Redefining the hospital


What will it take for hospitals to stay relevant as tectonic plates in the healthcare industry shift?

It's clear something's got to change. Many signs point to areas where hospitals could deliver care better.

Here's an example of where hospitals don't seem to be delivering on their promise: The most expensive hospital stays tend to be ineffective and pricey. We recently noted that the top 0.5 percent big-ticket hospital stays cost more than $500,000 for a 48 day stay on average. Yet more than 80 percent of those patients will die, despite the inpatient stay. Could it be that there's too much emphasis on last ditch-efforts that have little chance of succeeding, when a patient might do better getting palliative care in a hospice? 

In a more rational world, better preventive primary care would mean fewer preventable hospital stays. Ten percent of nearly 40 million hospital stays could have been avoided in 2008, according to the Agency for Healthcare Research and Quality. The bulk of that would be preventable chronic conditions. 

Already the growth in demand for outpatient care is outpacing growth in the inpatient slice of the healthcare pie. Technological advances mean smaller incisions avert the need for long hospital stays. As a result, a growing share of healthcare is getting delivered on an outpatient basis.

Hospitals increasingly find themselves treating the very sick or significantly injured as the market shifts to outpatient care. Given that diagnostics, chronic care management and rehab are mostly outpatient, perhaps hospitals would be best suited as the destination of last resort for patients who have exhausted other approaches. - Sandra

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