Description

When Crisis Strikes, Who Do You Call?

Gain confidence solving complex CMO challenges through 30 real scenarios and proven solutions from experienced physician executives — practical wisdom without the consultant price tag.

You are facing an intoxicated physician in the ER. A respected surgeon is violating HIPAA protocols. A top revenue generator refuses to follow best practices. And you need answers — now.

Difficult Dilemmas for Chief Medical Officers: 30 Case Studies is like having a trusted mentor on speed dial. Drawing on more than 150 years of collective CMO experience, editors Rex Hoffman, MD, and Doug Koekkoek, MD, have assembled battle-tested solutions to the most challenging scenarios you will face as a physician leader.

This isn't theory. These are real dilemmas solved by real CMOs who have been in the hot seat — and lived to share their wisdom.

Inside, You Will Discover How Experienced CMOs Handled:

• Physician management crises that threaten patient safety
• Resistance to workflow changes and evidence-based practices
• Complex administrative and operational challenges
• Leadership situations that test your competencies and courage

Each case study walks you through the scenario, the thinking process, and the actual solution implemented — giving you a proven playbook for your toughest days.

Why This Book Is Different:

Unlike expensive consultants or lengthy executive programs, this book gives you immediate access to expert guidance you can reference whenever crisis strikes. Read it cover to cover or jump to the exact scenario you are facing today. Either way, you will gain the confidence that comes from knowing you are not alone — and that others have successfully navigated these same treacherous waters.

Perfect for:

• Current Chief Medical Officers seeking peer-tested solutions
• Aspiring CMOs preparing for leadership roles
• Physician executives in hospitals, medical groups, and health plans
• Anyone responsible for physician performance and hospital operations

Stop second-guessing yourself. Start leading with confidence.

About the Authors

Rex Hoffman, MD

Rex Hoffman, MD, is chief medical officer at Providence Holy Cross Medical Center in Mission Hills, California, where he has served since 2019. After a 19-year career as a practicing radiation oncologist, Hoffman earned an MBA in the Business of Medicine from the Kelley School of Business at Indiana University before transitioning to healthcare leadership. He has also served stints as interim CMO at two sister hospitals within Providence. Hoffman is dedicated to helping current and aspiring CMOs succeed through practical, experience-based guidance.

Doug Koekkoek, MD

Doug Koekkoek, MD, has been an influential leader in healthcare for more than two decades, leading primary care and specialty physician practices across major health systems. His respected leadership at Providence St. Joseph Health and PeaceHealth was instrumental in building strong physician cultures centered on quality, safety, and patient experience. Koekkoek is a fellow in the American College of Physicians and a senior fellow in Hospital Medicine at the Society for Hospital Medicine. He received his medical degree from Oregon Health Sciences University and completed his internship, residency, and chief residency at Providence Portland Medical Center.

Table of Contents

Dedication

Acknowledgments

About the Editors

Contributors

Foreword: John Koster, MD

Introduction: Rex Hoffman, MD, MBA, CPE, FAAPL, FACHE

Part I – Physician Management

1. Managing the Advanced Practice Clinician and Provider Workforce
2. Addressing the Intoxicated Physician
3. Interacting with the Disruptive Physician
4. Evaluating the Competency of the Aging Physician
5. Approaching a Complaint of Sexual Harassment
6. Responding to a HIPAA Violation
7. Ensuring Timely Documentation and Scrub Compliance
8. Acknowledging When Physician Rehabilitation Isn't Enough
9. Developing a Comprehensive Ambulatory Quality and Patient Safety Program in Your Medical Group

Part II – Physician Acceptance of Workflow and Best Practice

10. Creating Value by Standardizing Pharma and Device Choices
11. Striking the Balance — Tackling the E/M Coding Dilemma
12. Building a Peer Review Committee in an Employed Medical Group
13. Understanding and Addressing the Extended Stay of a Patient: The CMO's Role in Quality, Finance, and Patient Throughput
14. Establishing Peer Review in Small Departments: Strategies, Challenges, and Multidisciplinary Solutions
15. Dealing with Physicians Who Won't Get with the Guidelines
16. Ensuring Hospitalists Write Prompt Discharge Orders

Part III – Hospital & Medical Group Administrative and Operational Challenges

17. Promoting Provider – Payer Collaboration
18. Navigating Physician Pay Redesign Successfully
19. Overseeing the Management of Locums Tenens
20. Leading During a Disaster on Campus
21. Mitigating Gaps in Specialty Call Coverage
22. Negotiating Physician–Hospital Relationships: The Crossroads of Friendship and Fiscal Reality
23. Optimizing Operating Room Utilization
24. Reducing Malpractice Costs
25. Understanding Inpatient vs. Outpatient Reimbursement: Clinical Classifications, Financial Implications, and Controversial Cases

Part IV – Leadership Competencies

26. Becoming an Influential Chief Medical Officer
27. Promoting Hospital Benchmarks and Grades That Matter Most for Chief Medical Officers
28. Serving as a Multi-Hospital Chief Medical Officer
29. Getting Deposed … How to be a Good Corporate Witness
30. Tackling Primary Care Redesign

Bonus: Stepping in as Hospital's Interim Chief Medical Officer and Setting up the Next CMO for Success

Bringing It All Together