In this new era of healthcare under the Affordable Care Act, hospitals are working hard to improve outcomes, both for patients and for their bottom lines. There are two main drivers for change. One is negative: financial penalties, such as the one percent cut in Medicare payments under the Center for Medicare and Medicaid Services' Hospital-Acquired Reduction Program, which penalizes poor performing hospitals. This year, 724 hospitals will be penalized for failing to meet new standards. The other driver is positive: the opportunity for increased profitability.

The annual Truven Health Analytics list of the One Hundred Top Hospitals for 2015 evaluates 2,787 institutions. Performance is measured across more than a dozen categories, including mortality, complications, length of stay, readmissions, patient satisfaction and spending per beneficiary. In terms of financial performance, the top-rated hospitals had an average operating margin of 14.4 percent, compared with 3.6 percent for the peer group. Inpatient expenses per discharge were three percent lower, and the Top One Hundred also saw two percent lower costs per episode in treating Medicare patients. Lower costs and higher performance equals better business for hospitals and better outcomes for their patients.

Provide three operational strategies that these top performing hospitals need to achieve to be successful in quality and profitability.

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