"World-Class Care Right in Your Neighborhood” sounds good as a marketing campaign, but as a strategy for healthcare systems, it is too often a formula for high-cost, mediocre care. To deliver value, there is a virtue to volume—concentrating patients with similar needs at sites where integrated teams can deliver better outcomes with increasing efficiency.
That means providers should not try to do everything everywhere, and that patients should be willing to travel a little further to get coordinated, higher-value care.
We do not mean going to teaching hospitals for every problem. On the contrary, to deliver value, routine care should be moved out of tertiary hospitals to lower-cost settings. But community hospitals should not try to meet all the needs of the patients in their local communities, if these needs can be addressed better and more efficiently elsewhere in the hospital's system or through affiliation with other well-equipped institutions.
It is not easy for community hospitals to give up services such as bariatric, cardiovascular and thoracic surgery—particularly if they are currently profitable under fee-for-service payments. But the harsh reality is that when every hospital in a region provides such services, patient volumes are diluted and at many institutions are insufficient to support the multidisciplinary, closely knit teams needed for real excellence. Also, costs are higher because staff cannot work efficiently, and supporting services needed for the condition (e.g. tailored nutrition counseling) are unavailable, inconvenient, or high-cost.
Consolidating and concentrating volume in fewer locations is the right thing to do for patients, for society and for delivery systems. When the volume of patients with a particular condition is concentrated, providers can build what we call “integrated practice units”—multidisciplinary teams that are completely focused on meeting the most common needs of patients with that condition over the full care cycle. In treating more patients with a particular condition, outcome and cost measurements improve, which can enable gains in quality and efficiency, led by team leaders who wake up every day thinking about how to do a better job. Volume also allows the institution to contemplate bundled-payment contracts, as well as incentives (financial and non-financial) to reward clinicians for improving outcomes and efficiency for the condition.