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When religious systems take on secular partners, they can find themselves in difficult situations regarding their ethical obligations. In Denver, a Roman Catholic system is co-sponsor of hospitals that perform abortions and other services. But the battle to unwind the business relationship has been knocked off track by resistance from the hospital management company. Exempla considers its "dual heritage" a strength, says CEO Jeff Selberg, left.

When a federal judge in Arkansas tossed out an antitrust complaint, hospitals nationwide got some legal guidance on fighting physician-owned specialty hospitals. The court "ultimately boiled down to a simple, logical conclusion: A hospital cannot monopolize a market in which it doesn't offer a product," says general counsel for the Federation of American Hospitals Jeffrey Micklos, left.

A small but growing number of specialty hospitals have found a less- expensive way to expand: They're locating satellite facilities within community hospitals. The host hospitals gain a handy referral source, while the satellite facilities take advantage of ancillary services.