Hub-and-spokes regionalization. The teaching hospital should be the hub of its healthcare market.

To remain viable, teaching hospitals must be horizontally and vertically integrated, multilevel healthcare delivery systems. Such integration is needed for a teaching hospital to remain the hub of its urban or rural regional healthcare market and to generate sufficient fiscal resources to support its medical education programs, research activities, quality of care, and innovative technology. Teaching hospital trustees, physicians, and managers must evaluate an increasing number of alternatives to improve quality of patient care, maximize educational and research opportunities, and increase revenues. These options include merging with community hospitals and improving relationships between community physicians and teaching hospitals and their full-time clinical faculty. To ensure long-term viability, teaching hospitals may need to use an approach that concurrently employs a hub-and-spokes arrangement, a horizontal and vertical diversification, and a multilevel healthcare delivery system configuration.