Discussion Case 1
Certificate of Need (CON) legislation was designed to control costs by limiting the approval of new construction and new health care services based on the demand for those services. By limiting supply, the CON would allow efficient development of the health care infrastructure. The first CON legislation was enacted in New York State in 1964. Other states enacted various forms of CON legislation, and in 1974, the Nixon administration supported federal legislation calling for all 50 states to enact CON laws. This mandate stood for 13 years until it was repealed in 1987. Today, 36 states retain their CON laws.
Without CON legislation, the health care environment becomes a free market with open competition and decision-making about expanding services that are not directly related to the demand for them. For example, the Pennsylvania's CON legislation sunset in 1996. With the market freed from CON supply and demand controls, the state saw significant changes in health care services. A case in point is open-heartsurgeryahighly profitable service, which often supports many ofahospital'smoney-losing services that are, nonetheless, part of its mission. With the lifting of CON controls, from 1996 to 1997 and from 2007 to 2008, Pennsylvania experienced a 25% increase in the number of hospitalsproviding open-heart surgery, even though the number of procedures across the state declined 37% during that period. The result was that the average annual volume per hospital declined 49%, from 653 to 300. At the same time, it is well documented that facilities performing a higher volume of complex surgeries have better patient outcomes, and that it can be dangerous to have such services in facilities that do too few of them.
This change resulted not only in the less efficient use of clinical facilities,cardiothoracicsurgeons, and highly skilled surgical teams, but also in a change in the landscape of health care. The Philadelphia's five-county region experienced similar changes, which contributed to the closure of three urban teaching hospitals: Medical College of Pennsylvania, Graduate Hospital, and Episcopal Hospital.
1. Why would so many open-heart programs be launched in the face of a declining market?
2. Were the new programs justified?
3. What would you do to rationalize the number of programs in an open and free market? If you were the governor of Pennsylvania, would you consider returning to a CON-based health care environment?
Discussion Case 2
What follows is a summary of Montefiore Medical Center's 2015-16 strategic plan:
? Mission: To heal, to teach, to discover, and to advance the health of the communities we serve.
? Vision: To be a premier academic medical center that transforms health and enriches lives.
? Values: Humanity, innovation, teamwork, diversity, and equity.
? Strategic Goals:
-Advance our partnership with Albert Einstein College of Medicine
-Create notable centers of excellence in heart care, cancer care, and the Children's Hospital
-Build specialty care broadly
-Develop a seamless delivery system with superior access, quality, safety, and patient satisfaction
-Maximize the impact of our community service
? Organizational Goals:
-Create a culture of high performance, motivation, and fulfillment
-Sustain strong financial health
-Develop and train a sustainable process for implementing EHR (electronic health records)
-Invest in state-of-the art facilities and technology
-Build an aligned and interconnected organization
-Foster supportive partnerships and alliances
Case Questions: Given the previous statements of fundamental purpose:
1. How should organizational performance at Montefiore be measured?
2. Why do not all HCOs have strategic goals like Montefiore's?
3. What contributions could Montefiore's governing board make toward accomplishing the strategic goals?
4. What contributions should the management team make?
5. How is Montefiore accountable to its various stakeholders for organizational performance?
6. How do the new EHR standards impact the organization moving forward?