两种策略的故事:保持独立还是加入一个系统
自COVID-19大流行开始以来, the trend of independent hospitals and small community health systems joining larger systems via full-asset mergers has slowed when compared to the last 10 years overall. 尽管2023年宣布的交易数量(55笔)高于2022年的近期历史低点(52笔)。, 它仍落后于2012年至2019年每年宣布的近100笔交易.
尽管交易总数有所减少, 近年来,每笔交易的平均规模都显著增加, 这表明被大型系统收购的组织类型不是小型的, 十多年前的独立医院. 而, faced with sky-high labor costs and competitive pressure stemming from nontraditional organizations investing in the healthcare space, midsize community systems—which previously had large enough balance sheets to weather economic uncertainty—are now pursuing partnerships with larger systems as their strategic direction of choice¹.
近年来,参与交易的医院的平均规模有所增长, 交易设施的平均收入超过4亿元. 如图1所示,这超过了大流行前2.96亿平方美元的历史高点. 对于大型, 资金充裕的机构, the current market represents a buyer’s opportunity as midsize systems and the remaining independent hospitals express significant concern about taking on the future alone.
图1: 每间销售医院的收入,2017-2023年(百万)
小型系统希望通过加入大型系统实现各种好处,包括:
- 帮助管理不断变化的付款人环境的基础设施.
- 具有开发门诊护理站点的专业知识.
- 以可承受的利率获得资金.
- 支持解决劳动力成本上升问题.
- 扩大市场准入.
- 规划和医师成长的能力.
然而, giving up community-based governance to join a system is not a sacrifice any entity makes without much deliberation and contemplation. 来支持这个决策, 领导者通常会比较保持独立与加入一个更大的体系的截然不同的未来. Detailed below are the key success factors to be considered by boards and executives as they determine which strategic direction to pursue.
在保持独立的同时获得成功
如果一个组织决定保持独立, 它未来的成功取决于以下八个因素. Community health systems that are positioned strongly in these eight areas are likely well positioned to remain independent, 而那些没有的人应该考虑其他选择. 此外, the value gained from joining a system will be far less for well-performing systems compared to those in weaker positions.
重要的是要注意,组织实际控制或影响每个因素的能力是不同的. System leaders should carefully analyze their position relative to each factor and create strategies to strengthen those that can be influenced.
图2: 决定成功保持独立的因素
- 地理位置: Both broader geographic coverage and long distances to other competitors offer a strong advantage to the community systems that enjoy them. 而组织的位置可能很难改变, 通过精心规划和有针对性的bet8网站备用合作,可以提高bet8娱乐区域的覆盖率.
- bet8网站备用对齐: 在三个关键因素下调整bet8网站备用——经济, 临床活动, 目的是建立牢固的医患关系的关键. 因为bet8网站备用影响着整个护理过程的发展和效果, 强大的医师联盟是成功的首要指标. 此外,它可以通过有针对性的举措直接受到领导的影响.
- 付款人的关系: 特定社区的付款人组合在决定医院可用的财政资源方面起着很大的作用. Markets with large concentrations of payers or high percentages of lower-reimbursing payers have a large risk and low margin for error. 另外, systems that have not developed the relationships and infrastructure necessary to manage risk-based payments are facing significant challenges in the future payment environment.
- 成本和收入结构: 那些大大减少了开销和, 通过伙伴关系, optimized economies of scale outside their organization have strengthened their financial position and thereby their ability to remain independent. 一个更大的系统在节省成本方面不会提供太多.
- 高质量的投入、过程和结果: 提供高质量的护理几乎完全在一个组织的影响范围内. Leadership’s role in defining the quality signature of the organization has become increasingly important as consumers demand more transparency. 此外, 在市场上创建高质量的签名可能很难被竞争对手模仿, 因为这需要各利益攸关方的协调与合作, 尤其是bet8网站备用.
- 资本资产基础: 没有先进设施和技术的组织, 或者那些资产负债表状况不佳的公司, 如果他们独立于一个更大的系统,可能会面临挑战吗. 未来的环境将要求财务灵活性和以负担得起的利率获得资金.
- 社区支持: A community’s commitment to supporting a hospital’s independence is directly correlated to the perceived value provided by the facility. An organization’s strong ties to the community can reduce opportunities for competition from physicians or outside players and, 在某些情况下, 通过税收收入或慈善事业直接支持其财务成功.
