What Can Hospital Do About Service Line

Healthcare organizations must strategically structure their services and operate with an center towards cost and resource availability. By utilizing a consolidated approach with a service line structure, organizations will garner benefits across only economies of scale through edifice upward their stability for the future.

In healthcare contexts, the term "service line" is a fashion of defining a specific line of business, ofttimes inclusive of operational, financial, and strategic attributes, and organizing that line of concern with a governance structure. In other industries outside of healthcare, this is known as a production line.

A service line focuses on a type of patient or illness group, with considerations for the location of service, diagnosis-related groups (DRGs), ICD-10 procedure codes, and other fiscal coding terminology.

In contempo years with the expansion of population health inquiry, additional variables can help define a service line, such as the social determinants of health, demographics, and other lifestyle factors. This concentrated focus allows for a service line to be divers internally and externally based on mutual clinical and operational factors. Since emerging in the 90s, service lines have grown far beyond simply beingness a footing for marketing an system's clinical services available at the local hospital.

Service lines likewise can exist found in a variety of specialty care areas. Well-nigh often you lot'd find a service line approach to providing care in geriatrics, orthopedics, cardiology, oncology, neurosciences, too equally umbrella categories such as women'due south health, chronic care management, and behavioral wellness.

Two Examples of Service Line Approaches in Healthcare

There are several ways you lot can implement a service line approach. To edify the benefits of service lines, this commodity will cover two governance structures, to be implemented in larger, multi-facility organizations:

1. Directly management and operational oversight
2. Strategic and "Center of Excellence"-way leadership

Note that these ii styles are distinct for this article, but many healthcare organizations combine traits of each to formulate their own model for a service line.

Direct Management and Operational Oversight

A bedrock service line governance structure has been the direct operational accountability and management of facilities within one clinical service pathway.

The UPMC Women'southward Wellness Service Line operates in this fashion, with 1 line of business, including inpatient and outpatient operations to serve a patient's unique needs. With services ranging from pregnancy and deliveries to breast care, the Women'southward Health Service Line is able to accommodate patient care in four geographic regions across two states.

In a 2016 presentation at the Healthcare Analytics Top, the UPMC Magee Women's Hospital leadership discussed the formalization of the service line past edifice in action-based costing and financial reporting support. By featuring the comprehensive service line's expenses within one P&L argument, it displays visibility that the service line had not had in the past with traditional statements. The full moving picture of the service line's direct expenses, both variable and total costing, allows for a greater agreement of operational operation drivers.

When considering this type of directly direction service line structure for a big integrated healthcare delivery system, leaders can employ standardization and pilots to test new innovative projects earlier spreading them across the enterprise, yielding cost savings should the airplane pilot be successful. If a pilot is not worth spreading, the investment in the pilot is the but loss. The knowledge gained from that pilot will only further aggrandize on the foundation for the next pilot. With direct operational oversight of the locations involved in the airplane pilot, there is oftentimes less hesitation in using resources to test a new thought.

I of the near favorable aspects of this approach is the inclusivity of multiple locations with various services, populations covered, and clinical professionals and specialists. This multifariousness ultimately offers the opportunity to create a hub-and-spoke model to bulldoze further specialization and quality outcomes. With direct management of large "hub" community hospitals and small "spoke" rural facilities, delineation of where to invest in specialty care, engineering, or external partnerships can be adamant past regional operational leadership.

This tin create advantages in developing specialized sites resulting in higher quality outcomes, but also could unintentionally develop challenges with access without advisable planning.

To summarize, the direct oversight secured with this arroyo to service line governance allows for healthcare organizations to more effectively drive the following:

• Financial Functioning: formalized reporting to understand and reply to functioning drivers
• Standardization: economies of calibration with multiple facilities
• Specialization: strategically hub services to develop higher quality outcomes

Innovative Leadership: The Strategic Advisor

If belongings the reins with operational oversight is not possible through straight management, an alternative approach tin can be taken with innovative service line leadership. An executive partner who can drive "Center of Excellence"-mode thinking inside a clinical service line can prove useful when considering strategies for the future.

