Even as hospitals and doctors are giving gas to their system-formation efforts, communities are crying, "Hit the brakes!"
That means integrated delivery systems better show they can perform in 1997 or they will appear increasingly inadequate to meet community and financial pressures.
Community scrutiny of systems, which was growing in 1996, will intensify.
For example, December brought a surprising lawsuit in Florida in which a private hospital essentially was asked to justify its merger plans. In the suit, Florida Attorney General Bob Butterworth demanded Boca Raton (Fla.) Community Hospital show how the deal meets the wishes of hospital donors.
Elsewhere, citizens are alert for trouble at existing systems. Three class-action suits have been filed against Marshfield (Wis.) Clinic that accuse the 450-physician clinic of overcharging consumers. The suits came after a court found the clinic had violated antitrust laws.
The trend seems to be toward increased questions about the value of integration, and 1997 promises to be the year communities ask of all hospital integration, "What's in it for us?"
Financial pressures are mounting, too.
Profits are slipping at HMOs, which are supposed to save America from spiraling healthcare costs. Only 61% of HMOs reported operating profits in 1995, down from 88% in 1994, mainly because of increased medical costs, according to InterStudy, a Minneapolis-based managed-care research firm.
As a result, providers can't escape rate-reduction pressures from HMOs.
The Twin Cities often are touted as the place that's gotten healthcare right, but integrated healthcare is struggling there.
Allina Health System, which pooled a giant HMO and provider network under one company in a highly praised and widely watched merger, said it had "a difficult year" in 1996. It's now locked in a battle with Blue Cross and Blue Shield of Minnesota, which wants a rate reduction. And it plans to reduce system overhead by 15%, or $37 million, next year.
If Allina Executive Officer Gordon Sprenger-who's also American Hospital Association chairman-can't make integrated healthcare work, who can?
And if you thought 1996 was nasty, get ready for the mean season of 1997. All signs point to more open feuding between health plans and systems as they strive to perfect integrated healthcare.
Dirty advertising already is on the rise as organizations scratch and claw at each other. Criticism of for-profit healthcare likely will grow louder, too, partly because not-for-profit systems will want to use their tax status as a marketing edge.