By Jennifer Larson, contributor
April 1, 2013 - The future of care delivery may lie beyond the hospital walls--but not beyond the hospital’s influence.
Many hospital and health care systems are expanding their reach to provide more care in the community, rather than inside the hospitals themselves. Health systems like Geisinger Health System in Pennsylvania and Kaiser Permanente in California are just two examples of systems that use an integrated care model.
They are opening new outpatient care centers, broadening their community-based services and expanding their existing clinic networks to drive down costs, reduce admissions and change the patient experience.
Lois Elia of AdvocateCare noted that many patient care services can be delivered safely and efficiently in an outpatient setting.
The move toward value-based care was a major driver for Advocate Health Care, which is based in Illinois, to steadily grow its outpatient services. Advocate logs nearly 1.7 million outpatient visits annually. The overall approach is to achieve a successful blend of cost reduction efforts with the provision of better care to people, said Lois Elia, vice president of AdvocateCare, Advocate’s accountable care organization (ACO), which was established in partnership with Blue Cross Blue Shield of Illinois.
“Outpatient [care] is a part of it--and a growing part,” said Elia, but added, “It’s less about growing the complement as making sure people get the right care at the right time in the right place.”
The transition to more outpatient care is a phenomenon that many feel will continue to grow.
“If hospitals want to remain financially solvent, the trend will continue,” said Jessica Nantz, president and founder of Outpatient Health Strategies. “Hospitals that do not run lean, are not efficient and don’t establish a strong network of outpatient care centers and programs that provide services for specific specialties aren’t likely to be successful, and their ability to remain in operation is doubtful.”
Creating a better patient experience
Health reform mandates and the overriding need to reduce costs and streamline care are certainly major drivers in the shift to outpatient care, said Nantz. Improvements in technology have played a major role in facilitating the integrated care approach, but the patient’s perspective is another significant factor.
“Patients prefer this model because they can receive more individual and focused treatment instead of going to a hospital, experiencing long wait times and rerouting throughout the system,” she said.
The patient’s perspective has long been a consideration for Sutter Health, which began transitioning to an integrated care model more than 20 years ago.
Gordon Hunt, MD, SVP and CMO of Sutter Health, said that his system's outpatient services are "all part of the integrated care that’s needed to care for people’s needs.”
Sutter began opening ambulatory surgical centers and cancer care centers and acute rehabilitation centers, among other types of facilities, to offer patients the chance to receive care outside the hospital walls. Today it has more outpatient surgery centers (27) than it does hospitals (24).
This is all part of the growing drive to improve the patient experience, noted Sutter’s chief medical officer and senior vice president Gordon Hunt, MD.
As an example, he pointed to the new breast care center that Sutter Pacific Medical Foundation opened as part of its Advanced Imaging Center. By concentrating the services that a woman would need in one location, the center eliminates some of the wasted time that would occur if she had to go back and forth between facilities for visits, tests and follow-up. That may also eliminate some of the fear and frustration that she might experience, too.
“The patient experience is generally so much better in that kind of setting,” he said.
William Lewis, MD, chief of clinical cardiology for MetroHealth in Cleveland, agreed.
“The patients are telling us this is what they want,” he said.
His health system’s main campus is in Cleveland, but it has 17 satellite centers throughout the county. The system’s leaders deliberately chose to offer about 90 percent of its care in the community to make care delivery more efficient--and leave the most complex cases for the main campus hospital. As a result, the system logs nearly 877,000 outpatient visits per year.
“This is a model that is consistent with health reform,” said Lewis. “It’s a high-quality, high-value proposition. That works for us.”
Technology will enable the shift to continue, noted Nantz.
“Currently a significant majority of surgical procedures can [be] and are now performed on an outpatient basis,” she said. “It is anticipated that this number will continue to grow as new technology and advancements in clinical medicine and surgical technique continue to improve outcomes and the quality of patient care provided.”
Where the jobs will be?
According to data from the American Hospital Association, there were 1,305 freestanding outpatient care centers in 2010. By 2011, there were 1,342.
Peter McMenamin with the American Nurses Association said the outpatient care trend opens up good job prospects for registered nurses.
In general, the trend toward more community-based care is likely to be good for nurses seeking employment.
“It has to mean more jobs for nurses,” said economist Peter McMenamin, PhD, a senior policy fellow with the American Nurses Association. “It’s hard to run a clinic without registered nurses.”
McMenamin noted that the U.S. Bureau of Labor Statistics is forecasting an additional 712,000 nursing jobs during this decade.
“The trend of hospitals opening up outpatient care centers is consistent with what they’re forecasting where the jobs will be,” he said.
Also, the shift in care delivery models is likely to open up many new nursing opportunities, such as in care coordination.
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