Steven Kmucha, MD, JD is an otolaryngologist focusing on sleep surgery and sleep medicine. Based in the San Francisco Bay Area, Dr. Kmucha serves on the Board of Directors for the Health Services Advisory Group (HSAG), sharing his expertise on patient engagement, patient safety, and patient education.
Q: What are your area(s) of expertise in healthcare?
Dr. Steven Kmucha: I am a board-certified otolaryngologist with a fellowship in otology and certification in allergy by AAOA. I have extensive experience in sleep medicine/surgery. I have a master’s in medical management and a JD with an emphasis in health/healthcare law. I have served on numerous committees at the hospital medical staff, county medical society, state specialty society, and national specialty society level. I am very active in the California Medical Association (CMA) where I currently serve as a member of the House of Delegates and vice-chair of the Council of Ethical, Legal and Judicial Affairs; I was prior chair of the Committee on Quality Care and a member of the Committee on Science and Public Health. I served for many years in the Board of Governors of the American Academy of Otolaryngology (AAOHNSF) and was elected to the Board of Directors in 2019. I was a member of the California Delegation to the AMA where I served as chair of the Bylaws Committee.
Q: How did you become an expert in physician practice management education, patient safety, patient education, and risk management?
SK: Many years ago, I was appointed by the California Medical Association as a representative to the Pacific Business Group on Health where I was involved in projects to monitor physician compliance with scientific evidence, national care guidelines and clinical indicators, and appropriate antibiotic stewardship. This project was focused on identifying attribution at a granular level to determine which specific physician was responsible for which medical decision and for the provision of the precise components of a patient’s overall medical care. I was later appointed medical director of a large health-plan covering four western states where I was intimately involved in the daily decision-making about physician compliance with scientific evidence, national care guidelines, antibiotic stewardship, and chemotherapy protocols; much of this work was focused on the high cost and high-risk specialties of cardiology and orthopedics as well as medical oncology (due to the high cost of most chemotherapy). I was later promoted to the position of the chief medical officer with the same organization.
Q: How does patient education impact patient safety? Why does it matter?
SK: I was chosen to serve as a liaison between AAOHNSF and The Doctors Company to review closed malpractice claims in otolaryngology where I was provided with an insight into patient engagement, informed decision-making and the high variation in medical care and decision-making about surgery with resulting increased (and often avoidable) patient risk, as well as high (and again, often avoidable), increased cost. It is this potentially unnecessary medical care and associated costs that drives the high cost of healthcare in the US and also the diversion of healthcare dollars from patients and treatment where the long-term benefit and impact on patient quality of the life would be greater (considered a “tragedy of the commons” in law school), this has motivated me even more to increase my involvement in patient engagement and physician quality improvement. Part of these efforts include increased involvement in telemedicine to improve patient access to specialty care, provide support to primary care providers, reduce overall healthcare costs and, hopefully, reduce patient anxiety about their medical problems and the possible need for more travel, time off work/school for potentially unnecessary provider visits and testing. As a result of these experiences, I have been appointed to the highest level of certified medical specialist by the Medical Board of California and by the California Attorney General for which I have spent many years reviewing the appropriateness of care and providing feedback and physician guidance about abnormal variations in care and cost. I am the otolaryngology representative to the Medicare Carrier Advisory Committee in California as well as a member of the Board of Directors of HSAG, which is the Medicare QIO/QIN for California; in both positions, I am regularly asked to review appropriateness of medical decision-making, appropriateness of care, physician quality of care, care outcomes/cost, and whether the outcomes of care were consistent with patient goals. As a result, I have also become a quality of care consultant for the California Department of Rehabilitation and the California Department of Corrections.
Q: How does your work positively impact population health?
SK: I am very aware of the generally poor patient engagement in health care information and decision-making in the US, and I lecture and publish frequently in these areas to hopefully improve patient understanding of health and medical conditions and improve their engagement in their own medical care, improve patient decision-making and choices that affect their health, improve shared decision-making when medical care is necessary and improved informed consent about major medical decisions. Yet, I am also very aware that even the most advanced medical services provided to the right patients at the right time in the right location still only contribute about 20% of overall wellness; nearly 80% of wellness is defined by genetics, patient choices and social determinants of health. As a result, I have been involved in the development of 7 national guidelines and have had input into many more clinical indicators and other practice management publications. As a result, I am an active member of the AAOHNSF Practice Management Education Committee and the Patient Safety and Physician Quality Improvement Committee.
The Physician Innovation Network thanks Dr. Kmucha for his interest and engagement in our work, as well as his efforts in the patient safety and engagement spaces.