he healthcare industry has undergone dramatic change and restructuring during the decade of the $1990$s and early $2000$s$.$ Mergers, consolidations, and downsizing have become the norm as organizations struggled to provide more cost$-$effective, high$-$quality services demanded by managed$-$care organizations and corporate employers. A major response to these pressures has been the development of $$integrated delivery systems,$$ which typically combine multiple units of hospitals, physician practices, outpatient facilities, long$-$term care facilities, and insurance.