Under Vision 2020, hospital officials evaluated various practice models, in part by looking at how service line physician groups and organizational staff "relate to one another and the hospital." In addition, the hospital leadership stated in the plan that the "acute care hospital should no longer be the center of the health system, but rather part of a coordinated continuum of care delivery to serve people through the illness, healing, and wellness phases of life."
Indiana University Health made a strategic decision about how to deliver services as a large system, according to Schwartzentruber, noting that the system's oncology service line, for instance, "had been functioning as a bunch of independent components" at its various hospitals. The components were not coordinated. As they developed the strategic plan, leaders examined other facilities within the Indiana University Health system to determine how best to proceed.
About 18 months ago, the IUH officials examined their hospitals' experiences to review the quality of service lines and get tips whenever and wherever they could. "We were charged with putting together the service line and basically we traveled the state. We created a vision for what the service line would be like," Schwartzentruber recalls.
Dealing with demographics
Depending on regional needs, one service line may be important for a hospital or healthcare facility, while it is a losing proposition for another. One factor that could have an impact on individual service lines is the healthcare needs of those who may be among the 32 million people to be insured within the next two years under the Patient Protection and Affordable Care Act.
The Christ Hospital initiated a new musculoskeletal program geared toward the elderly population and younger baby boomers who are now reaching age 50. The hospital chose musculoskeletal services to form a "market-leading program," Caillouet says.
"It was important to develop a strategic network of care—similar to what we had in successful heart and vascular programs—for musculoskeletal," he says. The Christ Hospital musculoskeletal service line includes surgical and nonsurgical spine, total joint replacement, sports medicine, and general orthopedic services. The program was added to the hospital's other service lines: heart and vascular, oncology, women's health, and geriatrics. Other hospital departments fall into either "specialized surgical care" or "integrated medical management" categories, Caillouet says.
"The ortho community here was quite fragmented and so we believed there were great opportunities," Caillouet says. Recruiting and realigning physicians was essential, with "surgeons and nonsurgeons working together to streamline the service," as well as improving relationships with primary care, rehab, and neurology physicians, he adds.
With a better-aligned and -positioned service line, The Christ Hospital had 7,100 orthopedic surgical cases in 2012—a 9% increase over 2011, which had 6,500 cases. In addition, the hospital led the tristate area with 24% share in spine surgery. Surgical complications rates decreased to 24% last year. In the meantime, inpatient direct variable cost per case in the 2012 fiscal year decreased by 8% compared to the same period the previous year, Caillouet says.
The hospital is coordinating the new musculoskeletal program with The Christ Hospital Spine Surgery Center, a freestanding facility for outpatient spine surgeries and pain management procedures. The surgery center is included in a partnership among The Christ Hospital, spine specialists from the Mayfield Clinic in Cincinnati, and United Surgical Partners International, a Dallas-based for-profit that owns and operates surgery centers and private surgical hospitals in the United States and the United Kingdom.
Keeping an eye on competition is critical, says Loos of Palmetto Health. "You don't want to be a patient and wait six months to see a specialist." If they faced that kind of wait, "patients may choose to go to Charleston or Greenville to competing hospitals," he says. So Palmetto is examining potential shortages in key medical and surgical positions or subspecialties that it may need to buttress to maintain or expand patient access. Service lines are being designed not only for improved clinical care and outcomes, but also with an eye to the manner in which the organization can attract them into the system, he adds.