If 1993 was the year of healthcare reform awareness, 1994 has the potential to be the year the legislative logjam is broken.
Regardless of what happens on Capitol Hill, healthcare administrators should stick close to home. The tone and outcome of committee hearings, behind-the-scenes lobbying and political posturing should serve as a guidepost to help shape strategy.
Congress may pass a comprehensive reform bill based on President Clinton's vision of a government-regulated, managed-competition model. However, it's just as likely that, instead of a major legislative package, only incremental changes will be signed into law in 1994.
Savvy providers will let trade associations, board members and the medical staff fight the war of words. The hospitals best suited to succeed under any reform scenario are those already constructing the organizational framework to compete in a prepaid managed-care environment.
By now, most hospitals have at least studied the market and discussed formal ties with physicians and other hospitals. Providers now realize they no longer can stand alone, oblivious to change. Employer coalitions, discount-minded insurers and cost-conscious government payers are demanding accountability and affordability. That translates to adaptability from providers.
Just getting the wheels in motion has proved an arduous task for some hospitals. The next steps in the streamlining process are bound to be challenging and painful, but they'll go a long way in separating the survivors from the doomed.
Integration efforts will require that managers identify physician leaders who can help develop the kind of physician-hospital organization that doctors want to join. Allowing physicians to retain a sense of autonomy is the best way to gain their confidence and financial support of the organization.
In addition, integration necessitates cooperation with rivals and partnerships with community groups and local government agencies. A sensible first step is assessing the community's health status and what can be done to improve the situation. Keeping the local media abreast of the activity is crucial.
Finally, integration may spark more collaborative efforts and mergers among hospitals. Such consolidation is viewed as a viable strategy to deal with reform. Forming new business ventures is easy. Choosing leaders, laying off workers, cutting costs and reshaping the institution will be much more difficult.
It's these kinds of changes that should monopolize most of top management's brain power in 1994. Let Congress wrestle with reform of the system while you concentrate on your organization's future and the healthcare needs of your community.
Clark W. Bell