The topic of bedless hospitals is much in the news these days and the subject of a previous note in Lab Soft News (see: The Future of Healthcare: Virtual Physician Visits & Bedless Hospitals). The basic idea of the bedless hospital revolves around the fact that inpatient admissions are decreasing and telemedicine/ambulatory care are growing rapidly. Newer hospitals need to be designed to respond to these trends. A recent article addressed this topic (see: Who needs beds? New ambulatory centers offer everything except inpatient care). Below is an excerpt from it:
...[Detriot Medical Center] is one of a growing number of healthcare providers designing and building facilities that offer a wide range of hospital-type services without inpatient beds. The [new] 63,000-square-foot, $44 million pediatric outpatient center in Troy will have a 24-hour pediatric emergency room, operating rooms for a range of pediatric surgeries, and outpatient care in several specialties, including cardiology, neurology and oncology....Montefiore Medical Center in New York opened a “bedless hospital” last year in the Bronx. The $152 million, 12-floor, 280,000-square-foot tower features 12 operating rooms, exam rooms, a headache clinic, imaging facilities and, eventually, a full-service pharmacy—but no inpatient beds....Technology allows patients to avoid being kept overnight for monitoring. Many routine checks can be done through remote digital technology....The new facilities offer a mix of telemedicine, imaging, short-term observation care and surgery, with technology making it possible to monitor patients at home following treatment...Some provider systems are even moving post-treatment observation and recovery out of their ambulatory facilities. Also, these facilities don't necessarily need physicians on-site to read diagnostic imaging tests since doctors can do that from another location....One of the big drivers of the trend toward bedless hospitals is cost. Under pressure from insurers and consumers, hospital systems have been shifting to lower-cost outpatient care, from which they generally earn higher margins than inpatient care. But a lot of this also is driven by consumer demand and the evolution of technology. Many health systems are forgoing traditional hospital expansions and building free-standing emergency centers away from main hospitals.
For me, the design requirements of the bedless hospital are continuing to evolve. One aspect of the design is a better understanding of what physicians and patients expect from, and can accomplish, during a virtual visit. The easiest part will be diagnostics. Teleradiology is now very mature and has evolved to a point that it's a simple matter for the majority of images taken in a hospital to be "read" at some distant point. With the exception of stat testing, the majority of lab specimens can also be analyzed off-site with specimens transported to a very efficient, high-volume central reference lab. A recent decision by the FDA to regulate whole slide imagers (WSI) as Class II medical devices will rapidly enable the use of telepathology for primary diagnoses (see: DPA Recommends Whole Slide Imaging Manufacturers Submit De Novo Applications to the FDA for Primary Diagnosis in the United States).
Prestigious health systems like the Cleveland Clinic are now offering e-consultations to Ohio residents at a nominal fee, thus expanding its client base without the need for bigger and better ambulatory care centers (see: Details of Cleveland Clinic's MyCare Online Virtual Telemedicine Visits). One of the most important statements in this excerpt is the following: Under pressure from insurers and consumers, hospital systems have been shifting to lower-cost outpatient care, from which they generally earn higher margins than inpatient care. As is usually the case in healthcare, major changes are driven by changes in reimbursement and the development of bedless hospitals is no exception to this rule. It is likely but yet to be definitively proved that bedless hospitals are cost-effective.