Lee A. Fleisher, M.D., M.L., of the University of Pennsylvania and former Chair of Anesthesia at Penn

Summary

Becker’s Healthcare Podcast: In-Depth Conversation with Dr. Lee A. Fleischer

Episode Overview

Title: Becker’s Healthcare Podcast
Host: Becker's Healthcare
Guest: Dr. Lee A. Fleischer, M.D., M.L., of the University of Pennsylvania and former Chair of Anesthesia at Penn
Release Date: July 29, 2025

In this insightful episode, Scott Becker engages in a comprehensive discussion with Dr. Lee Fleischer, a distinguished physician leader with a remarkable career spanning clinical practice, administrative leadership, and policy development. The conversation delves into the current and emerging trends in U.S. healthcare, the integration of artificial intelligence, challenges between medical staff and hospital leadership, and strategic advice for health system leaders.

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Introducing Dr. Lee Fleischer

The episode begins with Scott Becker welcoming Dr. Fleischer, who graciously shares his extensive background. Dr. Fleischer outlines his multifaceted career:

“I'm still a practicing anesthesiologist twice a month at the University of Pennsylvania, where I was the chair of anesthesia from 2004 to 2020...” ([00:33])

He highlights his leadership roles, including his tenure as Chair of the Credentials Committee and involvement with the Professionalism Committee and Quality Improvement. Dr. Fleischer also discusses his pivotal role at the Centers for Medicare & Medicaid Services (CMS), where he served as Chief Medical Officer and Director of the Center for Clinical Standards and Quality from July 2020 until 2023. Post-CMS, he established Rubrim Advising, focusing on quality, regulatory, and policy work, and collaborates with the Bipartisan Policy Center on Artificial Intelligence regulations and serves on the Health IT Advisory Committee to the Office of the National Coordinator.

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Key Trends Shaping Healthcare Today

Dr. Fleischer provides a broad perspective on the predominant challenges facing the healthcare sector:

“All of healthcare is now having, I think, two challenges. One, we recently had the passage of the big beautiful bill that has put incredible financial pressures on health systems...” ([02:37])

1. Financial Pressures: The recent legislative changes, particularly those affecting Medicaid in rural areas, are exerting significant financial strain on health systems. Dr. Fleischer is actively collaborating with Governor Mike LeVitt and other stakeholders to address these downward financial pressures.

2. Workforce Challenges Post-COVID: The healthcare workforce has not fully recovered from the strains of the COVID-19 pandemic. Issues such as burnout and staffing shortages remain prevalent, complicating patient care delivery.

3. Rise of Artificial Intelligence (AI): The integration of AI in healthcare presents both opportunities and challenges. Dr. Fleischer emphasizes the dual aspects of AI—enhancing patient safety while introducing new risks. He notes that patients are increasingly seeking information from AI tools like ChatGPT, which can lead to more time-consuming consultations amid already constrained resources.

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Navigating the Integration of Artificial Intelligence

The conversation delves deeper into the role of AI in healthcare:

“A lot of people are using it for ambient listening. But we know that many of these products can hallucinate...” ([04:12])

Opportunities and Risks: AI technologies offer promising advancements in areas such as clinical decision support within Electronic Health Records (EHRs). However, concerns about AI "hallucinations" and its applicability to diverse patient populations highlight the need for meticulous oversight.

Regulation and Trustworthiness: Dr. Fleischer discusses regulatory frameworks, suggesting that Quality Assurance and Performance Improvement (QAPI) programs will play a crucial role in governing AI usage. He states:

“AI will be regulated if there are medical errors that occur within health systems... perform the same sort of QAPI programs as you would if you had a medical error from an infusion pump or bed rails...” ([04:12])

Ensuring AI systems are trustworthy involves continuous assessment and local implementation strategies, with accreditation bodies like the Joint Commission overseeing compliance.

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Challenges Between Medical Staff and Hospital Leadership

Dr. Fleischer shares his experiences balancing clinical roles with administrative responsibilities, especially during the COVID-19 pandemic:

“I still remember when there were discussions between OSHA and the CDC about whose guidances should dictate what happens in hospitals...” ([06:21])

Safety Concerns: The pandemic underscored the importance of maintaining both patient and staff safety. Dr. Fleischer recounts addressing rising violence against healthcare workers by prioritizing safety as a condition of participation for hospitals. This initiative was reinforced by accrediting bodies holding governance bodies accountable.

