I have a keen interest in the development of new types of healthcare facilities beyond "hospitals" as we know them today and have blogged about bedless facilities (see: The Future of Healthcare: Virtual Physician Visits & Bedless Hospitals; The Design of Bedless Hospitals Continue to Evolve Based on Cost and Technology; The Future of Healthcare: Virtual Physician Visits & Bedless Hospitals; Some Additional Ideas About the Bedless Hospitals of the Future). A recent article, focusing on increased hospital spending on outpatient care, touched many of these same points (see: Patient preferences tug hospital spending toward outpatient facilities). Below is an excerpt from it:
Finishing work on big projects in Detroit, El Paso and San Antonio, Tenet Healthcare Corp. is about to throttle back capital spending for hospitals to the tune of $150 million. Tenet's 2017 capital budget is expected to range between $700 million and $750 million. That doesn't mean the nation's third-largest investor-owned hospital company is done spending on healthcare facilities though. In fact, it's just the opposite on the ambulatory side. Tenet plans to open 15 free-standing emergency departments or micro-hospitals over the next 18 to 24 months, as well as add urgent-care centers in its hub markets....Hospital systems have begun in earnest to shift more of their capital spending to outpatient facilities to provide more cost-effective and convenient settings for consumers. As fee-for-service medicine gives way to value-based reimbursements that put providers at greater financial risk, hospital systems need access points in the community that offer convenient care at what is normally a fraction of the cost of going to the hospital. That means not only building more ambulatory centers, but investing in information technology as well. Oakland, Calif.-based Kaiser Permanente, the nation's largest integrated health system, spends one-quarter of its $3.8 billion capital budget on information technology....More than half of the 100 million patient encounters that Kaiser Permanente clinicians have with the company's 11.7 million health plan members are now virtual visits through telemedicine or other electronic means.....Hospital systems have begun in earnest to shift more of their capital spending to outpatient facilities to provide more cost-effective and convenient settings for consumers..... Memorial Hermann has eight large "convenient care" centers either open or being built in its markets that offer a wide variety of ambulatory services. The centers each feature a 24-hour free-standing ER with an imaging center. They are anchored...by a primary-care practice with other services as well, including physical therapy and rehab space. Northwell Health, based in suburban New York City, plans to spend about $200 million on ambulatory facilities in 2017 or nearly twice what it spent in 2015....
First of all, I can't pass up the opportunity to comment on the fact that the huge Kaiser system is spending one-quarter of its $3.8 billion budget on information technology. Kaiser, more than most integrated health systems, is a major innovator in healthcare IT and understands that it needs to tap into its physician expertise even more about patient workflow. We also need to be aware that 52 percent of patient transactions in 2015 at Kaiser Permanente were conducted online via virtual visits or through the health system's apps (see: Kaiser CEO: Telehealth Outpaced In-Person Visits Last Year). Germane to Kaiser's huge expenditures on IT, or course, is the need for training many more physicians with a deep knowledge of medical informatics.
As the excerpt above clearly indicates, much of the future of healthcare and hospitals rests with outpatient care. This is where major health systems are placing much of their capital investments. Here is a list of what I think are the key words from the excerpt above: freestanding ERs, convenient care centers, ambulatory care, imaging centers, physical therapy, and rehabilitation centers. Many hospitals give lip service to the idea of patient convenience but still require them to compete for parking spaces in urban outpatient facilities. Put another way, hospital central physical plants are being rapidly decentralized with information technology as the glue that connects patients to healthcare professionals. Health systems need to invest much more capital in this "glue."