One question that often comes up when health systems are undergoing a transformation effort is to what degree should functions be centralized or decentralized. As integrated delivery networks take root, and many smaller systems face mounting cost pressures, this philosophical debate over how to position limited resources impacts both clinical and administrative functions alike.
A centralized organizational model brings resources, decision-making authority, and investments into one domain. Centralization of talent, processes, and technology generates economies of scale and operational consistency. Procurement/Supply Chain is an ideal candidate for centralization – aggregate supply ordering to maximize volume discounts and minimize variability in supply rooms.
In a decentralized model, it’s the opposite. Individual hospitals or entities are given autonomy to manage resources and investments at the local level and make decisions within the walls of the facility. Front Desk/Security is an example of a decentralized function – the needs of big, small, urban, and rural care sites are so varied that staffing and budget are left to local leadership to determine.
We are seeing a trend in our larger health system clients where patient transportation is centralizing within the health system. The supply and the demand for transportation cuts across in-patient, outpatient, acute, and post-acute care settings, and it’s too difficult for multiple individuals to own slivers of the process and the infrastructure.
Putting a system-wide transportation role, often at a Vice President or Director level, elevates the role of transportation in care delivery and creates a single point of accountability, both operationally and financially. The position most commonly reports through Operations or Clinical Support Services but works across the spectrum of capabilities in the health system:
There is no better time to think strategically about who owns patient transportation in your health system. CMS continues to experiment with bundled payment (BPCI) and shared savings (MSSP) programs where downside financial risk is at play, and care coordination and preventative health are critical for success. In parallel, social determinants of health programs are expanding and Medicare Advantage plans are adding transportation as a plan benefit. To champion the physical wellbeing of your patients and the financial health of your system, establish an enterprise patient transportation role that owns all levels of transportation in all care settings.