We are moving toward a future where inpatient admissions are becoming less common with more specialized, remote centers becoming more numerous. More hospitals are also being designed as "bedless" facilities (see: 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 discussed how large hospital chains seems to be moving in this direction (see: Warding Off Decline, Hospitals Invest in Outpatient Clinics). Below is an excerpt from it:
Some of the hospital industry's most active investing these days is happening outside the hospital. Giant U.S. hospital operators, including Tenet Healthcare Corp., Dignity Health and HCA Healthcare Inc., are investing heavily in surgery centers, emergency rooms and urgent care clinics located outside hospitals, chasing after patients who increasingly want cheaper and more convenient care. Insurers and employers that pay for health care are helping drive the change as they shift more Americans to high-deductible insurance plans, which require patients to pay more of their medical bills before insurance kicks in. That has pushed more patients to seek lower-cost options....Hospital demand slumped during the last recession, a trend that has continued even as the economy recovers....Admissions growth at HCA hospitals has slowed in recent quarters to 1% to 2%, as a boost from the Affordable Care Act faded, while Tenet's admissions have been flat or down 1% to 3% most quarters since late 2015. In an effort to strengthen their hold on their markets and prevent rivals from siphoning off patients, hospitals are investing outside their own walls. They are "following the patient,"....The strategy also places hospital satellites closer to where patients live and work, which executives say they hope will win over new, loyal customers....
Trevor Fetter, Tenet's outgoing chief executive, says company executives have pursued rapid outpatient expansion partially out of necessity.....Non-hospital operations typically generate lower revenue than hospitals but produce higher profit and require less capital to build and run.....Prices for common surgical care can be sharply lower outside of hospitals, which generally have higher overhead related to round-the-clock operations and the technology and specialists needed to treat more complex cases. Cataract surgery and knee arthroscopy prices at ambulatory surgery centers were $5,000 to $2,500 less than at hospitals for employees and retirees with health insurance provided by the California Public Employees' Retirement System....Tenet said it would spend an additional $100 million to $150 million annually on other free-standing surgery centers, emergency rooms and satellite locations.
In a previous note, I discussed the tug-of-war between free-standing surgicenters, often owned by orthopedic surgeons and hospitals that are vying for the same knee replacement patients. The surgicenters offer lower cost procedures because of their specialized approach (see: Tug of War between Hospitals and Surgicenters for Knee Replacements). The same pressures are occurring in radiology. Here's the latest about Anthem refusal to pay for MRIs and CT scans performed in hospitals (see: Anthem's new outpatient imaging policy likely to hit hospitals' bottom line):
In what may be the first strike in a battle over what healthcare services should be provided in a hospital, Blues giant Anthem will no longer pay for MRIs and CT scans performed on an outpatient basis in hospitals across the country.
To summarize, hospital inpatient admissions are trending downward nationally and, in response, large health systems like Tenet are building new surgicenters, emergency rooms and urgent care clinics located outside their hospitals. At least one health insurance company will now only reimburse for MRIs and CT scans performed in imaging centers because of their lower costs. All of this is going to result in a major clinical data "dis-integration" challenge.