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Leveraging Existing and New Assets to Compete Effectively
As the sole acute care provider in the community, this community health care system has been building their network of care for over 100 years. Despite the strong community reputation and ambulatory network the system has established over time, the system is now facing internal and external pressure associated with incoming competitors in growing markets and aging infrastructure. Catalyst was hired to provide strategic direction on how and where to make large capital investments.
Ambulatory Approach and Solution
The existing ambulatory clinics have varying degrees of occupancy and profitability. Although a majority of the ambulatory clinics are primary care, the system controlled less than 15% of the primary care market share and needed a strategy to increase market share and strengthen their referral stream to the hospital. Before simply adding another ambulatory clinic to the network to try to increase market share, Catalyst conducted a baseline analysis of the existing network and determined the underutilized clinics were oversized for their population base and located in areas with minimal new growth. Instead of continuing to sink capital into these locations, Catalyst recommended right-sizing the clinics and consolidating services into new locations that geographically better position the system to face competitors.
Even with no competing hospitals in the market, the system controlled less than 15% of the primary care market share.
SFMP Approach and Solution
The needs and opportunities in the acute care environment were also considered throughout the ambulatory strategy development process. The hospital campus evolved around the original 1909 building. Consequently, the main goal of the master plan was to identify how to phase out of the oldest buildings to reduce costs, improve operations and departmental adjacencies, and improve patient flow. The surgical department was located in the 1909 building. Catalyst tested various surgical department shift scenarios to evaluate the best options to improve access, decompress inpatient space, and generate revenue. After evaluating these scenarios and factoring in recent policy changes related to CMS’s site-neutrality rule, the Planning Team determined it was best to relocate surgery on the existing hospital chasee.
CMS will not pay hospital off-campus facilities the same as hospital-based outpatient departments if they started billing Medicare after Nov. 2, 2015.
Medical Village Approach and Solution
To phase out of the remaining old structures on the hospital campus and create distinct inpatient and outpatient zones, the Emergency Department (ED) needed to move. The existing ED is operationally inefficient and is not properly designed to serve its high behavioral health population. Since the system received a grant to create a medical village to better serve this population, Catalyst recommended combining the ED, outpatient behavioral health, and surgery into a new pavilion and demolish the old space to create a consolidated campus with improved adjacencies and patient flow. The pavilion could be structured to expand vertically for inpatient beds when the system is ready to decompress semi-private beds and/or needs to abandon old infrastructure. Planning for the campus to self-perpetuate over time reduces hospital expenditure on infrastructure and poor operations.
Community Medical Center
Ambulatory Master Plan