3. Take the savings and invest. Now reallocate the resources you were going to spend on the closed program—salaries, equipment and the like—to the service lines in which you do have a competitive advantage. You might have a top cardiology program that desperately needs more resources to compete with competitors who are nipping at your heels or you might want to spend some of the cash on developing a strategy to buy or build complementary services, such as wellness centers and rehab centers. Part of your reimbursement under bundling will depend much more on how the patient progresses over a longer period of time, with penalties for rehospitalization.
4. Develop alliances and sub out parts of the healthcare continuum. Of course an alternative acquisition or organic growth into support services like rehab, imaging or wellness is building strong contractual relationships with providers who will take care of your patients once they leave your high-acuity facility. Even Geisinger, held up as a model of effective bundling of healthcare services, doesn't own its rehab facilities. They're owned by HealthSouth, but since the facility depends on Geisinger for about 80% of its patient census, it has a vested interest in keeping those patients, and Geisinger, happy with the care outcomes.
Granted, this is only a column and is not a substitute for your own due diligence in these matters, but I sense a feeling of helplessness among many of the leaders I talk to about being held hostage to a constantly moving target that is healthcare reform. By preparing in broad strokes for a future that is less procedure-based and more holistically based, you're doing the right work, even though you're not sure how the reimbursement landscape might ultimately change.
I'd love to hear from those of you who have retooled in the face of growing pressure to achieve value in healthcare. I'm sure there are lots of great ideas out there, and I'm excited to see how hospital leaders plan to transform their organizations strategically.