Hospital innovations in the pipeline

This is an interesting time to be a hospital executive--and a turning point in the business. New business models are popping up every six months, a fevered pace more akin to Silicon Valley than the staid halls of medicine. And practices which have standard for decades, such as expecting on-call physicians to work for free, are dissolving under pressure.

This week I spoke to Richard Reese, MD, a Minnesota-based pathologist who has practiced medicine for 25 years, to get his take on how some of these changes will shake out. Reese, author of the new book Innovation Driven Health Care, has taken a hard look at some of the industry's emerging trends, and he has some strong opinions on how it will all work out.

Some of his conclusions:

With specialists "abandoning the mother ship" to form their own ventures, hospitals will have to take new approaches to partnership, Reese suggests. He believes that hospitals will have to do build more outpatient centers with specialists, or risk losing some of their highest-revenue admitters.

* He's skeptical that the retail clinic movement is going to keep expanding. "People expect more professionalism from clinicians than having to go behind a curtain at the back of their drug store," he says.

* He's expecting to see the rise of "big-box" medicine, 250,000 to 375,000 square foot facilities co-owned by hospitals and doctors. These retail-style facilities--which resemble suburban shopping malls--have joint reception areas, ample parking, imaging facilities, outpatient facilities, diagnostic centers, pharmacies. The idea, which is already taking root in the Midwest, is spreading across the country, according to Reese.

* Reese anticipates that hospitals and doctors will increasingly build MACs--multi-specialty ambulatory centers--in partnership with real estate developers. These MACs, which are being built in several locations already, will typically be found at the intersections of highways, often in areas which are medically underserved.

* He sees a movement toward Japanese-style lean models of production within hospitals. This will involve getting people together to plan how to do things more efficiently, such as reducing patient waiting times or times from biopsy to surgery, he says.

All of this boils down to a dramatic shift in the hospital paradigm, Reese suggests. In the future, hospitals will have to turn themselves "inside out," and find new ways to meet consumers where they live.

So what do you think, readers? Is Reese on target, or do you disagree with his conclusions?  Write to me and let me know where you stand. It's time to dust off that crystal ball!- Anne

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