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Relevance, Impact & the Road Ahead for Health Care the FUTURE OF DISRUPTION! Relevance, Impact & The Road Ahead for Health Care THE FUTURE OF HOSPITALS Dr. Farzaneh Sabi, Associate Medical Director Mid-Atlantic Permanente Medical Group 1 Accreditation Statement This activity has been planned and implemented in accordance with the accreditation requirements and policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint providership of Washington Regional Transplant Community (WRTC) and the District of Columbia Hospital Association (DCHA). WRTC is accredited by the ACCME to provide continuing medical education for physicians. WRTC is accredited as a provider of continuing nursing education by the California Board of Nursing Education. 2 The Future of Hospitals Education is the passport to the future, for tomorrow belongs to those who prepare for it today. Malcolm X 3 The History of “Hospitals”/Medical Facilities Ancient Egypt, Greece, India Temples not only served as a place of worship but also as a center for physical healing. 18th Century – “Age of Enlightenment” Voluntary Hospital Movement Royal Infirmary, Edinburgh Scotland 19th Century – Public and private hospital systems emerge Florence Nightingale Introduction of medical and nursing schools 4 The History of Hospitals – 20th Century Early 1900’s – the introduction of incubators for premature babies and the beginning of the Neonatal Intensive Care Unit 1960’s – Coronary Intensive Care Units offering continuous cardiac monitoring 1966 – Duke University offers consultation to physicians in developing countries via the radio 1968 – The first “Hospital Information System” The system routed back and forth orders placed by physicians to other departments in the hospital. Monmouth Medical Center, New Jersey 5 The History of Hospitals – 20th Century 1970 First Freestanding Ambulatory Surgery Center in Phoenix, Arizona 1980’s and 1990’s – Era of Laparoscopic Surgery 1990’s – Age of the Internet and Electronic Medical Records 2000s “Meaningful Use” of EMRs 2001 Lindbergh Operation – Remote Robotic Cholecystectomy Surgeons in New York City (French and Canadian Surgeons) – Patient in Strasbourg Civil Hospital in France Challenge, time delays between control and operating ends 6 Trends in Total Joint Replacement Surgeries From 15 days To 1 day in an in the hospital Ambulatory Surgery Center Health services research Trends and determinants of length of stay and hospital reimbursement Confidentialfollowing kneeand Privileged and hip Information replacement: evidence from linked primary care and7 NHS hospital records from 1997 to 2014 Vaginal Hysterectomies, Same Day Discharge The Decreasing Length of Hospital Stay following Vaginal Hysterectomy: 2011–2012 vs. 1996–1997 vs. 1995–1996 Geburtshilfe Frauenheilkd. 2014 May; 74(5): 449–453. Confidential and Privileged Information 8 Advancements in Cardiac Surgery Surgical Aortic Valve Replacement Transcatheter Aortic Valve Replacement Valve crimped onto balloon and advanced through catheter to heart Valve deployed by dilating balloon to inflate valve in aortic annulus Inpatient Length of Stay: 6 to 11 days Length of Stay: 1.4 to 2.3 days Procedure performed under MAC, no ICU stay. Patients typically ambulating within 4-6 hours after the procedure. 9 Overnight Sleep Studies at Home Sleep Studies 10 Transformation from Hospitals to Patients as the Center of the Medical Universe 11 Resource Optimization and Venue Management “Care at the Right Time, in the Right Location” Clinical Hospital Clinic Telemedicine Decision Unit Outpatient Ambulatory Hospital Procedure Clinic Surgery Center Suite Confidential and Privileged Information 12 Comparison of Number of Hospitals and Ambulatory Surgery Centers: 1970 to 2016 Source: American Hospital Association Annual Survey 2018; Data through 2016 Confidential and Privileged Information 13 Transition from Hospitals to Medical Office Buildings Kaiser Permanente’s First Oakland Hospital State of the Art, Technology Based Kaiser Permanente’s South Baltimore County Medical Office Building Confidential and Privileged Information 14 Urgent Care / Ambulatory Observation Units Advanced Imaging Clinical Decision Unit Laboratory Services Pharmacy 15 Ambulatory Surgery Centers 16 Declining Number of Hospital Beds Source: American Hospital Association Annual Survey 2018; Data through 2016 Confidential and Privileged Information 17 Differing Hospital Bed Capacity per Population Beds per 1000 by State, Comparison 2015 to 2016 State 2015 2016 District of Columbia 5.34 5.06 South Dakota 4.66 4.71 North Dakota 4.21 4.30 West Virginia 3.72 3.72 Pennsylvania 