In yesterday's note, I discussed how decentralization/disintermediation was affecting healthcare in general and the lab industry in particular (see: Direct Access Testing; One Facet of the Decentralization of Healthcare Delivery). I mentioned the bedless hospital (BH) as part of this discussion. There are many opinions floating around about what the BH will look like (see: Are 'bedless' hospitals the wave of the future?). Here are some of my thoughts about what will be major units in BHs:
- Clinical labs and radiology will certainly have a prominent place in the BH of the future. This is partly because we are now in the golden age of diagnostics when lab tests and imaging make major contributions to the diagnosis of diseases. I believe that many of the more common lab tests will soon be performed in neighborhood health centers as point-of-care tests or in consumers' homes so the test menus of the labs operating in BHs will tilt toward more esoteric tests.
- Under pressure from MACRA, some large health systems will consolidate/insource their lab operations and testing to their own central labs. With economies of scale, these centralized labs will be able to perform most esoteric testing with few remaining send-outs such as some genomic and molecular tests. Some of these large health system centralized labs will be located in bedless hospitals.
- Because I also believe that telemedicine visits will increase exponentially in the next five year, some of the space in the BHs of the future will be occupied by physicians and nurses managing the telemedicine line-of-business in offices designed specifically for this purpose. For this reason among others, BHs will have sophisticated IT capabilities.
- Health systems with a large number of smaller hospitals will have "virtual" critical care beds in their smaller facilities (see: New Virtual Critical Care Command Center Opens May 7). These beds will be supervised locally by physicians and nurses but with continuous remote monitoring by telemetry. Thus, some of the BHs will have virtual critical care centers staffed by intensivist physicians and nurses who closely monitor the patients in the virtual critical care beds and provide support and advice to the local healthcare professionals.
- Obviously and as emphasized in the link to the article about BHs above, BHs will have large outpatient surgery units. I have been following the evolution of outpatient surgery for many years and have seen the type of cases change from minor surgery to very complicated procedures. The same trajectory will occur in the use of telemedicne starting today with minor problems and growing to the more complicated physician visits that I foresee for the future. This will require sophisticated telemetry of patients' vital signs from their homes during the visit but that technology is available even today.