EXECUTIVE SUMMARY
The Issue
Fairly or unfairly, 学术医疗中心的经济引擎是临床企业, 也被称为学术bet8网站备用(AHS)，即教学医院的综合资产, the clinical faculty, and the affiliated or owned nonacademic (or “community”) physicians. On their own, 通过传统的收入来源，研究和教学项目的资金不足，需要从临床企业的利润中获得稳定的投资. 对于战略和组织定位不佳的组织来说，AHS的这一重要投资来源面临风险. 在《bet8网站备用》(ACA)出台之前，医疗市场已经充满了挑战。, the headwinds have further intensified for AHSs, 因为他们需要证明他们以适当的成本提供了更高质量的护理. This challenge exists for nonacademic providers as well, 然而，amc要复杂得多，因为它们要努力解决由三部分组成的任务(临床护理)中出现的魔方问题, teaching, 和研究)，同时平衡三要素组织结构(教学医院)的动态, medical school, and faculty group practice [FGP]). Further, ahs几乎没有犯错的余地，因为它们在市场上面临着独特的业务劣势, 包括不太有利的付款人组合和传统上较高的管理费用，因为他们的学术使命.
Recent studies and literature, including from the Association of American Medical Colleges (AAMC) and the Institute of Medicine (IOM), reinforce the idea that the success of each AMC component entity is inextricably entwined with the others; therefore, 由于外部市场因素不断提出新的挑战，各组成部分需要找到增加协作的方法. 许多资产管理公司正在做出回应，并已经或正在计划做出重大改变，以提高业绩. 例如，31%的学术健康中心协会(AAHC)成员是 changing their governance structures or significant reporting relationships. 近年来，市场上出现了范德比尔特(Vanderbilt)或西北大学(Northwestern)等资产管理公司的重大交易, 临床资产正在向何处转移，以使医院与bet8网站备用组织更紧密地联系在一起. However, the majority of the AMCs that do not already have a highly integrated clinical enterprise appear hesitant about making major structural changes; many are unsure of the best approach and are unwilling to assume the risk without understanding the tangible benefits of more closely aligning the teaching hospital with the FGP. After all, what exactly does greater alignment or integration mean? If the AHS was fundamentally more integrated, would it result in a better margin and improve the quality of care? 本研究试图通过检查AHSs的组织架构和功能行为，并确定其整合水平与绩效之间是否存在相关性，来解决这些问题和其他问题.
The Study
本研究的最终目的是确定AHSs整合程度较高的amc是否优于那些AHSs整合程度较低的amc, 重点关注临床事业——成人初级教学医院与FGP之间的关系. 第一步是分析美国104个AHSs所展示的整合程度，并根据经验数据和制度洞察力将每个AHSs分类为整合程度较高或较低. 然后根据组织绩效的五个主要方面对两组进行比较:声誉, quality of care, financial success, research funding, and resident program ranking (i.e., graduate medical education [GME]).
The Results
结果表明，成人初级教学医院和FGP (i.e., 在总体上衡量时，AHS在结构和/或功能上一体化程度更高的材料表现优于那些一体化程度较低的材料. More integrated AHSs outperform in four of the five performance categories. Financial performance is the one measure where the reverse is true, and this study presents a possible explanation for this variation, including the disadvantaged payer mix of the more integrated AMCs.
Conclusions
这项研究的结果证实了人们普遍持有的观点，即AHS越具有战略意义, financially, and otherwise aligned, the better the results for the whole AMC. Nonetheless, the full integration of a corporate structure (e.g., 合并为单一首席执行官结构(教学医院和FGP)可能不是唯一的整合途径，对一些人来说也不是一个现实的选择. In fact, functional integration has proven to be equally effective. 没有公司整合的机构已经证明，随着当代附属协议的加强(例如.e., a bilateral commitment to perform and share financial risk), 通过在许多领域中协调规划和执行，可以实现高水平的功能集成, such as strategic planning and joint budgeting. On the other hand, 对于一些组织来说，通过合并或其他方式进行全面的公司整合可能是巩固关系并确保其战略和财务利益完全一致的最佳解决方案.
Most AMC leaders acknowledge, at the very least, 在当今的市场竞争中，他们的临床企业应该更加整合, 但在关键利益相关者中，往往缺乏推行此类倡议的政治意愿. However, the focus on performance must ultimately trump politics in order for an organization to thrive in today’s healthcare environment; and, as this study indicates, 集成程度较高的AHSs比没有集成的AHSs在更高的级别上执行任务. 对于临床企业来说，不采取措施建立一个更综合的AHS的机会成本将很高, and will also have a direct adverse impact on the AMC as a whole (i.e., (连同大学和医学院)，因为可用于再投资于学术使命的资源将减少.
Published November 9, 2015
