"Are hospital leaders overwhelmed by day-to-day challenges or are they in serious denial?" That question keeps coming up in conversations among providers, payers and policymakers. And it's being asked more frequently as the reality of reform sinks in.

The people asking it are genuinely concerned that the speed at which change is coming will catch many hospitals flat-footed. Last month, at a gathering of health care leaders in Chicago, I heard one consultant, with executive experience at both a big regional health care system and at a national insurer, warn that once pay for performance actually kicks in, it will take just 18 months to fundamentally transform the payment system. The typical hospital, he asserted, needs three years to get all its ducks in a row to ensure that it is reimbursed properly when the time comes.

"People say we're running a marathon," a hospital executive said recently, "but it's really a series of sprints. And it's one sprint right after the other."

You know what those sprints involve: quality reporting, bundled payments, accountable care, population health, new IT systems that can collect and analyze all the required data. Whew.

A lot of that is aimed directly at the most ambitious aspiration of reform: to move the system away from the silos of care we now have — with physician practices, ambulatory care centers, hospitals and post-acute care providers operating largely independently — to what are increasingly being referred to as comprehensive care organizations. The goal: more coordination, better outcomes and a flatter cost curve.

But will these be loose constellations or formal integrations? Will hospitals lead them, or physicians or payers? How will data be collected, how will results be measured and how will payments be distributed? And those are just the most obvious questions.

I seriously doubt hospital leaders are sticking their heads in the sand about any of this. Most are hungry for direction so they can figure out where their organizations fit into the future. And many already have taken the bull by the horns.
For example, in her article on page 34, writer Lola Butcher describes how Henry Ford Macomb Hospital, Yale-New Haven Hospital and Allina Health are building strong partnerships with skilled-nursing facilities in their markets to share patient information, ensure proper follow-up care, avert avoidable readmissions and improve patient satisfaction.
"As an industry, we historically have put hard stops on our services when the payment ends," says Suzanne Schut, director of older adult services at Henry Ford Macomb Hospital in Clinton Township, Mich. "We need to think more globally now and reach out to different partners."

At a meeting a few weeks ago, I heard another hospital consultant contend that not all the mergers taking place these days are based on sturdy strategy. Some are creating sprawling acute care systems while ignoring the continuum of care that will be so important in the new payment era.

Turn the next page and you'll read how the American Hospital Association's Committee on Research plans to help you sort out the most effective and efficient ways hospitals can integrate care and improve performance across the continuum. — You can reach me at bsantamour@healthforum.com.