Monday, June 30, 2014

Care Beyond Hospitals

Fish say, they have their
streams and ponds;
But is there anything beyond.

Rupert Brooke (1887-1915), English Poet

Currently hospitals have their revenue streams and their surgical ponds for collecting that revenue.

But for hospitals what lies beyond?

ObamaCare is cracking down on hospital Medicare and Medicaid revenues, penalizing hospitals for unsafe care, and imposing new more costly regulations.

But due to improved technologies and increased managerial efficiencies, specialists throughout the land are pulling out of hospital surgical units to create their own surgical ambulatory surgical centers in a variety of fields – ophthalmology, orthopedics, gastroenterology, general surgery, cosmetic procedures, orthodontics, podiatry , cosmetic procedures, orthodontics, podiatry.

You name the surgical specialty, and somewhere there is an ambulatory surgery center for it.

It is apparent specialists can perform many surgical procedures more safely, more cost efficiently, more effectively, more quickly, less bureaucratically, and more profitably outside of hospitals, rather than hospitals.

These factors are obvious to specialists, and they are moving fast to set up and to own their own surgical centers.

Consider this story in the June 30 Utica Consumer-Dispatch.

In part, it reads

“Ophthalmologist Dr. Patrick Costello removes cataracts, performs laser eye surgery and does cosmetic eyelid procedures at the free-standing Griffiss Eye Surgery Center in Rome.”

“He said the center, which opened about three years ago, offers patients cheaper, faster and more convenient care than a hospital.”

“Everyone is highly specialized,” he explained. “Typically, I can do two-and-a-half times as many cases at the surgery center in the same amount of time. And I’m not operating any faster. It’s the turnover of the room and the efficiency.”

“His center is not alone. Two more local ambulatory surgery centers are in the works: an orthopedic, plastic and pain surgery center in Westmoreland and another for pain management in either Utica or Kirkland.”

“The facilities are just the latest step in a decades-old march of services moving away from hospitals into community settings, whether that be an X-ray machine in an orthopedic surgeon’s office, chemotherapy in a doctor’s office or stitches in an urgent care center.”

The availability of so many services in the community raises the question: Do we still need hospitals?” Maybe not, pundits predict more than half of hospitals may close in the next decade.

But of course, we need hospitals – for major procedures, for serious diseases and complications, for trauma, for treatment of burns, for emergency care, for pediatric care, for all sorts of psychiatric treatments.

“The major difference between a medical office and a hospital is access,” said Dennis Whalen, president of the Hospital Association of New York State. “The hospital is open 24/7, 365 days a year. Anybody who walks into a hospital is required under the law to be treated, regardless of their ability to pay.”

Hospitals are reacting by cutting back on inpatient beds, expanding outpatient services and creating health systems that offer care outside hospital walls. and closing.

These trends will continue. And a new phenomenon, independent free-standing emergency rooms, is cropping up.

Health-care reform is reshaping the mission of hospitals. Gone are the days when hospitals’ major profits were in surgical procedures.
Now hospitals must find ways to replace lost surgical revenues – with joint ventures with specialists, with ownership of outpatient surgery centers, with hiring of specialists, or be declaring themselves as center to prevent disease and restore health to their communities, while making these ventures profitable, or in some cases, closing their inpatient doors.

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