Returning to revenue growth. A new series examines five revenue growth strategies in a difficult health care market.

W inds such as turbulent, volatile, and chaotic have all been used to describe the last decade for health care, but the past tew years have been particularly difficult tor nearly all health care organizations. With few exceptions, financial performance plummeted as a result of three key factors: • Market forces began to work, and the excess supply of most health care services resulted in price and reimbursement pressures on providers. • The accumulated effect of a number of years of managed care growth, combined with excess supply and other market forces, resulted in revenue deterioration. • The Balanced Budget Act of 1997 dramatically affected Medicare reimbursement, despite recent rollbacks. Developments in the past decade drove a shift in the focus of health care organizations from pure growth (in the early 1990s) to building integrated delivery organizations (in the mid 1990s) to financial viability (in the late 1990s). Many health careorganizations are in their second or third wave of cost repositioning as they strive to cope with financial realities and threats. Some providers are also mounting significant efforts to maximize reimbursement for current patient demands, imple menting initiatives such as revised coding procedures, more thorough charge capture mechanisms, managed care contract review, and payor compliance activities. A few aggressive and innovative providers, however, are taking a more creative approach: pursuing new sources of revenue.