At the heart of regulatory reform: A doctor tempers public policy with diplomacy

Douglas L. Wood, MD, draws on problem-solving skills and cardiology training in his role as chair of the HHS regulatory reform panel.

By Markian Hawryluk, amednews staff. Aug. 26, 2002.

The Nation is their Patient
Doctors serve America at all levels of government. This occasional series explores how their medical background influences what they do.

A few years ago, Medicare regulatory reform seemed about as likely as a Middle East peace accord. Perhaps that made Douglas L. Wood, MD, the perfect man to chair the Dept. of Health and Human Services' regulatory reform task force. Dr. Wood almost opted for a career in foreign policy.

His senior year in college, Dr. Wood was torn between medicine and foreign affairs. His interview with a State Dept. recruiter fell two weeks after his medical school interview. The medical school appointment went so well, he never even met with the State Dept. official.

Douglas L. Wood, MD

Physicians and patients alike may be reaping the benefits of that decision. Dr. Wood has deftly led two high-profile efforts to relieve regulatory burdens for health care professionals.

He heads both the HHS advisory committee on regulatory reform and the American Medical Association's task force on Medicare evaluation and management codes.

The two panels are expected to release their recommendations this fall, and both hold significant promise for reducing doctors' Medicare burdens.

Dr. Wood's diplomatic talents are a prime reason why. "He's a consensus builder," said Nancy Nielsen, MD, PhD, a member of the regulatory reform committee.

This team approach has deep roots. Dr. Wood's interest in medicine came from seeing the strong contributions physicians made in his home town of Columbia, Mo. "I thought that was something I could aspire to -- the ability to give a lot to the community and others."

Dr. Wood began his medical training at the University of Missouri's Columbia School of Medicine, and then completed his graduate studies at the Mayo School of Medicine in 1983.

"The wonderful thing about Mayo is the intense commitment to the patient," Dr. Wood said. "Most of the people at Mayo train there, so there is a very intense bond and commitment to the way that we live and do our work."

Dr. Wood decided on cardiology after one of his early rotations in internal medicine. Cardiologists did not then have the drugs that are now a staple of treatment. Still, he was impressed by the impact the specialty could have on patients' lives.

He stayed at Mayo and completed cardiology training and advanced training in the emerging field of invasive cardiac electrophysiology. Dr. Wood worked on some of the first catheter ablations for supraventricular arrhythmia and ventricular tachycardia ablations.

"Our greatest limitation was equipment," Dr. Wood said. "We were using things that weren't really designed for what we were using them for. We had to find ways to make them work, as well as to find ways to invent new and more effective pieces of equipment."

That focus on innovation and overcoming hurdles has served Dr. Wood well in the public policy arena.

"I'm interested in doing what is necessary to solve problems," Dr. Wood said. "I tend not to be discouraged when somebody tells me it can't really be done this way."

Dr. Wood attributes that attitude in part to his mentor, Robert Frye, MD, who served as chair of the division of cardiology and subsequently the department of medicine at Mayo.

"He taught me much about being able to work in situations with people where there were obvious disagreements," Dr. Wood said. "And he taught me how to remain calm and organized in order to try to make progress when there appeared to be no chance of achieving any sort of agreement or solution to the problem."

Easing into leadership

Dr. Frye began to steer Dr. Wood toward leadership positions, sending him down the path to public policy work.

In 1990, Dr. Wood was named chair of clinical practice of cardiology. At the time, Mayo was beginning to get requests to develop a center of excellence for insurers.

"It was pretty clear that my background in cardiac electrophysiology didn't help me very much in understanding things like quality, management or reporting, or how to set up pricing structures or things like that," he said. "So I figured I had to get pretty smart about this pretty fast."

Dr. Wood began taking courses at the Wharton School and the University of St. Thomas in Minneapolis. That spurred an interest in some of medicine's administrative roles.

In a few years, Dr. Frye asked him to become chair of clinical practice for Mayo's department of medicine. That role introduced him to regulatory, rule-making and other Medicare payment issues.

Dr. Wood eventually chaired Minnesota's carrier advisory committee. He also presided over the American College of Cardiology's coding and nomenclature committee and was named to the Centers for Medicare & Medicaid Services' Practicing Physicians Advisory Council.

Within 10 years, Dr. Wood had become one of the nation's most knowledgeable physicians on coding and regulatory issues. Last year, he testified on regulatory reform before Congress and submitted similar testimony to the Medicare Payment Advisory Commission.

Dr. Wood's emergence on the national stage did not go unnoticed. Last year, HHS Assistant Secretary Bobby Jindal asked him to chair the regulatory reform committee.

Dr. Frye says Dr. Wood was a perfect fit. "He understands the reality on the business and health policy side, so it's a wonderful combination."

Dr. Wood, however, downplays his role, giving credit to his committee members. The panel has weighed in on the E&M guidelines, the Emergency Medical Treatment and Active Labor Act regulations, among other regulatory issues. A final report is due to HHS in October.

Dr. Wood, who still practices cardiology at Mayo, said that while patient care allows him to immediately see the effect of his work, it's limited to one patient at a time.

In the public policy arena, Dr. Wood can affect more people. "So they're both very gratifying but in very different ways."

However, he says that making public policy gains is much more complicated. There are multiple points of view, complex delivery systems and statutory limitations to consider. Still, as the regulatory reform and E&M efforts wind down, it's clear Dr. Wood has caught the bug.

"They've obviously both consumed a lot of my time over the last eight months, and when they're finished, there will be ... a little bit of a void," Dr. Wood said. "Public policy has an allure, so I hope to continue in another way."

He has no plans for policy work but expects "something will pop up."

If it doesn't, he'll probably spend more time gardening -- a hobby that suffered as his work load increased -- or playing golf with his kids.

He and his wife of 25 years, Julia, have four children ages 4 to 18. They are also hosting a foreign exchange student from Yugoslavia.

It seems Dr. Wood is still interested in foreign relations.

ADDITIONAL INFORMATION:

Douglas L. Wood, MD

Position: Chair, Health and Human Services Advisory Committee on Regulatory Reform
Born: June 24, 1951
Family: Married with four children
Specialty: Cardiology
Medical degree: University of Missouri, Columbia School of Medicine, 1977
Residency: Mayo Clinic, internal medicine, cardiology, 1977-1983.
Other positions: Vice-chair of Mayo Clinic department of medicine; coding and nomenclature chair, American College of Cardiology; charter member of Performance Measurement Advisory Council of Joint Commission on the Accreditation of Health Care Organizations; chair of Minnesota Medicare Carrier Advisory Committee; member of Practicing Physicians Advisory Council; and chair of AMA Evaluation and Management Task Force
Personal note: Spends free time gardening or thinking about gardening.