The Mayo study raises concernsabout too much consolidation of influence in the boardroom, ratherthan with those whose expertise is at the bedside. (Photo:Shutterstock)

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An annual ranking of the most influential people in health care hassharply tilted toward CEO's in recent years, a new study said, asthe number of academics and advocates on the list has decreasedsignificantly.

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The analysis, published in Mayo Clinic Proceedings, looked at anotherpublication: Modern Healthcare, and its yearly rankings of the 100most-influential people in U.S. health care. The study by Mayoresearchers noted that the widely quoted rankings have a relativelyopaque selection process—making it more difficult for power playersto game the rankings.

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Related: 12 biggest names in health caredisruption

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What the Mayo Proceedings study found is that the rankings haveincreasingly favored executives from health care organizations.Health care CEO representation in the top 100 list "…has increasedfrom 23 percent in 2002 to 72 percent in 2018, with an apparentsubstantial upward inflection in this trend since 2009," the studyfound. "This predominance appears to be at the expense ofacademics, advocates, and government officials."

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A sea change after passage of the ACA

Interestingly, the data seems linked to the passage of theAffordable Care Act in 2010, according to Victor Montori, aco-author of the paper. CEOs were generally ranked more highly thanother groups in the Modern Healthcare lists from earlier years. Butafter 2010 the rankings of the other two groups identified in thestudy—academics/advocates and government officials—dropped steadilyuntil the latest ranking, where those two groups stood at 10percent. The CEO rankings rose as those of other influencersdropped.

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"In the last decade or so there's been a takeover of the spaceof influence by chief executive officers," Montori said in aninterview published by the Brainerd Dispatch. "The proportion of themincreased in the last 16 years, from CEOs being about 23 percent ofthe list to being about 72 percent. Their influence has beensteadily increasing over time, and especially since 2009."

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The study also outlined the relatively lower influence of women(listed at a range of 17 percent to 28 percent of the Top 100rankings), patients, and trade associations of health care workers."Our findings suggest that patients and clinicians are neitherdefining what health care is nor deciding how it should evolve,"the study said.

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A Managers' Coup D'état?

A critic of corporate America, Roy Poses of the blog "Health Care Renewal," calls the study moreevidence that the manager class has taken over industries such ashealth care. "We have frequently discussed the rise of genericmanagers," he writes. "Managerialism is the belief that trainedmanagers are better leaders of health care, and every other sort oforganization, than are than people familiar with the particulars ofthe organizations' work. Managerialism has become an ascendantvalue in health care over the last 30 years."

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The Mayo study, while more cautious than Smith's blog, alsoraises concerns about too much consolidation of influence in theboardroom, rather than with those whose expertise is at thebedside.

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"We found that the perceived influence over US health care ofchief executives of health systems is increasing. To the extentthat the ranking validly reflects influence, the sharp rise in theinfluence of chief executive officers at the expense ofrepresentatives of patients or health professionals may underscorethe increasing industrialization of health care," the analysissaid. "This trend placing health care influencers within C-suites,accountable to boards mostly comprised of other corporate leaders,may explain the rise of business language and thinking, for example[the term] 'high-value health care.'"

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