- 连续管理: Being an integral part of its community’s continuum of care has always been important for a hospital’s continued success. 但随着对人口健康的日益重视, an organization’s ability to lead and manage the continuum of care beyond the acute care component offers it a strong and durable competitive advantage over other organizations in the market.
当加入一个系统时获得成功
Organizations that choose to join a larger system must follow up that decision with two critical next steps: (1) maximize their value to put them in the strongest bargaining position and (2) pick the right partner.
在某些情况下,选择伴侣很简单. 例如, some hospitals that join large regional systems do so because nearly their entire medical staff is already employed by the system. 因此,没有其他现实的选择.
在其他情况下, 然而, 组织必须使用以下标准确定正确的系统合作伙伴.
使命、愿景、价值观和文化
加入一个有着完全不同使命的系统, 愿景, 值集, 文化是一个困难的命题, 领导者必须诚实而现实地评估这些差异的影响. 当一个非营利性实体考虑一个营利性合作伙伴时,这一点尤其正确. 在这些情况下,“文化胜过战略”的说法应该推动决策.
治理
为了应对行业压力,当今的系统正在不断向更加集中的模式发展. 而治理方面的考虑往往围绕着储备权力, 社区系统的真正优先事项应该是确定如何以当地为基础, 管理, and governed institution will remain in touch with its population’s needs under this centralization and how future decision-making structures will allow for these needs to be met (e.g.(通过当地董事会的其余结构).
管理及架构
如上所述, 系统正在迅速整合决策, 这意味着在寻找合作伙伴时必须考虑当地管理层的角色和结构. 例如, 当地的管理团队能够领导社区的计划吗, 或者它的角色仅仅是实现和管理来自系统办公室的决策? 需要检查的其他因素包括(1)关键bet8娱乐的潜在集中化, 比如金融, 采购, and IT; (2) changes to key reporting relationships for physicians and staff; and (3) any shifts in the ownership of decision-making related to strategic and capital investments.
另外, 应大力考虑该系统精简程序的能力, 尤其是对规模经济敏感的后台流程. More value must be created to offset the overhead assignments from corporate offices that are a reality of every system.
连续的临床bet8娱乐
A primary driver of acquisitions and system growth is the focus on ambulatory health models and the changing healthcare delivery paradigm that many smaller community systems feel ill-prepared to handle. 像这样, 潜在合作伙伴在连续体中的定位, 以及组织和提供价值的能力, 应该被评估.
财务状况
财务往往是许多合伙和合并讨论的中心焦点. Organizations joining a larger system generally work to secure the best financial payouts possible for their community and/or the strongest commitments of capital investment for the local healthcare delivery system. Typical agreements have moved away from the “replacement hospital” pledges seen a few years ago to now include targeted inpatient facility upgrades and investments in physicians, 流动的空间, 以及医疗保健的其他部分.
展望未来
宏观经济和监管的变化改变了社区医院和小型医院的竞争格局, 区域医疗保健系统. Responding appropriately to these changes means determining the best strategic direction forward for your organization, 无论是保持独立还是加入一个更大的体系. 显然没有人知道未来会怎样, leaders can consider a variety of factors to help assess their organization’s potential for success under each scenario. Organizations that fail to capitalize on the success factors within their control risk being left behind by potential partners or forced to respond reactively to the strategic initiatives of better prepared systems.
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1贾里德·朗格斯, 马克·约翰斯顿, 布莱恩Barnthouse, 肖恩,马路, 亨利Strull, 安德鲁·施罗德, Vasco Zamudio estate, 卢卡斯啊. 医疗保健米&季度更新:2024年第二季度. 2024年7月.
²LevinPro Healthcare&A. http://accounts.levinassociates.com/login/index&,
杰夫·霍夫曼,杰瑞德·朗格斯,马克·约翰斯顿. 确定伙伴关系和从属关系中最负责任的时刻. 心电图管理咨询公司,2024年5月. http://s6j2.mogrenlandscape.com/insights/article/3251/identifying-the-most-responsible-moment-for-partnerships-and-affiliations&盼;
编辑:Emily Johnson
这篇文章最初发表在7月25日的《bet8娱乐》上, 2024.
版权所有2024,美国卫生法律协会,华盛顿特区. 已获转载许可.
出版于2024年8月2日