Ron Greeno, MD, has the bug. The physician-entrepreneur, who helped birth the hospitalist movement and then co-founded a company to propel it forward, now wants to explore new ways to revolutionize healthcare--and start new companies to take advantage of them.

Dr. Greeno originally trained as a pulmonary critical care physician and then, with a partner, started a specialty group in downtown Los Angeles. It was successful, but it was just the beginning. "In 1993, the IPA at the hospital we admitted to asked if we'd be interested in managing all of its adult patients in the facility," he recalls. "We had never thought about being hospitalists. At that time, the term hospitalist hadn't been coined. But by agreeing to do what the IPA asked, that's what we became."

The approach simply made sense, Dr. Greeno says. The doctors in his group spent all their time in the hospital anyway, so they were best suited to take on inpatient duties for other patients as well. "We saw very early on the huge potential of a good hospitalist program for improving quality of care and patient satisfaction and providing care in a cost-effective way," he says.

In the mid-1990s, Dr. Greeno started toying with the idea of creating "an infrastructure you could wrap around a group of hospitalists to improve their performance," he says. That included decision-support mechanisms developed through a standardized operational model for hospital information systems. His group teamed with other "early hospitalist" groups and started bringing in nonphysicians to fill in their gaps in expertise. "We knew we were good doctors, but we didn't know anything about operations or information technology," he says. The model that incorporated the team's collective expertise became Cogent Healthcare, where Dr. Greeno now serves as chief medical officer.

Interestingly, Dr. Greeno's plans called for raising the capital to launch Cogent in 1997--which he did--and then returning to private practice. But the tremendous success of the enterprise changed those plans quickly. Now he wants to replicate the success of Cogent's annual 40 percent growth rate with new ventures to streamline the delivery of high-quality healthcare.

One project is The Cogent Group, a consulting arm. "That's giving me the opportunity to build another new business," Dr. Greeno says, enthusiastically. "And long-term, I've got a bunch of ideas in terms of new opportunities for improving the way communications take place along the healthcare continuum. Right now, we deal with patients while they're in the hospital. But where are they before they come in? And where are they after they leave? How do all their providers communicate?"

Answering those questions is a task ideally suited to hospitalist physicians, Dr. Greeno says. "Hospitalist medicine is much more organized than uncoordinated care. It's not one doctor-one patient; it's a team of providers taking care of a population of patients," he explains. "The key questions are how can we communicate better and share planning responsibilities, and how do we design a more intelligent system of care that wastes fewer resources. Everything I plan to do in the future will address those issues."

It's not the place you'd expect Dr. Greeno to be if you knew his dad, his uncles and his cousins, all of whom are coaches. "Nobody in my family was ever in medicine. I'm the black sheep because I'm a doctor," he quips. He enjoyed sports as an athlete, but preferred the sciences as a professional pursuit. "Medicine appealed to me because I could apply my love of science in a way that would be a positive to society--in a setting where I could be my own boss."

Dr. Greeno graduated from the University of Nebraska College of Medicine and completed a residency in internal medicine at the University of Iowa Hospitals and Clinics. He did fellowships in critical care and pulmonary medicine at the Memorial Sloan-Kettering Cancer Center and a research fellowship in immunology and cellular physiology at Rockefeller University. He is boarded in internal medicine, pulmonary disease and critical care and until recently served as co-medical director of the ICU and co-director of respiratory medicine at Good Samaritan Hospital in Los Angeles.

Making the switch from clinical practice to a mix of medicine and business has been energizing, Dr. Greeno says. "What has thrilled me more than anything has been having a career change relatively late in life and, as part of that, really broadening my view of the world beyond what I would have seen if I'd stayed in purely clinical practice," he says. "Things I knew nothing about and had some discomfort with, I'm now very comfortable with. I had to push myself outside my comfort zone and find out what I was really capable of."

That's just what happens when you trust your own judgment--something Dr. Greeno celebrates in his personal life as well. "This year was my 25th wedding anniversary," he says. "In Southern California, that alone is a surprise. But in our case, it is even more special. We only knew each other for six weeks before we got married--and we eloped to do it." His wife is also a physician--a cardiac surgeon, to be exact. "We have a wonderful family, and we've had a great marriage for 25 years."