As they struggle to provide value-driven care, smaller hospitals and health care systems are having a tough time. In the transition from fee-for-service to fee-for-value operations, they're finding both performance and growth are challenged, and that's putting their financial futures at risk.

This comes from a new report from the Ernst & Young LLP Advisory Health practice, which identifies a number of prominent factors acting as obstacles to the transition.

There are four key factors, the report says, which challenge a move to value: rising care delivery costs due to system inefficiencies; clinical workforce challenges that increase the risk to patients of medical errors; a lack of standardization in how quality is defined and measured; and a lack of trust among providers, payers and regulators.

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