New hos­pi­tals shed beds

New hospi­tal projects are tak­ing am­bu­la­tory care to the ex­treme

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Am­bu­la­tory care is get­ting more so­phis­ti­cated, and ad­vanced health­care ser­vices that once re­quired hos­pi­tal­iza­tion can now be de­liv­ered on an out­pa­tient ba­sis. While the “bed less hospi­tal” may ex­ist only as a con­cept to­day, the idea of us­ing bed counts to size up hos­pi­tals could be ready for re­tire­ment.

One no­table ex­am­ple of this is the mas­sive new $451 mil­lion re­place­ment naval hospi­tal be­ing built at Camp Pendle­ton near San Diego. Sched­uled to be com­pleted next Jan­uary, the 497,000-square-foot fa­cil­ity will house only 67 beds.

“Peo­ple al­ways ask, ‘How many beds do you have?’ ” Lt. Cmdr. Stephen Padhi, pub­lic works of­fi­cer for the Navy, told Mod­ern Health­care last year. “That’s an an­ti­quated ques­tion.”

Although the bed count is low, pro­jec­tions call for 2,000 out­pa­tient de­part­ment vis­its daily.

An­other project push­ing out­pa­tient care to the ex­treme is be­ing built in the Bronx.

While ren­der­ings of the $142 mil­lion prod­uct clearly iden­tify it with a sign above the door as the “Mon­te­fiore Am­bu­la­tory Care Cen­ter,” Mon­te­fiore of­fi­cials are de­scrib­ing it as some­thing else.

“This new tower will al­low Mon­te­fiore to bring the health­care of to­mor­row to our pa­tients here in the Bronx,” Dr. Steven Safyer, pres­i­dent and CEO of Mon­te­fiore Med­i­cal Cen­ter, says in a news re­lease. “We are re­shap­ing out­pa­tient care and es­tab­lish­ing lead­ing prac­tices that pro­vide Mon­te­fiore’s world-class treat­ments through mul­tidis­ci­plinary teams at a hospi­tal with­out beds.”

Henry Chao, a prin­ci­pal and health­care de­sign di­rec­tor with ar­chi­tec­tural firm HOK in New York, calls a re­duc­tion in hospi­tal bed counts “a nat­u­ral evo­lu­tion,” and part of the trend of fo­cus­ing on con­tin­u­ous well­ness care rather than episodic “sick care.” But he adds that there are other fac­tors that would block health­care from be­com­ing an ex­clu­sively out­pa­tient en­ter­prise.

“What is the hospi­tal C-suite fo­cus­ing on? Flat­ten­ing the cost curve,” Chao says, and that in­volves push­ing down the high cost of episodic care in the mid­dle while in­creas­ing re­sources for preven­tion and post-hos­pi­tal­iza­tion fol­low-up care on ei­ther end.

De­spite this fo­cus, Chao says the na­tion’s de­mo­graphic shift to an older pop­u­la­tion will drive a con­tin­ued need for episodic care, in­clud­ing sit­u­a­tions such as the cur­rent in­fluenza out­break.

“It’s not sim­ple, it’s a mov­ing tar­get,” he says of in­pa­tient bed re­duc­tion. “You may have more episodic care just be­cause peo­ple are get­ting older.”

Chao notes he’s also work­ing on projects in Ohio, Ger­many and Sin­ga­pore.

The Ohio fa­cil­ity will have “quite a num­ber of beds.” For the hospi­tal in Ger­many, “the big­gest chunk is the out­pa­tient cen­ter.” And, at the hospi­tal in Sin­ga­pore, a new con­cept is be­ing tested.

“In the old days,” Chao ex­plains, the Sin­ga­pore hospi­tal would have been a mas­sive 1,100-bed in­sti­tu­tion. In­stead, it’s be­ing bro­ken into a 700-bed hospi­tal for the most-acute care with an ac­com­pa­ny­ing 400-bed “step­down” hospi­tal where pa­tients can be trans­ferred if they still need care af­ter their con­di­tions have sta­bi­lized.

Chao says that in­stead of a “hospi­tal with­out beds,” the Ng Teng Fong Gen­eral Hospi­tal’s smaller Jurong Com­mu­nity Hospi­tal is be­ing re­ferred to as a “hospi­tal with­out walls” be­cause of the ef­forts to in­te­grate it into the lo­cal en­vi­ron­ment. The fa­cil­ity is be­ing built by Sin­ga­pore’s Jurong Health Ser­vices.

Mon­te­fiore is work­ing with New York­based Si­mone Devel­op­ment Cos. to build its 11-story fa­cil­ity at the Hutchin­son Metro Cen­ter, a 42-acre of­fice cam­pus.

Dr. An­drew Racine, Mon­te­fiore’s se­nior vice pres­i­dent and chief med­i­cal of­fi­cer, says the new fa­cil­ity rep­re­sents the gen­eral di­rec­tion that med­i­cal care is mov­ing in, ex­plain­ing how hospi­tal-level, high-tech care will be de­liv­ered in an am­bu­la­tory set­ting and “or­ga­nized the­mat­i­cally.”

In the new fa­cil­ity, lower floors will house di­ag­nos­tic imag­ing ser­vices. Above those will be two floors for sur­gi­cal ser­vices that will in­clude op­er­at­ing and pro­ce­dure rooms. Higher floors will be ded­i­cated to pri­mary care; gas­troin­testi­nal care and urol­ogy; car­di­ol­ogy; oto­laryn­gol­ogy; cos­metic surgery and der­ma­tol­ogy; and a pain cen­ter floor with anes­the­si­ol­ogy, phys­i­cal re­ha­bil­i­ta­tion, neu­rol­ogy and a headache clinic.

The idea is to have pa­tient-cen­tered care, Racine says, “rather than cater to silo-driven care.” “I ex­pect you’re go­ing to see more of th­ese types of fa­cil­i­ties,” he says. “We like to think this is go­ing to be a van­guard of this type of work.”

Two drivers of this, Racine says, are the de­sire to avoid the high-fixed costs of hos­pi­tal­iza­tion while im­prov­ing the ex­pe­ri­ence for pa­tients who, af­ter a pro­ce­dure, would pre­fer to go home and “sleep in their own bed.”

As health­care re­form plays out, find­ing a re­place­ment for bed counts as a way to gauge a hospi­tal’s size and scope of ac­tiv­i­ties ap­pears to be an­other task to add to health­care ex­ec­u­tives’ to-do lists.

“It de­pends on what you’re in­ter­ested in learn­ing about the en­ter­prise,” Racine says. He ex­plains that square footage re­mains the ba­sic mea­sure for those in­ter­ested in size, while the num­ber of pa­tients and pa­tient vis­its could help in siz­ing up ser­vices.

“Maybe pa­tient en­counter is the yard­stick to use,” Chao says, though he adds even that could be con­fus­ing.

Dur­ing one visit, a pa­tient might squeeze in en­coun­ters with med­i­cal, sur­gi­cal and di­ag­nos­tic imag­ing staff, as well as with a nu­tri­tion­ist and a den­tist. So this one pa­tient might gen­er­ate five en­coun­ters while never us­ing a bed.

“There are mul­ti­ple as­pects of look­ing at this,” he says.

The $451 mil­lion U.S. Navy hospi­tal be­ing built near San Diego will have only 67 beds.

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