Is this a fair representation of the hospital business model?

I have been looking for a way to represent pictorially the hospital business model and the forces which act upon it. The picture below came to me last night while playing this board game with my daughter. It is from the children’s game, Boobytrap. The way the game is played is that the players try to remove the red, blue, and green pieces without causing the trap to spring and displace all of the pieces.

If we represent patients as the individual playing pieces and make the assumption that each side of the game exerts pressure on the model, I think it represents fairly the external forces with which the large provider model has to battle. As the forces increase from some combination of costs, regulation, procedure price ceilings, and payor reimbursements, the number of patients in the model will decrease and may do so in a catastrophic manner. Without a concurrent decrease in those four forces it is unlikely that the model will support additional patients. Clearly, without changing the size of the board it is impossible to grow the number of patients beyond the board’s capacity.

A couple rules come into play.

The forces are all external. They cannot be controlled or abated by the hospital.
The strengths of the various forces change over time
The forces result in some maximum number of patients which can be serviced under the hospital’s existing business model.
As each patient is lost, the stability of the model weakens.

Does this way of depicting the large provider business model ring true? Does this help illustrate why the model must change?

Paul M. Roemer
Chief Imaginist, Healthcare IT Strategy