WINDBER, Pa. – Hospitals are changing – with their business models becoming increasingly built on outpatient, same-day discharges, health leaders say.
The shift over the past decade away from inpatient, overnight stays is forecasted to become “seismic” by 2030, according to the American Hospital Association.
Chan Soon-Shiong Medical Center at Windber President Tom Kurtz said technological advancements and payer preferences have set the change in motion. Already, more than 80% of Chan Soon-Shiong’s revenue is outpatient-driven, Kurtz said.
“A lot of things contribute to the shift: immunity-based procedures, pharmaceutical changes, medical-device advancement,” he said. “And when you couple that with patient convenience and accessibility, you can see how this came about.”
Citing a forecast from the market analytics firm Sg2, the American Hospital Association predicts hospital outpatient departments will grow by about 20% in the 10-year period from 2020 to 2030.
Ambulatory or outpatient surgery centers are set to grow by 25%. Virtual visits are forecasted to rise from near zero to 29% of all hospitals’ evaluation and management. Hospital inpatient discharge volumes, however, are projected to be flat or drop by 1% by 2030.
Throughout the COVID-19 pandemic, the lack of available hospital beds across the country appeared to signal a lack of planning, Kurtz said.
But he said the pandemic disrupted a strategically executed decrease in hospital beds that’s been occurring for the past 10 years alongside increased outpatient services.
“You can say, ‘Why weren’t we prepared?’ – but it’s because the hospital business is so far ahead toward the outpatient business,” he said.
However, Kurtz is concerned by hospital bed reductions caused by hospital closures.
According to the U.S. Government Accountability Office, more than 100 rural hospitals that provided essential health care to their communities closed from January 2013 to February 2020.
As a result of closures, people had to travel farther to get the same health care services – an average of about 20 miles farther for common services such as inpatient care. People had to travel even farther, about 40 miles on average, for less common services such as alcohol or drug treatment.
The loss of rural hospitals is a continuing trend, Kurtz said.
“We haven’t seen the full effects COVID has had on small hospitals’ finances,” he said. “Bed capacity will get strangled even more.”
During the height of the pandemic, the elective surgical procedures that generate the most revenue for hospitals were suspended. In addition, the cost of salaries increased millions of dollars over budget as hospitals turned to agencies to hire travel nurses.
Hospitals aren’t likely going to take hospital beds out of mothballs, but rather move to provide medical services outside hospital walls.
“Call it ‘hospital in a home’ or ‘hospital without walls’ or telehealth – whatever you call it, we are not making adequate investments in it right now (as a country),” Kurtz said.
Kurtz said a technology company, Dten, chose Chan Soon-Shiong as a partner to build a telehealth product that could be used across the state. The technology could be unveiled this summer, and Kurtz already gave a preview to Acting Pennsylvania Secretary of Health Keara Klinepeter during her visit in May to the hospital.
Conemaugh Memorial Medical Center CEO and Conemaugh Health System Market President William Caldwell said significant technological changes are in store for the next 10 years.
“When you couple telemedicine with home diagnostic tools – for example, an Apple watch – you can feed your physician information from home,” he said.
As hospitals become increasingly focused on outpatient and virtual services, the roles of nurses will continue to change, Conemaugh Memorial Medical Center director of nursing Daniel Rager said.
“Nursing used to be at the bedside,” he said. “Now it’s expanded to become more appealing to a larger group of people. They get to experience other types of patients and see them in a better state of health versus ill and in bed. I think it’s opened up more opportunities for RNs.”
Surgical procedures such as joint replacements that required day-long hospital stays in the past can be done the same day, Caldwell said.
He said changes in third-party payers’ reimbursements for hospital services have helped reserve hospital beds for seriously ill patients.
“Things you used to be admitted (for) that they simply won’t reimburse,” he said. “Going back to 1982, low back pain was cause for admission to the hospital. Today, you won’t see anyone admitted for low back pain.”