Co-ordinate to an commodity by James Elrod and John Fortenberry, "A center of excellence is a program within a healthcare establishment which is assembled to supply an exceptionally high concentration of expertise and related resource centered on a particular area of medicine, delivering associated care in a comprehensive, interdisciplinary mode to beget the best patient outcomes possible."

Service line leadership focused on developing Centers of Excellence in today's healthcare environment will need to practice flexibility and innovation. This blazon of service line leadership exists equally a strategic advisor to operational leadership, providing insights for hospital CEOs, health plan leaders, medical group executives, and other key decision-makers. Innovative service line leadership will be the keepers of data, ensuring solid strategy and business planning with analytical back up for all decisions.

Being outside of the operational c-suite, the service line leader tin provide focused—albeit, agnostic—business organization planning and proforma exercises to review potential business additions to the infirmary'south service offerings. The service line itself is not answerable for everything under the infirmary roof like the CEO and therefore tin can exist a peachy partner for smarter growth or divestment decisions.

Manufacture resource Modern Healthcare suggests that service line assay with invested leaders like hospital CEOs can fix strategic management for growth in priority areas. Tools that an innovative service line leader may use tin include:

• Review of market share for a clinical service line
• Place which services take nearly "drawing power" for the area
• Study market demographics to forecast volumes in various services for years ahead
• Review infirmary's case mix index (CMI) to understand the complexity of patients served
• Summate the percentage of overall revenue that comes from the services within the service line
• Appraise profitability of each service line
• Benchmark with external metrics for internal financial and operational performance

Due to the flexibility innate to a service line unencumbered by operations, the service line leadership role can be leveraged to eliminate inefficiencies in administrative processes and provide operational leaders a "50k human foot level" perspective on consolidation and merger efforts. For instance, maneuvering the often political challenge of meeting infirmary licensure requirements for securing 340B drug savings programs for oncologic drugs can be navigated from an objective position of influence and backed by solid data.

Cadre Responsibilities of Service Line Management

Regardless of the governance construction or P&Fifty approach selected, in that location are cadre responsibilities for managing a clinical service line. Attending to leadership structure, strategic assessments, and quality outcomes for a defined set of patients is primal for a developed service line.

Leadership Positions

Once a service line's scope has been defined (e.g., inpatient cardiovascular services), the leadership of the clinical service line can exist set. Oftentimes, this takes the form of a dyad partnership with a doc leader and an administrative leader, but in that location is a singular voice that lends strategic direction.

Although identifying the initial clinical management construction for the service line is important, service line leaders must be agile in adjusting to emerging contracting models.

Strategy

Service line leaders should review their place in the market regularly by updating previous analyses of all operations. Their function is the guidepost for many in the system on strategic moves for their programs. This operating review should include performance metrics for measuring the success of prior standardization and quality initiatives. This ongoing review of performance, coupled with situational modeling of federal and country laws affecting services provided, will help shape the investments and hereafter planning for the clinical service line.

Quality Outcomes for Patients

In the fullest iteration of a clinical service line, the structure should be built on the values of population health, providing quality health outcomes for a fix grouping of people in their service expanse.

As seen in burgeoning service line approaches to care commitment in chronic care management and behavioral health, service line leaders should expand their thinking across care sites, external partners, internal policies, and federally sponsored programs to deliver top quality services in their community: to the patients who walk through their doors.

Future Directions of Service Line Structures

In that location is no one solution to the perfect clinical service line structure. Both structures discussed in this article have their clear advantages, but without careful consideration for the organization's current surroundings, fiscal status, and vision for care delivery in their community, service line leaders will be challenged with a lack of commitment from their colleagues and stakeholders.

Leaders who recognize existing relationships and understand the historical decisions of their service lines will be successful in formulating the direction for the future.

Ashley Oates, MHA, CPH

Ashley Oates is a regional operations leader for the Oncology Service Line of Sutter Health, responsible for cancer data services and select supportive care programs across nine hospitals. She leads tumor site-specific governance groups to drive quality, access, and financial functioning.

Ashley received a principal of health administration (MHA) degree from the Academy of Pittsburgh and is Certified in Public Health (CPH). Ms. Oates serves as a board fellow member for Keaton's Childhood Cancer Alliance and is a member of the American College of Healthcare Executives (ACHE).

Source: https://www.mhaonline.com/blog/service-line-structures-in-healthcare

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