About

Lee A. Fleisher, M.D., M.Law, is an Emeritus Professor of Anesthesiology and Critical Care at the University of Pennsylvania Perelman School of Medicine. He continues to practice clinically and serves as the Founding Principal and CEO at Rubrum Advising, LLC. Dr. Fleisher has held significant leadership roles, including serving as the Chair of the Department of Anesthesiology and Critical Care at the University of Pennsylvania Health System and as the Chief Medical Officer and Director of the Center for Clinical Standards and Quality at the Centers for Medicare and Medicaid Services from July 2020 to July 2023. His responsibilities included executing national clinical, quality, and safety standards for healthcare facilities and providers, as well as establishing coverage determinations to improve health outcomes for Medicare beneficiaries. His research focuses on perioperative cardiovascular risk assessment and reduction, evidence-based medicine, measurement of quality of care, and health policy. Over the years, Dr. Fleisher has collaborated extensively on health services research and quality measurement, particularly within the Medicare population. He has authored over 300 articles, chapters, and books, and his work has been supported by numerous federal, industry, and foundation grants. His clinical expertise includes general anesthesia, and he has contributed significantly to the fields of anesthesiology and critical care through both research and practice. Dr. Fleisher was elected to the National Academy of Medicine in 2007 and has served on various committees related to health services and policy, reflecting his influence and leadership in healthcare quality and policy development.

Research topics

• Medicine
• Political Science
• Psychiatry
• Social psychology
• Psychology
• Intensive care medicine
• Surgery
• Engineering ethics
• Cardiology
• Pathology
• Nursing
• Anesthesia
• Law
• Engineering

Selected publications

• Advancing Antimicrobial Stewardship With Diagnostic Excellence: The Role of Bayesian Reasoning

  Open Forum Infectious Diseases · 2026-03-30

  articleOpen accessSenior author

  Antimicrobial resistance and inappropriate antibiotic use are urgent threats to global health and patient safety. Early antibiotic prescribing often occurs despite uncertain infection status, leading to unnecessary exposure and contributing to resistance. This article advocates for strengthening antimicrobial stewardship by integrating diagnostic stewardship and Bayesian reasoning to more explicitly consider disease probability in clinical decisions. In particular, probability thresholds should be included in clinical guidelines to inform testing decisions that may prompt antibiotic initiation. We provide several clinical examples and highlight the need for clinician education in Bayesian reasoning, underpinned by real-time decision support tools. Anchoring clinical practice in probability-based frameworks promises to refine antibiotic prescribing, enhance patient safety outcomes, and curb the progression of antimicrobial resistance.

  PublisherDOI

• A Retrospective Analysis of Post-Stroke Rehabilitation with Real World Use of Brain- Computer Interface

  Research Square · 2025-04-02

  preprintOpen access
  PublisherDOI

• Correction: Adherence to recommended practices for perioperative anesthesia care for older adults among US anesthesiologists: results from the ASA Committee on Geriatric Anesthesia-Perioperative Brain Health Initiative ASA member survey

  Perioperative Medicine · 2025-12-03

  articleOpen access
  PublisherOA PDFDOI

• Regional Anesthesia

  Anesthesiology Clinics · 2025-10-16

  articleOpen access1st authorCorresponding
  PublisherOA PDFDOI

• Reimbursement for AI—Balancing Innovation, Adoption, and the Medicare Trust Fund

  JAMA Cardiology · 2025-05-14

  article1st authorCorresponding
  PublisherDOI

• Artificial Intelligence in Anesthesiology and Perioperative Care: An Inevitability Requiring Appropriate Safeguards and Education

  Anesthesiology Clinics · 2025-07-02

  editorialOpen access1st authorCorresponding
  PublisherOA PDFDOI

• Postoperative Delirium in Older Adults Undergoing Noncardiac Surgery

  JAMA Network Open · 2025-07-08 · 28 citations

  articleOpen access

  Importance: Understanding the association of postoperative delirium with adverse outcomes and the hospital-level variation of postoperative delirium is important for efforts to improve perioperative brain health. Objective: To examine (1) the association of postoperative delirium with 30-day mortality and complications and (2) hospital-level variation in postoperative delirium. Design, Setting, and Participants: This retrospective cohort study examined hospitalizations among patients aged 65 years and older who underwent noncardiac surgery in US hospitals between January 1, 2017, and December 31, 2020. Data were analyzed between August 28, 2024, and April 10, 2025. Exposure: Postoperative delirium. Main Outcomes and Measures: The association of the composite of death and major complications with postoperative delirium was examined using multivariable logistic regression. Variability in the hospital incidence of postoperative delirium was evaluated using multilevel logistic regression analysis. Results: Among 5 530 054 inpatient admissions for major noncardiac surgery in 3169 hospitals, the mean (SD) patient age was 74.7 (7.0) years, and 3 161 054 admissions (57.2%) were of female patients. The incidence of postoperative delirium was 3.6% (197 921 admissions). Compared with patients without postoperative delirium, patients with postoperative delirium were more likely to experience death or major complications (adjusted OR [aOR], 3.47; 95% CI, 3.41-3.53; P < .001), 30-day mortality (aOR, 2.77; 95% CI, 2.71-2.83; P < .001), and nonhome discharges (aOR, 3.96; 95% CI, 3.88-4.04; P < .001). Controlling for patient characteristics, the odds of postoperative delirium were higher for patients undergoing surgery in hospitals with a higher rate of postoperative delirium compared with hospitals with lower rates of postoperative delirium (median OR, 1.53; 95% CI, 1.50-1.56). Conclusions and Relevance: In this national retrospective cohort study of more than 5.5 million hospitalizations, older individuals undergoing major noncardiac surgery who experienced postoperative delirium had 3.5-fold higher odds of death or major complications, 2.8-fold higher odds of death, and 4.0-fold higher odds of nonhome discharge. There was substantial variation in the hospital rate of postoperative delirium after accounting for patient risk, which suggests that this complication may be an appropriate target for hospital efforts to improve perioperative brain health, provided that delirium screening and coding accuracy are improved.

