NYAPRS Note: One thing I frequently talk about when explaining DSRIP is the changing role for hospitals in our health care. The system as a whole is expanding to meet the community-based, whole-person needs of consumers, while at the same time shrinking to rely on collaborative partnerships and specialized connections to services. In DSRIP, safety net hospitals are paid to take on a convening and administrative role, and re-purpose existing staff and infrastructure resources to minimize hospitalizations. The only way they can achieve this is if they begin to utilize and invest in strategies to keep beds closed. For community BH providers, this is a great advantage, as our services, expertise, and culture are necessary to ensure that the “hospital of the future” meets the needs of the people it serves.
Are Hospitals Days Numbered?
OPEN MINDS Daily Executive Briefing | Monica E. Oss; 7/24/2014
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Last December I was taken with a great article by Robert Pearl, M.D., in which he postulated that in the future, there will be fewer hospitals with increased volumes and that would lead to higher quality of care and better clinical outcomes (see What Is Your Organization’s ‘Strategic Inflection Point’?). However, a more recent article from Philip Betbeze of HealthLeaders Media suggests that maybe in the future, hospitals won’t be hospitals at all (see The Hospital of the Future is Not a Hospital).
His theory? Building both business models and models of care on inpatient volume is a strategic dead end “Inpatient care, increasingly, represents stagnation and shrinkage, in the business sense”, he writes. “Pursuing expensive inpatient volume in the traditional sense is a strategic dead end. Any new construction undertaken by hospitals and health systems should be based on adaptability, patient flow, and efficiency gains not bed count.” The evidence? Ninety-five percent of the hospital organizations he surveyed said most of the projects they are undertaking are predominantly ambulatory in nature.
The alternatives for hospital systems? The new business investments by hospitals seem to be in a few categories specialty services delivered in a single location, ambulatory care locations with modular design, home care, and e-health services top the list. To make these new services work in the context of the larger system there must be large investment in health information technology.
This market pressure on facility-based health care provider organizations is part of the macro-environment in health and human services. Almost every new initiative in the field is designed to reduce the use of emergency rooms (ERs) and prevent hospital admissions and readmissions from value-based payment models, to ACOs, to medical homes, to crisis stabilization programs. And there is a wide variety of initiatives with a wide variety of approaches that are focused on this issue. To give you a feel for the range of approaches, here is just a small sample of these initiatives:
- Social Work Intervention Reduces Hospital Readmission Rates By Half
- VGo Telepresence Robot Used To Reduce Hospital Readmissions
- Strong Link Between Patient Satisfaction Rankings & Hospital Readmissions
- OneRecovery Addiction Recovery Program Reduces Aetna Treatment Readmissions by 67%
- Georgia Medicaid Peer Support Increases Costs For Prescriptions & Outpatient Care, Lowers Inpatient Costs
- Veterans Health Administration Home Telehealth Program Cuts Inpatient Admissions by 20%
- Medication Adherence Reduces ER & Inpatient Expenses By 34% For Complex SMI Consumers
- Virtual Patient Advocate Cuts Hospital Readmissions & Costs at Boston Medical Center
- Walgreens & Greystone Healthcare Management Launch Collaborative Therapy Management Program In Florida To Cut Readmission Rates
- Connecticut-Based Magellan’s Medication-Assisted Treatment Program Demonstrates Significant Drop in Substance Abuse Readmissions
- Magellan Launching Performance-Based Reimbursement For Inpatient Services
- MPRO Initiative Aims To Reduce Behavioral Health Readmissions
- EHR-Based Predictive Risk Software & Targeted Interventions Cut Readmission Rates For Heart Failure by 19%
- Hospital/Long-Term Care Collaboration Lowers Medicare Readmission Rates By 5%
- Psychiatric Readmission Rates 30% Lower When Data Within EMRs Accessible To Non-Psychiatrists
There will always be a need for acute care, but the unanswered question in the market is how much and where. According to the Centers for Disease Control and Prevention (see Health, United States, 2010), average lengths of stays in U.S. hospitals have dropped from 6.4 in 1990 to 4.8 in 2007, a 26% drop over that time period. And, the hospital market has responded. In 2009, the average number of hospital beds was 2.6 per 1,000 people. In 1999 the national average was 3.0; a 13.3% drop according to Karen Minich-Pourshadi in her article, How Many Hospital Beds is Enough?, in HealthLeaders Media.
This shift in the delivery system landscape has a couple important implications. First, the focus of payers on services, technologies, and tools that decrease ER use, admissions, and readmissions will likely continue. The second is that as hospital systems shift their sites to ambulatory services, home care, and tech-enabled services, traditional community-based provider organizations will find themselves with new competition.
Whether or not you think hospitals are “going away” in the future, I think these changes in the role of inpatient services is an important consideration for every organization in the field. For a look at transforming your organization to meet some of the biggest challenges in the health and human services industry, join me for my town hall session, Can CEOs Change Their Organizations Fast Enough? The Challenges Of Transforming A Provider Organization, at the upcoming 2014 Executive Leadership Retreat.