Hospitals of the future: Fewer beds but more comprehensive care

by Larry Nagengast
Special to Delaware Business Times 

The hospitals of the future may have fewer beds but, aside from that prospect, the operative word to describe changes in health care seems to be “more.”

Delaware health care systems are not only expanding services at their main facilities, but they’re also adding to satellite operations that bring care closer to where their patients live.

At the same time, they’re anticipating the arrival of a new wave of technology that will make a new kind of house call commonplace — through the internet.

“I expect a sea change in health care, and some of it is already going on,” says Wayne A. Smith, president and CEO of the Delaware Healthcare Association.

Bedless hospitals and virtual care centers “are certainties in the near future,” says Brian E. Dietz, president and CEO of Saint Francis Healthcare in Wilmington. “These are already taking place in other states. As part of our strategic planning process, we have been tracking the development and evolution of these new models of care delivery.”

The bedless hospital is essentially an advanced outpatient center that offers a combination of imaging, telehealth, surgery and short-term observational care. Rather than spend the night — or several days — in a hospital bed, patients are moved to lower-cost outpatient settings that provide essential and convenient care until they are ready to return home.

Mercy Healthcare in Chesterfield, Mo., opened the nation’s first virtual care center last October. Described as “a hospital without beds,” it houses 330 health-care professionals who “see” patients who may be in a hospital, a doctor’s office or even their own homes. Services range from making what is essentially an online house call to providing essential support to staff in emergency rooms and intensive care units at affiliated hospitals.

“We’re certainly spending a lot of time developing new ways of caring for people, trying to keep people out of the hospital and out of the emergency room,” says Jeffrey Fried, president of Beebe Healthcare in Lewes.

Fried and Terry Murphy, president of Bayhealth Medical Center, agree that telemedicine applications will become increasingly popular, especially in rural areas and wherever patients have limited access to providers. With a statewide shortage of psychiatrists, they say telemedicine can be an effective means of connecting patients to mental health providers, something Beebe often does from its emergency department.

In addition to through telemedicine, Smith says health care’s reach into individual homes may expand by having nurses and other professionals visit patients after their release from the hospital to make sure that they are taking their medications and following all the instructions on their discharge orders.

“Hospitals realize that one way to minimize readmissions is to continue to treat patients once they are discharged,” Smith says.

Another technological innovation now under way to enhance patient care is the development of electronic health records, which permit the sharing of patient health records among multiple providers. Since its launch in 2007, the Delaware Health Information Network has steadily extended its reach. All of the state’s hospitals input its patient data into the system and 98 percent of the state’s health-care providers access its data, according to DHIN’s 2015 annual report. Still, Fried says, the system isn’t perfect. He said he believes some of the data embedded in Beebe’s own systems isn’t accessible through DHIN, and connections with other states’ systems — important when vacationers visit Beebe’s emergency room — don’t always work. “Different systems, different vendors, they don’t always talk to each other,” he says.

While technological advances are expected to lead to fewer and shorter hospital stays and easier access to at-home care, there is little sign of abatement of the healthcare building boom. “Many services still need to be rendered in an inpatient setting,” Murphy says.

Bayhealth, he notes, is in the midst of building a $300 million campus in Milford, replacing the aging Milford Memorial Hospital. The 165-acre site will include a pediatric facility operated by the Nemours Children’s Health System, and Nemours will also offer some services for senior citizens at the site.

In addition, Beebe has plans to add 100 to 120 private rooms as part of an expansion of its Lewes campus, Fried says.

“You always have to replace facilities when they get to a certain age,” Smith says, citing the Milford hospital as an example.

And, he adds, private rooms are preferred — and practically de rigeur in new construction these days because the added privacy helps minimize the possibilities of infections spreading among patients.

Besides, Fried says, private rooms increase flexibility and efficiency. When patients are admitted from the emergency room, he explains, they can be assigned to a room immediately, without any concern over the condition or matching the sex of a patient in a semiprivate room.

In Delaware, and especially in Sussex County, hospitals will continue to need more beds because of the state’s aging population and the attraction of its beaches and low tax rates to senior citizens, Smith says. “Retirees obviously use hospital and healthcare serves at higher rates than your average 22-year-old,” he says.

Paralleling hospital expansion is the continuing growth of satellite centers that were meant, in part, to keep hospitals from becoming clogged with patients.

Beebe already has three major outpatient centers, two smaller ones and four walk-in, urgent care centers, and they’re getting busier every year, Fried says. “About 50 to 55 percent of our revenue is generated by outpatient services, so that’s a pretty significant growth area.”

Bayhealth anticipates expansion at its emergency and outpatient facility in Smyrna and possibly at its string of eight outpatient centers that stretch from Middletown to Milton, Murphy says.

St. Francis continues to broaden services offered at its satellite sites in north Wilmington and near Christiana and will soon offer cardiology care in the Pike Creek area, Dietz says.

For the long term, Smith and other officials say hospitals are paying closer attention to costs as the health-care system moves from a volume-based fee for services system to one that bases payments on value — keeping patients healthy and minimizing the likelihood of their return to a hospital.

Concern over the changing cost model, he notes, is another reason that hospitals are devoting more attention to following up with patients after their discharge.

Equally important, he says, are the initiatives hospitals are taking “to broaden their reach outside their walls.”

While citing the Alfred I. DuPont Children’s Hospital for its leadership in “trying to educate the public on childhood health issues,” Smith notes that “all hospitals are doing more to reach out into their communities.”

“With increased healthiness and less disease, eventually there will be fewer situations that lead you to come to the hospital,” he says.

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