Beth Israel Deaconess sketches budget plan for next year

The challenges begin with reimbursements from government and private insurers that will not match medical inflation, Levy predicts, and will likely include changes in how healthcare is paid for. Rather than paying for diagnoses made or procedures performed, public and private payers may move to a per-capita payment model, which Levy explains as an annual budget per person for healthcare.

In response, he says, the hospital needs to maintain and enhance focus on safety and quality while also working with insurers to have quality and efficiency efforts recognized and rewarded in reimbursement programs. The hospital also should become leaner by improving the way its work is organized, he said, without specifying where changes may be made.

Research and education are part of the picture, too.

"Because of financial pressures on the clinical side of the house, the margins that have traditionally supported research have shrunk, and so researchers too will have to meet more explicit financial targets," Levy writes. "We will be gradually redesigning our education program so that efficiency, quality, and safety in clinical functions is more explicitly supported by our house staff, something that will also enhance the academic value of our training programs."