A Tale of Two Strategies: Remain Independent or Join a System

A Tale of Two Strategies: Remain Independent or Join a System

自COVID-19大流行开始以来, 与过去10年相比，独立医院和小型社区云顶集团40011官网通过全资产合并加入大型系统的趋势已经放缓. While the number of announced transactions for 2023 (55) is up from 2022’s recent historic low (52), it still trails the nearly 100 transactions announced each year from 2012 to 2019. 

Despite a decrease in the total number of transactions, the average size of each deal has notably increased in recent years, indicating that the types of organizations being acquired by larger systems are not the small, 十多年前的独立医院. 而, 面对天价的劳动力成本和来自非传统组织在医疗保健领域投资的竞争压力, 中型社区系统——以前有足够大的资产负债表来抵御经济不确定性——现在正在寻求与更大的系统合作，作为他们的战略选择方向1.

The average size of the hospitals engaging in transactions has grown in recent years, with the average revenue of transacting facilities exceeding $400 million. As shown in figure 1, this surpasses the prepandemic historic high of $296 million². 对于大型, 资金充裕的机构, 目前的市场代表了买方的机会，因为中型系统和剩余的独立医院对单独承担未来表示了极大的担忧.

_{图1: Revenue per Selling Hospital, 2017–2023 (in millions)}

There are various benefits smaller systems hope to realize in joining larger systems, including: 

• Infrastructure to help manage a shifting payer environment.
• 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, 放弃以社区为基础的治理来加入一个系统，并不是任何实体在没有经过深思熟虑的情况下做出的牺牲. 来支持这个决策, leaders typically compare the contrasting futures of remaining independent versus joining a larger system. 以下是董事会和高管在确定战略方向时要考虑的关键成功因素.

在保持独立的同时获得成功

如果一个组织决定保持独立, its future success depends on the eight factors shown below. 在这八个领域地位稳固的社区云顶集团40011官网很可能处于保持独立的有利地位, while those that are not should consider other options³. 此外, 与处于较弱位置的系统相比，加入一个表现良好的系统所获得的价值要少得多. 

It’s important to note that the ability of an organization to actually control or impact each factor varies. 系统领导者应该仔细分析他们相对于每个因素的位置，并制定策略来加强那些可能受到影响的因素.

_{图2: 决定成功保持独立的因素}

• 地理位置: 更广泛的地理覆盖范围和与其他竞争对手的距离都为享有这些优势的社区系统提供了强大的优势. While an organization’s location may be difficult to change, service area coverage can be improved with careful planning and targeted physician partnerships.
• 云顶集团40011官网对齐: Aligning physicians under three key elements—economics, 临床活动, and purpose—is essential to strong physician-hospital relationships. Because physicians influence all parts of the care continuum’s growth and effectiveness, strong physician alignment is the top indicator of success. 此外, it can be directly impacted by leadership via targeted initiatives.
• 付款人的关系: The payer mix of a given community plays a large part in determining the financial resources available to hospitals. 支付者高度集中或低偿付支付者比例高的市场风险大，容错余地小. 另外, 在未来的支付环境中，尚未建立必要的关系和基础设施来管理基于风险的支付的系统将面临重大挑战.
• 成本和收入结构: 那些大大减少了开销和, 通过伙伴关系, 组织外部优化的规模经济加强了他们的财务状况，从而加强了他们保持独立的能力. A larger system will not offer much by way of cost savings.
• 高质量的投入、过程和结果: Providing high-quality care is almost entirely within an organization’s sphere of influence. 随着消费者要求更高的透明度，领导层在定义组织质量标志方面的作用变得越来越重要. 此外, creating a high-quality signature in the market can be difficult for competitors to emulate, as it requires coordination and cooperation with various stakeholders, 尤其是云顶集团40011官网.
• 资本资产基础: Organizations that have not advanced their facilities and technologies, 或者那些资产负债表状况不佳的公司, are likely to face challenges if they remain independent of a larger system. The future environment will demand financial flexibility and access to capital at affordable rates.
• 社区支持: 社区对支持医院独立性的承诺与该设施提供的感知价值直接相关. 一个组织与社区的紧密联系可以减少来自云顶集团40011官网或外部参与者的竞争机会, 在某些情况下, directly support its financial success through tax revenues or philanthropy.
• 连续管理: 作为社区连续护理的组成部分，一直是医院持续成功的重要因素. But with the increasing emphasis on population health, 一个组织在领导和管理急性护理以外的连续护理方面的能力，为它提供了比市场上其他组织更强大和持久的竞争优势.

当加入一个系统时获得成功

选择加入更大系统的组织必须遵循这一决定，采取两个关键步骤:(1)最大化其价值，使其处于最有利的议价地位;(2)选择合适的合作伙伴.

在某些情况下，选择伴侣很简单. 例如, 一些加入大型区域系统的医院之所以这样做，是因为几乎所有的医务人员都已被该系统雇用. 因此，没有其他现实的选择.

在其他情况下, 然而, the organization must determine the right system partner using the criteria below.

使命、愿景、价值观和文化

Joining a system with a significantly different mission, 愿景, 值集, 文化是一个困难的命题, and leaders must honestly and realistically assess the impact of these differences. This is especially true when a nonprofit entity considers a for-profit partner. In these scenarios, the statement “culture trumps strategy” should drive decision-making.

治理

Systems today are continually moving toward a more centralized model in response to industry pressures. While the governance consideration often revolves around reserve powers, the real priority for community systems should be determining how a locally based, 管理, 在这种集中化下，受治理的机构将继续与人民的需要保持联系，以及未来的决策结构将如何允许满足这些需要.g., through the remaining structures of the local board).

管理及架构

如上所述, 系统正在迅速整合决策, which means the role and structure of local management must be considered when seeking a partner. 例如, will the local management team be able to lead initiatives for the community, or will its role be simply implementing and managing decisions from the system office? Additional elements to be examined include (1) the potential centralization of key services, 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, strong consideration should be given to the system’s ability to streamline processes, especially back-office processes that are sensitive to scale economies. 必须创造更多的价值来抵消来自公司办公室的间接分配，这是每个系统的现实.

连续的临床云顶集团

收购和系统增长的主要驱动因素是对流动卫生模式和不断变化的医疗保健提供范式的关注，许多较小的社区系统感到准备不足. 像这样, the potential partner’s positioning within the continuum, as well as the ability to organize and provide value across it, 应该被评估.

财务状况

财务状况 tend to be the central focus of many partnership and merger discussions. 加入更大系统的组织通常会努力为其社区确保最佳的财务支出，并/或为当地医疗保健云顶集团系统提供最强有力的资本投资承诺. 典型的协议已经从几年前的“替换医院”承诺转变为包括有针对性的住院设施升级和对云顶集团40011官网的投资, 流动的空间, 以及医疗保健的其他部分.

展望未来

Macroeconomic and regulatory changes have shifted the competitive landscape for community hospitals and smaller, 区域医疗保健系统. 对这些变化做出适当的反应意味着为您的组织确定最佳的战略方向, whether it be remaining independent or joining a larger system. 显然没有人知道未来会怎样, 领导者可以考虑各种因素来帮助评估组织在每种情况下的成功潜力. 未能在其控制范围内利用成功因素的组织可能会被潜在的合作伙伴抛在后面，或者被迫对准备得更好的系统的战略计划做出反应.  

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_{编辑:Emily Johnson}

_{This article was originally published in the American Health Law Association Journal in July 25, 2024.}

_{Copyright 2024, American Health Law Association, Washington, DC. 已获转载许可.}

出版于2024年8月2日