Quality Assurance: Emphasizing the role of governing bodies, Dr. Fleischer explains:

“Governing bodies are responsible for ensuring quality assurance, performance improvement...” ([06:21])

By integrating quality assurance into the core responsibilities of hospital leadership, institutions can better navigate the complexities of patient care and staff well-being.

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Current Focus and Exciting Initiatives

As the healthcare landscape evolves, Dr. Fleischer highlights several initiatives he is passionate about:

1. Hospital at Home Program:

“We stood up hospital at home. In fact, we stood it up in seven days, which I think is unheard of for a government program...” ([08:44])

Originally launched in response to the pandemic, the Hospital at Home program enables patients to receive hospital-level care in their homes. Dr. Fleischer is advocating for its continuation and permanent establishment, emphasizing its benefits in reducing the need for rehabilitation and enhancing patient comfort.

2. Safe Integration of AI:

“How should we really bring that safely into the health care system?... keeping the physician and the clinicians in the thought process to improve care for patients.” ([08:44])

Dr. Fleischer envisions AI as transformative, particularly for rare diseases, provided that clinicians are adequately trained to interpret and incorporate AI-generated insights into patient care.

3. Enhancing Communication Between Clinical and Administrative Leadership:

“The ability to talk to each other and understand each other's language is critical...” ([12:44])

Through teaching courses on quality and innovation, Dr. Fleischer is fostering better communication between clinical staff and financial/administrative leaders. He underscores the importance of mutual understanding in prioritizing patient care and innovation, ensuring that initiatives like Hospital at Home receive necessary support and funding.

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Core Advice for Hospital and Health System Leaders

Wrapping up the conversation, Dr. Fleischer offers strategic guidance for healthcare leaders:

“We need to keep the patient at the center of what we do... no money, no mission...” ([12:52])

1. Patient-Centered Focus: Prioritizing patient care while aligning with the organization's mission is essential for sustainable success. Dr. Fleischer recounts how focusing on quality care during a financial crisis at Penn led to improved patient outcomes and system stability.

2. Quality Over Compliance: He advocates for exceeding minimum standards, emphasizing that delivering high-quality care will naturally attract patients and ensure organizational success.

3. Collaborative Learning: Encouraging leaders to teach and support each other in achieving common goals fosters a culture of continuous improvement and innovation.

4. Support from Accrediting Bodies: Dr. Fleischer expresses enthusiasm for the Joint Commission's efforts to delineate minimum standards from excellence in care, promoting a clear pathway for healthcare organizations to strive beyond compliance.

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Conclusion

Dr. Lee Fleischer's extensive experience and forward-thinking perspectives provide invaluable insights into the current state and future direction of U.S. healthcare. From addressing financial and workforce challenges to harnessing the potential of artificial intelligence and fostering strong leadership, his contributions underscore the multifaceted approach required to navigate the complexities of modern healthcare systems.

As healthcare continues to evolve, leaders can draw inspiration from Dr. Fleischer's commitment to quality, innovation, and patient-centered care, ensuring that the industry not only meets present demands but also anticipates and prepares for future advancements.

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Notable Quotes:

• “AI will be regulated if there are medical errors that occur within health systems... perform the same sort of QAPI programs as you would if you had a medical error from an infusion pump or bed rails...” ([04:12])

• “We stood up hospital at home. In fact, we stood it up in seven days, which I think is unheard of for a government program...” ([08:44])

• “The ability to talk to each other and understand each other's language is critical...” ([12:44])

• “We need to keep the patient at the center of what we do... no money, no mission...” ([12:52])

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This episode of Becker’s Healthcare Podcast offers a comprehensive exploration of the challenges and innovations shaping healthcare today, guided by the expertise of Dr. Lee Fleischer. Whether you are a healthcare professional, administrator, or policy maker, the insights shared provide valuable guidance for navigating the evolving landscape of U.S. healthcare.

