Could this be the death of the hospital arms race?

Over the past year or so, as I've watched hospitals struggle to survive without meaningful access to capital, I've wondered how they've pulled it off.

After all, for decades, U.S. hospitals have more or less been defined by huge investments in buildings and medical equipment, partly to build revenue and prestige for themselves, and partly to compete against aggressive rivals in market-share wars.

How were community hospitals avoiding going belly up, I wondered, without pretty new women's centers or hot new 64-slice CT scanners? Weren't patients staying away in droves because that convenient new five-story parking lot didn't get built? It sounded grim and workaday at best, and a marketing and patient volume disaster at worst.

Well, now we're 18 months or so into one of the worst dry spells for capital in healthcare history, and what have we got? A whole lot of pain? Yes. Falling patient volumes? Check. Less money for new service lines and nice new buildings to house those services? Definitely. And funds for cutting-edge medical devices, sadly, is scarcer than hen's teeth. Sure, people are getting to lay out for EMRs, but a) much of it's coming from Obama, and b) they pretty much have to do it whether it hurts or not.

Still, from where I sit, it seems that the pain is spread a lot more evenly than you might think between the hospitals that have still managed to eke out a few neat additions to their facilities and those who just had to hold off. Where patient volumes have fallen, it's often been because consumers have lost insurance or couldn't afford hiked-up deductibles and co-pays.

Now, I don't have comprehensive data in front of me, so I'm sure there's exceptions aplenty to my theory. I'm sure such capital expansions have had more marketing impact in some markets than others, particularly in crowded urban markets where prosperous consumers are picky shoppers who go for a sophisticated pitch.

But in other markets, where the glam factor isn't as important, maybe, just maybe, aren't today's trends suggesting that mode of delivery--outpatient versus inpatient, retail clinic vs. primary care--is proving to be more important than investments in hardware and fancy outbuildings with lovely plants and color schemes? Aren't hospitals getting some evidence that their whole way of thinking about spending for consumer engagement has to change?

I don't know, truthfully, but I think it's a question worth asking. How about you? - Anne