Hospitals not only are faced with declining reimbursement, market share and revenue challenges, but they also must find ways to remain a provider of choice for patients and physicians. One way hospitals, along with health systems and payers, are addressing these concerns is by distinguishing themselves through niche programs.

Referred to as centers of excellence, these programs have been developed in a number of specialty fields, including diabetes, neurosciences, spine, craniofacial surgery, musculoskeletal and orthopedics, cardiology and interventional pain. This model likely will grow in importance and may be as close as possible to a perfect model for care in this changing environment.

Why the Model Works

Centers of excellence are built on a comprehensive continuum that allows for the operative, allied health and nonoperative components of care. They are an optimal response to the growing need for disease-based medical management of chronic-type conditions and the requirement to demonstrate efficacy and superior outcomes. Because a multidisciplinary team approach is central to the model, the primary, secondary and tertiary needs of patients can be addressed from diagnosis to discharge in a seamless, coordinated manner.

Whether the millions of new patients expected from the extension of health benefits receive coverage through an affiliation with an accountable care organization or direct payer contracting, these specialized centers likely will receive a significant portion of patients with disease-state conditions that generate recurring symptoms and high cost. The center of excellence team deals with the same diseases every day and focuses on treating all ancillary, primary and secondary diagnoses. At the same time, they can command appropriate reimbursement as long as they're transparent and accountable through dissemination of case reports, collection of quality outcome data, and the use of metrics and standards.

Directing these patients to the centers frees up the ranks of internal medicine, primary care and family practice to treat urgent, non-chronic problems.

Examples of Successful Programs

There are numerous successful centers of excellence that show the tremendous value of the model: The Rothman Institute in Philadelphia has dominated the marketplace on a local, regional, national and international level in bringing multidisciplinary care to patients with hip, knee and joint disease. The Barrow Neurological Institute in Phoenix has become a global force in the neurosciences.

Becoming a successful center of excellence does not require a location in a major market. In one year, a spine center in Sioux Falls, S.D., saw such rapid growth that it brought in additional neurosurgeons to address the demand from patients within the community and surrounding states. Within about two years, the center saw 5,000 new patients. That center of excellence virtually became a major market destination center for spine care.

Why was this center so successful? There are hundreds of millions of people who suffer from spine-related pain around the world. The pain comes from many different sources, including a genetic or congenital problem; a tumor or condition like fibromyalgia that causes bone overgrowth; or a work-related injury, car accident, personal injury or sports injury. Factor in an aging population and you have a vast number of people searching for services in spine care.

One of the most significant benefits of these niche programs is their ability to direct incremental and spin-off business to the hospital. Data indicate that about 80 percent of the spine patients coming through the door of the Sioux Falls center do not require surgery, but are identified to have comorbidities and other conditions that ultimately feed the entire hospital — the cardiologists when a patient has congestive heart failure or chronic obstructive pulmonary disease; the endocrinologist for diabetic-type problems; the orthopedic surgeon for hand and joint issues. This doesn't even include patients' diagnostic needs.

Developing Centers of Excellence

Developing successful centers of excellence always starts with a vision, physician champions and planning. A market analysis, feasibility study and business plan are critical to understanding opportunities, threats, risks and rewards in the immediate market and surrounding areas. Will your center cater to the local community, or is there an opportunity to attract patients from outside your immediate market? Is there the potential for an international program that targets patients as medical tourists? Will you start with a virtual center before developing a concrete entity? Do you want to create a stand-alone building on the campus of a hospital or build a separate medical campus?

After the planning stage, you have to be able to implement the program. The first steps include creating an operational plan for each section of the center and a patient through-put algorithm to process patient flow. You also need to build a team of physician leaders to run the clinic. Then you will need to create payer, patient, medical, employer and consumer education programs to build awareness and interest in the center.

Another critical component is team building for the individuals who support each niche program. Often, the individuals identified as the team members for a center of excellence were never in the same room or talked with one another until the center started coming together. Once a month, you'll need to hold team conference staffing of patients, as it's vital to building group cohesiveness and team leadership. You also need to assemble a clinical operating committee tasked with overseeing the center, handling the clinical affairs, and ensuring continuous quality improvement and analysis of the provider base.

Finally, you must create a system or standard for measuring all the services offered at the center, and constantly monitor the data to see how well your center is performing against internal benchmarks, peers, literature and any accrediting agency or payer standards. If there are service areas that are lacking — for example, if it took several hours for a patient to receive labs or if radiology is backlogged for months — there must be processes in place for immediately rectifying and addressing these deficiencies.

Centers of excellence are patient-focused, patientcentric organizations. They excel through efficiencies and standardization, through collecting and using their data. They become opportunities to differentiate an institution in a market by offering measurable, high-quality care in an era of accountability.

Marcy T. Rogers is president and CEO of SpineMark Corp. in San Diego.