  PublisherOA PDFDOI

• Towards responsible artificial intelligence in healthcare—getting real about real-world data and evidence

  Journal of the American Medical Informatics Association · 2025-07-26 · 6 citations

  articleOpen access

  BACKGROUND: The use of real-world data (RWD) in artificial intelligence (AI) applications for healthcare offers unique opportunities but also poses complex challenges related to interpretability, transparency, safety, efficacy, bias, equity, privacy, ethics, accountability, and stakeholder engagement. METHODS: A multi-stakeholder expert panel comprising healthcare professionals, AI developers, policymakers, and other stakeholders was assembled. Their task was to identify critical issues and formulate consensus recommendations, focusing on the responsible use of RWD in healthcare AI. The panel's work involved an in-person conference and workshop and extensive deliberations over several months. RESULTS: The panel's findings revealed several critical challenges, including the necessity for data literacy and documentation, the identification and mitigation of bias, privacy and ethics considerations, and the absence of an accountability structure for stakeholder management. To address these, the panel proposed a series of recommendations, such as the adoption of metadata standards for RWD sources, the development of transparency frameworks and instructional labels likened to "nutrition labels" for AI applications, the provision of cross-disciplinary training materials, the implementation of bias detection and mitigation strategies, and the establishment of ongoing monitoring and update processes. CONCLUSION: Guidelines and resources focused on the responsible use of RWD in healthcare AI are essential for developing safe, effective, equitable, and trustworthy applications. The proposed recommendations provide a foundation for a comprehensive framework addressing the entire lifecycle of healthcare AI, emphasizing the importance of documentation, training, transparency, accountability, and multi-stakeholder engagement.

  PublisherOA PDFDOI

• Enabling access to genetically modified cell therapies through flexible approaches to manufacturing and cost recovery

  Journal for ImmunoTherapy of Cancer · 2025-12-01 · 3 citations

  articleOpen access

  Genetically modified cell-based therapies hold transformative potential, particularly for patients with rare cancers and ultra-rare diseases. However, progress toward regulatory approval, reimbursement, and broad patient access is often constrained by misaligned regulatory, manufacturing, and financial frameworks that do not reflect the realities of treating small populations and low-throughput production models. Drawing on a collaborative white paper and public meeting convened by Friends of Cancer Research and the Parker Institute for Cancer Immunotherapy in May 2025, this commentary outlines three strategies to streamline regulatory pathways and enable timely, sustainable access: (1) flexible approaches to Chemistry, Manufacturing, and Controls requirements in small populations, (2) adaptable regulatory frameworks to support diverse manufacturing models, and (3) limited cost recovery mechanisms to bridge early access and development gaps. Recent regulatory and policy discussions have echoed these priorities, signaling an opportunity to align oversight with operational realities to advance innovation and access for patients in high-need settings.

  PublisherOA PDFDOI

• Integrating Performance Measurement into Payment Policy – The Role of the Federal Government in the United States

  2025-08-08

  otherOpen accessSenior author

  The US Federal Government, particularly through the Centers for Medicare & Medicaid Services (CMS), has significantly influenced the integration of healthcare quality performance measurement into payment policies, promoting accountability, transparency, and improvement. CMS programs cover nearly 150 million people and account for over $1 trillion in annual healthcare expenditures, with value-based programs (VBPs) directly linking payment to performance. The evolution of quality measurement has occurred in a complex ecosystem involving multiple federal agencies and stakeholders. Yet despite challenges such as fragmentation, reporting burdens, and alignment across programs, these initiatives have led to some notable improvements in care quality and safety. Ongoing efforts focus on enhancing equity, adopting digital data strategies, and refining quality metrics to better serve diverse populations. The federal government remains pivotal in shaping healthcare's future by continuing to push for higher standards and more efficient systems.

  PublisherOA PDFDOI

Frequent coauthors

• Duminda N. Wijeysundera

  131 shared

• Mark D. Neuman

  University of Pennsylvania

  126 shared

• Michael P. W. Grocott

  University of Southampton

  122 shared

• Paul S. Myles

  The Alfred Hospital

  100 shared

• Meghan B. Lane‐Fall

  University of Pennsylvania

  80 shared

• Ala Nozari

  Boston Medical Center

  75 shared

• Robert D. Dripps

  75 shared

• Jeffrey H. Silber

  University of Pennsylvania

  66 shared

Awards & honors

• Elected to the National Academy of Medicine of the National…