5. Meet the decision-makers. Some of these partnerships may take a few years to establish, so make sure that there is a true alignment of goals and that the people working on it are steadfast, says Michael Iltis, vice president of professional services of Emanuel Medical Center. Smaller hospitals have fewer people to weigh in on decisions, whereas, larger systems have multiple silos to work through, he says. "These relationships take a lot of organizational fortitude."
6. Include all the stakeholders. Many small facilities are not familiar with these types of partnerships, says Littrell. Take the time to sit with the medical staff, hospital leaders, and board members, so that everybody understands how the arrangement will work and has time to get comfortable with it, he says. "Otherwise the partnership won't last because not everyone has bought into it."
7. Local commitment. "There has to be an understanding that the larger facility is going to provide care in your community and not just take all the care back to the central location," says Dan Ayres, CEO of O'Connor Hospital.
8. Look for support services and technology that are exportable and scalable. "Just because it is the greatest thing on the market for a tertiary-level hospital doesn't necessarily mean it will work for a critical-access hospital," says Martin Guthmiller, CEO of Orange City Area Health System.
9. It doesn't hurt to ask.
10. Patience is a virtue. These partnerships will always take longer than you expect.
Not Just for the Little Guys
When it comes to affiliation agreements, most people think of a small hospital partnering with a large health system. Moses Cone Health System and Wake Forest University Baptist Medical Center are looking to break that mold with the establishment of a new nonprofit company, The HealthCare Alliance. Both systems, which are about 25 miles apart, are careful to point out, however, that this is not a merger. They will retain their independence.
"We do have some overlap in terms of some of our services, so we compete on the fringes, if you will, but mostly we'll compliment each other," says Tim Rice, president and CEO of Moses Cone, a five-hospital system based in Greensboro, NC, which includes the 130-staffed-bed Wesley Long Community Hospital and 87-staffed-bed Annie Penn Hospital.
Rice says that Wake Forest, a five-hospital academic medical center in Winston-Salem, has always been his system's most logical referral hospital because of its proximity. "We have always had a good relationship with them clinically," he says. And that clinical relationship is something that he hopes to build upon in the future. "One of their products is doctors. We consume doctors. A lot is about lining up interests." For example, the two systems have already been discussing how Wake Forest's residents and fellows can spend time in Moses Cone's trauma and critical-care programs and emergency rooms. In addition, Wake Forest can utilize the larger patient base for additional research opportunities, Rice adds.
Even though the relationship is relatively new, some perks have already been realized. Both facilities use GE computer products, so they can share patient data and eliminate duplicative tests, says Rice. Moses Cone has already given some of Wake Forest's specialists access to its picture-archiving and communications system. "So if a patient has been here and already had a CT and MRI and we transfer them to Baptist, none of that needs to be duplicated anymore," he says.
As for the future, Rice wouldn't mind expanding the partnership to other organizations in the region. "Sitting down across the table, you never know what solutions you might be able to come up with."
'Independence is a State of Mind'
Northeast Ohio is an area dominated by major players like the Cleveland Clinic and University Health System, which places 113-staffed-bed Wadsworth-Rittman Hospital in a tough position, says President and CEO Jim Pope. "It is not unlike what happened to the small hardware stores of the '70s and '80s when the big-box stores came in."
To remain a viable part of its community, Wadsworth affiliated with the six-hospital Summa Health System last year with the goal of becoming a full member over the next several months. Through the affiliation, Wadsworth has gained access to specialty docs, technology, better managed care contracts, and capital. In addition, Wadsworth now has the opportunity to work with a neighboring hospital—roughly 12 miles away—that used to be direct competition, says Pope. "This is where a tertiary hospital works well with a community hospital—when you are looking at ways to keep the patient at the right level of care."
Its decision to merge with Summa, however, differs from many community hospitals and their high priority on maintaining their autonomy. Pope says that one of Summa's core values is supporting the importance of local hospitals' commitment to their communities. "That really was what took us a long way toward selecting Summa," he says. Even as a full member, Wadsworth will still have a local board with its own reserve powers and decision-making.
"If you can meet the needs of the community, then you are successful no matter how you structure this," Pope says. "Independence is a state of mind."