Transcript

[Scott Becker]

This is Scott Becker with the Becker's Healthcare Podcast. We're thrilled today to be visiting with a brilliant physician leader who's had an incredible career. We're joined today by Dr. Lee Fleischer. We're going to talk to him about a number of issues, trends. He's watching what he's most focused on, advice for health system leaders, and sort of the biggest challenges he sees between medical staff, hospital leadership, and a lot more. Dr. Fleischer, can you take a moment to introduce yourself and tell us a bit about your background and your experience?

[Lee Fleischer]

Scott, thank you so much. Please call me Lee. I'm very proud. I'm still a practicing anesthesiologist twice a month at the University of Pennsylvania, where I was the chair of anesthesia from 2004 to 2020. I had a phenomenal time while I was there, and I ended up being the chair of the credentials committee for 15 of those 17 years because two of the years I was chair of the medical board and very involved with the Professionalism Committee and Quality Improvement. But then in July 2020, I was invited by Seema Vermin to be the Chief Medical officer and the director of the center for Clinical Standards and Quality at cms. So at that time, I oversaw all the conditions of participation, the survey and certification and national coverage decisions and quality measures for the country. So in 2023, I left the agency after the end of the public health emergency, and I continue to work. I have an advising firm called Rubrim Advising who does quality regulatory and policy work, including with health systems, to address challenges based on how the federal government sees them. But I've stayed involved in the policy side, and I work with the Bipartisan Policy center on Artificial Intelligence and Regulations of Artificial Intelligence, as well as being a member of the Health IT Advisory Committee to the Office of the National Coordinator.

[Scott Becker]

Fantastic. You have a big view of health care. You understand it as well as anybody. What are the key trends that you're watching currently? What do you see? What do you watch? What are the big trends you have your eye on?

[Lee Fleischer]

Well, you know, all of healthcare is now having, I think, two challenges. One, we recently had the passage of the big beautiful bill that has put incredible financial pressures on health systems that, particularly with the concerns around Medicaid, particularly in rural areas, that we hear about, something that I'm working on with Governor Mike Levitt and others, that that downward pressure on finances is real. At the same time, we have a workforce that really has never fully recovered from COVID They continue to see challenges, and with the Rise of artificial intelligence. There are lots of questions about how do we use it to both achieve greater patient safety? What are the risks? And our patients are now going to be coming to us, asking us questions based upon going to one of the AI queries, whether it be ChatGPT or any of the others, and asking us questions that will take us more time when we have actually less time to spend with an individual patient, given those other pressures.

[Scott Becker]

Yes. And there's going to be lots and lots of those pressures and there is going to be less time to spend with patients. And that's a horrendous situation. How do you solve that? Are there ways to solve that?

[Lee Fleischer]

Lee, you know, a lot of us have been thinking about how do you get to trusted artificial intelligence? And you know, as one part of the equation, can it help on the back end? And lots of people are using it for ambient listening. But we know that many of these products can hallucinate. We know that they may not understand some of the issues of unique populations that they haven't been trained on. We now have clinical decision support being implemented in our electronic health records. So our EMRs, how do we know it can be trustworthy? One of the things that I published immediately after I left the agency was that the conditions of participation and that quality assurance and performance improvement is a way that AI will be regulated if there are medical errors that occur within health systems that in fact you should perform the same sort of QAPI programs as you would if you had a medical error from an infusion pump or bed rails or anything else in your health system. So I think as we continue to look and make sure we're up to date with our artificial intelligence and that we know assess how to implement it locally, we have to realize that there are potential for risk. And that being the oversight and the idea of accreditation, that I think will be one of the ways it's regulated at the local level.

[Scott Becker]

Fascinating. And talk about you've had this fascinating sort of relationship and role as an administrator, the chair of a medical board, you're a practicing physician. What do you see flipping into hospitals now systems as the biggest challenges between medical staff and hospital leadership today?

