Healthcare executives who are serious about ensuring the survival of their institutions know they must walk the walk- not simply talk the talk-of transformation.
But amid the furious consolidation of nearly half the nation's hospitals into larger systems, some troubling sidesteps are evident. After the ink on the merger agreements dries, few institutions are making critical changes in service delivery and consolidating services to provide more effective care.
A survey released this summer by Deloitte & Touche found largely untouched the real challenge of combining services to achieve greater efficiencies. A meager 7% of respondents said patient services were cut or eliminated when they merged or joined larger organizations. What few service consolidations have been done have occurred primarily on the administrative side, said Deloitte's Raymond J. Cisneros. For example, 31% of 1,020 hospital executives queried said they consolidated accounting and finance functions, and 28% combined billing and collections.
Executives have been told repeatedly that in a managed-care era, bigger is not automatically better. But while many continue to be enamored with adding bricks and mortar, the industry is being swept by a growing tide of cost containment and capitation.
The era of patient evaluation of health plan data-and ultimately judgments about providers-is fast approaching. Some 9 million employees who are part of the Federal Employees Health Benefits program have just been told they will get quality data included in National Committee for Quality Assurance accreditation ratings to help them choose health plans for 1997.
Physicians and hospital executives must lead their organizations on a march toward value, defined as a combination of low cost and high quality. Achieving such excellence requires not bigger organizational charts but streamlined institutions responding to informed consumers and purchasers who are getting the tools needed to measure results.