CEO's challenge: balance fiscal solvency, service to poor

Competitive practices and the prospective payment system are among factors challenging Catholic health care facilities' commitment to serve the poor and elderly and to provide individualized care. To concentrate their mission on services to the marginated and thus alienate other payer groups through inability to compete in either services or price is fiscal suicide. Sponsors and CEOs of Catholic facilities are exploring creative solutions to this dilemma: Revising the mission statement. The facility may restate its goals--e.g., to provide an "adequate" level of care and technology, rather than "the best care possible;" Changing delivery methods to focus on outreach services, ambulatory care centers, surgicenters, etc.; Finding new ways of providing charity care through endowment, trust, foundation, and unrelated business income. Corporate restructuring to generate income and protect the facility's asset base is being widely studied. Because many congregations sponsor several institutions, Catholic health facilities are well positioned to enter multi-institutional systems and participate in networking as a means to save money and to market services. Catholic health care facilities must form a nationwide system of influence in the growing public policy debate about access to and rationing of health care. Before these issues are resolved; Catholic facilities will continue to feel pressure to provide services beyond their means. The chief executive officer has four particular tasks during this period: To use an entrepreneurial approach to generate funds to support the facility's mission activity; To guide the board of trustees to accept multi-institutional arrangements; To raise legislators' and citizens' awareness of the institution's fiscal challenges; To motivate the institution's staff to provide individualized, compassionate care in spite of the depersonalizing effects of DRGs.(ABSTRACT TRUNCATED AT 250 WORDS)