[Lee Fleischer]

You know, it was interesting when I continued to practice during COVID In fact, I still remember when there were discussions between OSHA and the CDC about whose guidances should dictate what happens in hospitals. And being a practicing clinician, I was able to say what would happen if both of them were implemented locally. And that was helpful in really focusing at least the federal oversight on CDC guidances. But this idea of the stresses that the clinicians are feeling. So in one place, one of the things that we did was we issued a guidance that said you must keep and have a priority around safety in hospitals. And that not only is patient safety, but safety of the staff. Every time I would come in, in 2021, 2022, the staff would tell me, the nurses, the physicians, the rest of the environmental staff, that they felt unsafe because they would see a rise of violence against clinicians. And that's why we said it's important that the leadership of the hospital, that that is a condition of participation. And the joint commission and DNV and the state survey agencies and CMS would all hold you governance bodies accountable. In fact, one of the changes we made during my tenure was to say that governing bodies are responsible for ensuring quality assurance, performance improvement, and that it is important when they do surveys on behalf of CMS that they look at how much time is spent on quality assurance.

[Scott Becker]

Thank you. And so critical. Take a moment. Lee, you do so many interesting things. It's amazing, the constant network, the bill that you visit with. What are you most focused on and excited about as we get to the back half of this year and into next year?

[Lee Fleischer]

You know, one of the things that what's very exciting to me is in November 2020, Deborah Birx, who headed the White House task force in the first Trump administration, came and said to my boss, the administrator, we have nothing left. What ideas do you have? And to ensure hospital capacity? And we stood up hospital at home. In fact, we stood it up in seven days, which I think is unheard of for a government program. But I had an amazing team of clinicians and non clinicians, and it's still going. And I'm excited that they are still looking at how with the waiver, we could continue that program. It should be overseen by hospitals. That's my strong belief. We recently formed an alliance to try to bring ideas that would help Congress decide how to extend it and then how to make it permanent. Because I think it really helps patients who have the right infrastructure stay at home for their hospitalization and then not need rehab because they actually start at home. So very exciting program that I hope to continue. We're spending a lot of time, as I talked about, about artificial intelligence. How should we really bring that safely into the health care system? I think it will be transformative for rare diseases because we as clinicians will start thinking about it. But I think that we need to be trained how to use it how to think about the output from the computer which says here's things to think about and then use our own thought processes to incorporate it. Really keeping the physician and the clinicians in the thought process to improve care for patients. Lastly, you talked about medical staff and one of the things I've seen in this period of intense financial pressures. I teach a course at Pennsylvania on the science of quality and Masters in Innovation. And I used to bring in the CFO and the CEO because what I've always learned going back to that book Men are from Mars and Women are from Venus is the ability to talk to each other and understand each other's language is critical. I think the other thing I'm excited about and some of the things we're working on is how do we make sure that clinicians always say this is great for patient care. This gets back to my innovation. How do we make sure that they say this is a high priority that will make a difference? Here's the return on investment. This is why you should start some innovation. Give me funding to innovate quickly. But if it doesn't work, and here are the metrics, here's how we should de adopt this innovation into clinical practice. And I think that what I'm hoping, given the various roles I've had, is helping others learn about that way to really talk to the CFOs who are under intense pressure and CEOs particularly if they're non clinical, so that we adopt the right programs like hospital at home, like safety for our staff and why that's so important.

[Scott Becker]

Thank you. And Lee, to finish up, take a moment and talk about what sort of core advice would you give to hospital and health system leaders today?

[Lee Fleischer]

You know, I think that the core advice is that we need to keep the patient at the center of what we do. But as I was taught by the multiple CEOs that I've worked with, you can't do it. No money, no mission. Mission is critical. And what was great at a time I was at Penn as they were coming out of a financial crisis and we really worked as a team, both the health system and the leadership, to say this is what's important, this really will make a difference. And what we learned particularly was if we focused on quality, but really did it in a thoughtful way and improve quality and we delivered that high quality care, patients will come and we will be successful. So that is my advice. Learn how to teach each other how to help each other to achieve the goals. And importantly, I'm very excited about the work of the Joint Commission, how they're really moving to separate in their new accreditation system the conditions of participation, which is that minimum standard that I had the privilege of leading for those three years at CMS in their development and the guidances and how we thought about it, as well as delivering care above that minimum standard.

[Scott Becker]

Dr. Fleischer, I think that's a remarkable message on delivering the highest quality care above standards. Greatness, aiming for greatness. And we focus there. We'll be okay. Thank you so much for joining us today on the Becker Self Care Podcast. Look forward to visiting with you more. Thank you very much for joining us.