For many years I have had a dream – wouldn’t it be wonderful if new technologies and excellent disease management would permit medical care to be delivered outside our traditional hospital walls! What a legacy we would all share if in some small way each of us could say we contributed to their closures, like our colleagues in the past did with TB Sanitariums, Polio Hospitals, and large Eye Hospitals where mostly post-cataract patients were bedded for two to three weeks.
Clearly we are not there yet, and may never be totally. But there are significant signs that “the hospital of the present” will not be “the hospital of the future”. The size, configuration, number of beds, and types of services will significantly vary from what we see on the hospital landscape today.
You ask, then….What are some of these signs? They include:
1. Over 1000 hospitals have been closed or merged in the last decade, and another 1000 or more will close or be merged in the next 8 to 10 years. This is an ongoing process that is happening as we speak.
2. Inpatient volumes, particularly in communities with stable growth, have been declining between 2% and 3% annually for the last several years.
3. Busy, high revenue services, often the mainstay of the inpatient facilities, are now safely done in outpatient clinics and ambulatory surgery centers. Stark examples of this are cancer treatments, orthopedic surgical services, eye procedures, abdominal laproscopic procedures, and gastrointestinal and cardiac diagnostic procedures.
4. There is significant agreement by clinicians now that utilization of some high volume diagnostic services and treatment plans are no longer necessary. Diminished use of the PSA (Prostate-Specific Antigen) Test and associated high risk procedures for the treatment of prostatic cancer are some of the most recent examples.
5. Decrease in length of stays, unnecessary readmissions, infection rates, and surgical complications have occurred and will continue to decrease as more payers align incentives to high quality care metrics.
6. The “aging population”, which is touted as the primary reason for the need for more beds, is proving to be a much healthier population, “not aging like their parents”. And when they are facing a disease, they often are opting for the least invasive treatment plan, most often delivered outside the hospital.
7. Patients dealing with chronic diseases, which in the past filled a large percentage of acute care beds, are now having their healthcare managed in outpatient clinics, in group clinics, by home health providers, by tele-medicine, and even by start-up “hospitals-at-home”.
8. Significant growth is also occurring in the fields of complementary and alternative medicine, where evidence is now showing that the best treatments for migraines and tinnitus may be acupuncture.
These signs are significant. Developing high quality and lower cost services in settings other than the acute care environment has proven to be effective and efficient.
To further drive home the fact that the acute care hospital of the future will be different is the recognition that in the near term some present diseases will be cured, and other diseases will be significantly controlled and stabilized. These will undoubtedly include cystic fibrosis, multiple sclerosis, some additional cancers, and some dementia disorders.
And a final driver will be trauma, which was the leading cause of death in children seven years and younger when I graduated from medical school in 1967. It is now the leading cause of death in people 60 years and younger, and will continue to rise. Why? Because many of the diseases which killed us in the past have also been irradicated, and so now we are “available” to be injured in car accidents, drive-by shootings, terror attacks, and natural disasters.
Yes, I still have my dream! And if you believe even half of what I have written is possible, perhaps we may all agree that the “signs of the times” are driving my dream to become our reality, With all this said, what will the hospital of the future look like? Stay tuned!