Roundtables

Community Hospital Affiliation Strategies Written by Heather Punke A s the healthcare industry changes, relationships between hospitals have also changed. Increasingly, smaller community hos- pitals and larger, tertiary hospitals in the same region are joining together to keep local healthcare strong. Here, executives from community hospitals, larger tertiary facilities and Community Hospital Corp. discuss what regional strategies look like in their markets and how facilities of all sizes can benefit from working togeth- er in a strategic regional relationship. Note: Responses have been edited for length and clarity. Question: What constitutes a region- al strategy — what could it look like? What constitutes best practices? Charlotte Burns, vice president of network affiliates for TriStar Health (Brentwood, Tenn.): Prior to joining HCA TriStar, I was a rural hospital CEO for many years, so I've been on both sides of regional partnerships and understand the importance of them. At TriStar, we are developing region- al strategies that are based upon the individual needs of the rural hospitals in our market. We realize that rural hospitals may have different needs at different times, so we do not have one set strategy for all hospitals. We are primarily focused on offering non- exclusive affiliations with a menu of services. e rural hospitals can select which services they're interested in. We're providing a lot of telemedicine services, primarily emergent stroke and behavioral health consults, and looking to expand into other service lines. Phyllis Cowling, president and CEO of United Regional Health Care System (Wichita Falls, Texas): Part of our strategic plan at United Regional was to look at how we could reverse or limit the outmigration of patients from both our primary and secondary service areas. We don't want patients exiting the region. An affiliation helps to prevent that. We have a clinical affiliation agreement with Bowie Memorial Hospital [in Bowie, Texas], which has a manage- ment agreement with CHC. Bowie Memorial can now market itself as a clinical affiliate of United Regional. It's important they continue to utilize their name, but they can tag on our name as well. We provide assistance with physician recruitment, and we've facilitated some transition in ER cov- erage to help provide better care. We will also be extending a line of credit for strategic and capital improvement. One of the positives of the relationship in my perspective is the limited finan- cial risk. It's defined risk relative to the line of credit, not associated with their bottom line performance. Shane Kernell, CEO of St. Mark's Medical Center (La Grange, Texas): From a community hospital stand- point, for us partnering with a larger hospital in a larger city lends imme- diate credibility to the local center. We're a beautiful hospital with a great medical staff, but to have "St. David's" [as in St. David's HealthCare in Austin, Texas] in small print below our name is an immediate credibility factor for us. From a perception standpoint, that's number one. But we can also align ourselves from a business stand- point. ey may have best practices we may not have, or policies and procedures, that we now have access to through afflation. We also have another partner; our business affiliate is CHC. It's a great ar- rangement. CHC helped in researching who we could partner with clinically. ey realized we needed a dance part- ner, that we couldn't be a stand-alone. Cindy Matthews, executive vice pres- ident of Community Hospital Corp. (Plano, Texas): From a community hospital standpoint, finding a part- ner is really important. It helps with physician recruitment and provides other benefits. Larger hospitals want to ensure the hospitals within their region are successful, but may not be in a position to acquire a smaller hospital. e larger hospital's regional strategy oen includes what we call a clinical affiliation, where they affiliate with a community hospital but do not necessarily manage or own it. With CHC, if we're working with a smaller community hospital, we look in the marketplace and see what ter- tiary hospital could benefit the rural hospital. ere are a number of ways tertiary providers can assist the smaller hospital. Sometimes, the tertiary hos- pital has specialists who could rotate, like an orthopedic surgeon or cardiol- ogist who could go to the smaller hos- pital once a week and do clinics there. Sometimes there can be assistance with ER coverage. Service line program development can be done from that standpoint, too. We also encourage someone from the tertiary hospital to sit on the rural hospital board to learn firsthand the needs of the community. 3 Community Hospital Affiliation Strategies

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