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Critical Care Organizations: Business of Critical Care and Value/Performance Building*

Leung, Sharon MD, MS, MHA1; Gregg, Sara R. MHA2; Coopersmith, Craig M. MD, FCCM2,3; Layon, A. Joseph MD, FACP4,5; Oropello, John MD, FCCM6; Brown, Daniel R. MD, PhD, FCCM7; Pastores, Stephen M. MD, FCCM8,9; Kvetan, Vladimir MD, FCCM1; for the Academic Leaders in Critical Care Medicine Task Force of the Society of the Critical Care Medicine

doi: 10.1097/CCM.0000000000002696
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Objective: New, value-based regulations and reimbursement structures are creating historic care management challenges, thinning the margins and threatening the viability of hospitals and health systems. The Society of Critical Care Medicine convened a taskforce of Academic Leaders in Critical Care Medicine on February 22, 2016, during the 45th Critical Care Congress to develop a toolkit drawing on the experience of successful leaders of critical care organizations in North America for advancing critical care organizations (Appendix 1). The goal of this article was to provide a roadmap and call attention to key factors that adult critical care medicine leadership in both academic and nonacademic setting should consider when planning for value-based care.

Design: Relevant medical literature was accessed through a literature search. Material published by federal health agencies and other specialty organizations was also reviewed. Collaboratively and iteratively, taskforce members corresponded by electronic mail and held monthly conference calls to finalize this report.

Setting: The business and value/performance critical care organization building section comprised of leaders of critical care organizations with expertise in critical care administration, healthcare management, and clinical practice.

Measurements and Main Results: Two phases of critical care organizations care integration are described: “horizontal,” within the system and regionalization of care as an initial phase, and “vertical,” with a post-ICU and postacute care continuum as a succeeding phase. The tools required for the clinical and financial transformation are provided, including the essential prerequisites of forming a critical care organization; the manner in which a critical care organization can help manage transformational domains is considered. Lastly, how to achieve organizational health system support for critical care organization implementation is discussed.

Conclusions: A critical care organization that incorporates functional clinical horizontal and vertical integration for ICU patients and survivors, aligns strategy and operations with those of the parent health system, and encompasses knowledge on finance and risk will be better positioned to succeed in the value-based world.

1Jay B. Langner Critical Care System, Montefiore Medical Center, Division of Critical Care Medicine, Department of Medicine, Albert Einstein College of Medicine, Bronx, NY.

2Emory Critical Care Center, Emory University, Atlanta, GA.

3Department of Surgery, Emory University School of Medicine, Atlanta, GA.

4Critical Care Medicine Service Line, Department of Pulmonary/Critical Care Medicine, The Geisinger Health System, Danville, PA.

5Department of Medicine, Temple University School of Medicine, Philadelphia, PA.

6Division of Critical Care Medicine, Department of Surgery, Icahn School of Medicine at Mount Sinai, New York, NY.

7Division of Critical Care Medicine, Mayo Clinic, Department of Anesthesiology, Mayo Clinic School of Medicine, Rochester, MN.

8Department of Anesthesiology and Critical Care Medicine, Memorial Sloan Kettering Cancer Center, New York, NY.

9Department of Medicine and Anesthesiology, Weill Cornell Medical College of Cornell University, New York, NY.

*See also p. 155.

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Dr. Coopersmith’s institution received funding from the National Institutes of Health and the Society of Critical Care Medicine (president-elect in 2014 and president in 2015, where an honorarium for his time was paid to Emory University for this role), and he disclosed grant support for research unrelated to this article. Dr. Oropello received funding from Association of Pulmonary and Critical Care Medicine Program Directors and New York Hospital Queens. Dr. Pastores’ institution received funding from Spectral Medical (grant support as principal investigator for Memorial Sloan Kettering Cancer Center for a septic shock trial) and Bayer Healthcare, and he disclosed other funding from Theravance and Bard Medical for Advisory Board participation, and from New York Hospital Queens and Winthrop University Hospital for medical grand rounds. The remaining authors have disclosed that they do not have any potential conflicts of interest.

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