Isn’t it curious when two intelligent people examine the same information and draw opposite conclusions? That is the dynamic I thought was at work recently, when The New York Times ran an opinion piece called “Are Hospitals Becoming Obsolete?” one day before The Wall Street Journal published an in-depth report titled “What the Hospitals of the Future Look Like.” Based on the headlines, I expected one article to focus on hospitals’ pending doom and another on their rebirth.
But it turns out only the headline writers were betting on obsolescence versus evolution. The articles’ authors agree that hospitals are undergoing radical changes and they cover much common ground about current trends and where the sector is headed. What do they think hospitals of the future will look like? Here’s a rundown.
Changing healthcare demands
CDC healthcare statistics capture the changing role of U.S. hospitals over the past 40 years. While the population grew and aged, hospital admissions fell. There are now about half as many community hospital beds per 1,000 residents and hospital stays are more than two days shorter on average.
Several factors are driving these trends, including changing reimbursement models and improved technologies that allow patients to go home within hours of certain surgeries. Patient preferences also are at play, as consumers increasingly seek care close to home and without the long waits often found in ERs. And many consumers know hospital stays carry their own risks. According to the CDC, about one in 25 patients is fighting a healthcare-associated infection on any given day.
All this means more care is moving outside the traditional hospital setting. So hospitals are adapting. They are setting up systems to monitor people at home, investing in smaller facilities, and leveraging big data and analytics to increase efficiencies in the large hospitals that remain.
Helping patients at home
Complex care once available only in hospitals now can be safely delivered at home, often with a cost savings. Johns Hopkins School of Medicine and Public Health developed the first “hospital at home” program in the late 1990s. Similar programs now exist across the country. Patients with pneumonia, heart failure, and some other conditions can be evaluated at the hospital and then sent home for treatment with hospital-level medical equipment, medications, and lab tests. Clinicians visit at least once per day and are available 24/7 if the patient’s condition worsens. Hospitals including Mount Sinai in New York City and Boston’s Brigham & Women’s have found this approach generally costs less than inpatient care does, while delivering lower infection and readmission rates.
Creating smaller facilities
Hospital systems are relying on new and repurposed facilities to deliver care in smaller settings and in locales where it does not make sense to build a new hospital. Why? Healthcare provided in surgery centers, urgent care clinics, freestanding ERs, and other facilities often is both less expensive than hospitals and more convenient for patients. For example, Tandem Hospital Partners works with big health systems to build and operate acute care neighborhood hospitals, also known as microhospitals, with minimal wait times. Each facility has ER physicians, an in-house lab, pharmacy, radiology, and 6 – 10 inpatient beds. The facilities treat non-life-threatening conditions and can transfer patients needing specialized care to the associated large hospital.
While Tandem builds its facilities from the ground up, other hospitals find new uses for old buildings. Mount Sinai, which acquired Continuum Health Partners in 2013, is now converting Continuum’s community hospitals. Kenneth Davis, Mount Sinai’s president and CEO, detailed the strategy for The Wall Street Journal. Different hospitals will deliver different specialties including cardiac interventions and orthopedics at St. Luke’s, and neurosurgery and complex ear-nose-and-throat cases at Roosevelt Hospital. New York Eye and Ear Infirmary will become a full-scale ER with stroke and heart care while the 125-year old Beth Israel Hospital will be replaced with a much smaller building.
Making hospitals more efficient
As many services migrate out of the traditional hospital setting, hospitals may merge, downsize, or close. Those that remain will strive to become as efficient as possible. Big data and analytics will help. Business intelligence helps hospital leaders optimize resources while the science of predictive analytics helps clinicians intervene before patients get sicker.
For example, Tandem hospitals use Dimensional Insight’s Diver Platform to track patient wait times on custom dashboards available to both clinical and operations staff. The systems can provide notifications when a patient has been waiting longer than a specified time. Western Maryland Health System deployed Diver to track key quality indicators, improve its reimbursement rates, and most recently, reduce spending on acetaminophen by 78% over two years. Clinically, hospitals are using predictive analytics tools to help reduce readmissions, sepsis cases, and newborn exposure to antibiotics.
Many healthcare leaders, along with the authors of the recent Times and Wall Street Journal articles agree: hospitals of the future will be reserved for truly acute patients and those requiring highly specialized care. Patients with less acute cases will find treatment in smaller settings, including microhospitals, specialized clinics, and even at home. Value-based reimbursements, patient preferences, and technology are among the forces driving this evolution. It certainly is an evolution – and as long as hospitals keep adapting, they will not become extinct.
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