What Is Going To Be Left?

As technologies and innovations continue to create more and more non-invasive procedures, the movement of “once required” inpatient care is moving rapidly to safer ambulatory settings where often better and less costly medical outcomes are achieved. This transformation is also being fueled by marked increases in the types of anesthesia that has become available over the last decade which permits rapid recovery with little or no side effects. Providers that are listening to their patients/customers are hearing that they prefer such care which results in easier access, high patient and family satisfaction, and high quality and safe care supported by outcome metrics. All of these factors indeed support a strategic imperative that should be embraced by the healthcare industry – “What sick and well-care can be performed in ambulatory settings should be delivered in ambulatory settings!”

Unless providers are located in organically growing communities or are receiving a bolus of newly insured patients, they are often reporting inpatient volumes decreases of between 5% and 8%. This is leading some hospitals, particularly the smaller ones in rural locations, to close or merge.

So the question that needs not only strategic reflection from the providers, but also a data-driven answer is:

What kinds of patients and services will be left in the inpatient setting?

On system recently indicated that they believe little will be left, so they are opening what may be the first healthcare facility designated as a “bedless” hospital. They report that it will provide all the services in a traditional hospital but will be devoid of beds and an emergency department – a 100% outpatient hospital facility. We already have a myriad of ambulatory surgery centers dotting the country, many partially owned by physicians, which have moved a considerable amount of surgery safely out of the often hectic inpatient surgical suite.

Recognizing that this revolutionary approach will not be suitable for many communities at this moment in time, we will still put forth our list of services that we believe will be the only ones likely remaining in the inpatient setting as this transformation continues to evolve. These include:

1. Severe Trauma
2. Organ Transplants
3. Highly Infectious Diseases and Epidemic Outbreaks
4. Patients requiring treatments that compromise their immune systems, such as bone marrow and stem cell transplants
5. Open cranial/neurosurgical procedures
6. Open procedures of the chest and abdomen (These are rapidly reducing in number)
7. Implantation of artificial organs, both on a temporary and interim basis,
8. High Risk Obstetrical Patients for Prenatal care and Deliveries.
9. Neonatal Care

Whether this list is totally accurate and comes true 100%, it is important to recognize that as metric-validated best practices driven by evidenced-based medicine continue to drive more inpatient care to ambulatory settings, payment reform will follow, both governmental and commercial. In most cases, this will result in a decline in revenues which will mandate a decline in expenses for the sustaining of a successful business model. Clearly, “What is Going to be Left?” is a question that must be answered!