Cook County Health chief medical officer encourages healthcare leaders to be staunch patient advocates

Each day, Claudia Fegan, MD, brings her passions about healthcare reform and social justice to her role as chief medical officer of one of the nation's largest public safety-net systems.

Dr. Fegan, an internal medicine physician, became CMO of Chicago-based Cook County Health in 2013.

During her tenure, the Physicians for Social Responsibility recognized her for her work inspiring medical students to commit to social justice careers, and she received the Paul Cornely Award in 2017 for her activist work, according to her biography. She also has been vocal about her support for universal healthcare, even penning a book on the issue: Universal Healthcare: What the United States Can Learn from Canada.

Becker's spoke with Dr. Fegan during Women's History Month to discuss her role caring for underserved patients in Chicago. She also shared her thoughts on whether she thinks single-payer healthcare will be a reality across the U.S. and offered some advice for her peers.

Editor's note: Responses were lightly edited for length and clarity.

Question: As CMO of Cook County Health, how is your role different than it would be at another health system?

Dr. Claudia Fegan: I was a medical director at the now-closed Michael Reese Hospital and Medical Center in Chicago before I came to work at Cook County. I had about 800 physicians who in theory reported to me, but they were in private practice. I represented their voice, but I was also trying to ensure the quality of healthcare that we provided.

At Cook County, I have an employee workforce, and the physicians who work here are deeply mission-driven and they are committed to the patients we serve. I view my role as an advocate for those patients. But I recognize that I'm also the voice of those physicians who are taking care of those patients. I'm responsible for the quality of care we deliver. It's important to speak with one voice about what physicians' needs are and how we can best meet the needs of our patients.

When I was at Michael Reese, which had a large indigent population, it was predominantly private medical staff. And that medical staff — while committed to their patients — also had to keep their practices going. They were concerned about the bottom line and how we were going to survive economically. At a safety-net hospital, you're always concerned about how you're going to survive economically, but you also need to consider how to reach the patients where they are.

Q: In your opinion, what is the biggest reform the healthcare industry needs?

CF: Right now, we spend a lot of time and energy trying to decide how the care is going to be paid for. The first thing you see when you walk into a clinic, an emergency room, is registration. What's the purpose of registration? To ascertain how that visit's going to be paid for. If we had made a commitment that everyone was going to be taken care of and we have limited funds, how would we spend those dollars? We would spend it differently. It's the difference between having to have hundreds of clerks who could do registration and insurance verification as opposed to when I went to Toronto General Hospital, where they had only three billing clerks, and that was for the occasional American who came to Canada and got sick while they were there.

First, we have to take responsibility, say we're going to take care of everyone. Then we figure out how we're going to provide the best care for everyone, recognizing it's a limited resource and how you spend your healthcare dollars will vary from region to region. How you spend your healthcare dollars in Miami, where you have a lot of people who have retired, or you have snowbirds, is different from how you would spend your dollars on the South Side of Chicago or even in the Bronx, where you're concerned about the opioid problem, and you're concerned about making sure babies get well-child care, get immunizations. I think the first thing we need to do is first accept responsibility for everybody and then figure out how we're going to deliver that care.

Q: Do you think single-payer healthcare will become a reality in the U.S.? 

CF: Single-payer is a financial conduit. I think we will get to something like that. I know Congress tried so many times to repeal the Affordable Care Act, and they couldn't. I think the American public is starting to think yeah, people should be able to get the best care available. Once you start to think that way, you begin to figure out how we can get it done. The problem was we as a country never decided to accept the responsibility for everyone. We do it for education. We do it for police and fire protection. We recognize one person can't put out a fire in their home, that they need the help of others. We all banded together and decided we're going to take care of each other that way. And we recognize children need to be educated, and they don't always have choices about that, so then we as a society should put forth the resources to make sure that happens. I think if we did that with healthcare, we would do better. We spend more than anybody else in the world per person on healthcare, and yet we leave a third of the people in the country either uninsured or underfunded so they can't afford to get the care they need. Then we pay a terrible price. I look at maternal mortality, which has quadrupled in the 40 years I've been in practice. If you look at our response to COVID, it's due to our lack of accepting responsibility for all the members of our society.

Q: If you could pass along a piece of advice to other hospital executives, what would it be?

CF: I think we are most powerful when we are advocating for the people we take care of. No one wants to hear about whether we're meeting our margins or whether we have the appropriate bottom line. But when we advocate for the patients, the public listens and the public responds. 

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