2.92 2.90 New York 2.67 2.66 Florida 2.62 2.61 New Jersey 2.23 2.33 Delaware 2.23 2.16 Virginia 2.13 2.13 Maryland 1.96 1.92 California 1.79 1.79 Hawaii 1.85 1.74 Washington 1.67 1.66 Oregon 1.68 1.63 Source: American Hospital Association AnnualConfidential Survey and Privileged 2018; Information Data through 2016 18 Consolidation of Hospitals in Health Systems Source: American Hospital Association Annual Survey 2018; Data through 2016 Confidential and Privileged Information 19 Consolidation of Hospitals into Health Systems 20 National Health Expenditure Trends $3.3 Trillion in 2016 $10,348 per person 17.9% of Gross Domestic Product Projected to grow at an average rate of 5.5% per year, and reach $5.7 trillion by 2026. Confidential and Privileged Information 21 https://www.cms.gov/Research-Statistics-Data-and-Systems/Statistics-Trends-and-Reports/NationalHealthExpendData/Downloads/NHE2016.zip Health Care Out of Pocket Expenses Mirrors Exponential Growth in Overall Health Expenditures in the United States Confidential and Privileged Information 22 https://www.cms.gov/Research-Statistics-Data-and-Systems/Statistics-Trends-and-Reports/NationalHealthExpendData/Downloads/NHE2016.zip Growing Out of Pocket Costs for Health Care Health care expenses account for anywhere from 6% to 16% of a household’s expenditures on an annual basis. Not surprisingly, the impact is greater with older Americans. Household Expenses Household Expenses Household Expenses 18 – 51 Years Old 52 to 70 Years Old 71 + Years Old 6% on Health Care 9% on Health Care 16% on Health Care Confidential and Privileged Information 23 https://www.cms.gov/Research-Statistics-Data-and-Systems/Statistics-Trends-and-Reports/NationalHealthExpendData/Downloads/NHE2016.zip If we as an industry don’t find a solution, others will. Confidential and Privileged Information 24 Mergers and Acquisitions Dr. Atul Gawande 25 Rise of the Consumer Voice 26 Care in the Right Place at the Right Time Respite care, guardianship, long term care 27 “People in the United States spend a lot of money at the end of life. In fact, about one quarter of all Medicare spending goes toward care for people during their last year of life. Beyond this shockingly high number, we know that end-of-life care patterns and spending vary widely across hospitals and communities. For example, although about 1 in 8 elderly persons living in Utah die in the hospital, the number is nearly 3 times higher for those who live in New York.” Innovation and Technology Confidential and Privileged Information 30 31 The Future of Hospitals 1. State of the art, technology based centers for high intensity and high acuity care. Fewer, but better. Care in the Right Place, at the Right Time, in the RIGHT location. A center of the ICU’s – neonatal, pediatric, medical, surgical 2. Same level of services 7 days a week. 3. Integrated system of image, lab, and information sharing among all hospitals and systems. 4. Non-hospital based solution for long term care. 5. Regulations catching up with the industry Recognition of Telemedicine Support for appropriate venue of care (surgical or medical) 32 Musical “Rooms” Emergency Department Intensive Care Unit Med-Surg Room Telemetry equipped rooms, move supplies and services to the patient and their family rather than the patient and their family to the room. 33 Labor & Delivery & Recovery & Postpartum ☺ 34 Confidential and Privileged Information 35 Same Level of Services Seven Days a Week Confidential and Privileged Information 36 Data Sharing Platforms 37 Network Adequacy? Confidential and Privileged Information 38 How do we fit into our patients lives, rather than make them fit into our schedules? Brick and Mortar Next available appointment Waiting Rooms Confidential and Privileged Information 39 Regulations 40 The best way to predict your future is to create it! Abraham Lincoln Our Time, Our Responsibility Thank you 41 History of Hospitals: https://www.electricscotland.com/history/medical/medicine8.pdf "The eighteenth century voluntary hospital movement" (PDF). Retrieved 23 September 2016. Porter, Roy (1999) [1997]. The Greatest Benefit to Mankind: A Medical History of Humanity from Antiquity to the Present. New York: W. W. Norton & Company. pp. 316–17. ISBN 978-0-393-31980-4. • Neonatal Intensive Care Unit; Autor: k1026a • November 7, 2012 • Essay • 545 Words (3 Pages) • Duke University Medical Center Archives- Project MED-AID https://archives.mc.duke.edu/blog/project-med-aid • https://www.hcsinteractant.com/about-hcs/health-care-software-history/ • Collen M.F., Miller R.A. (2015) The Early History of Hospital Information Systems for Inpatient Care in the United States. In: Collen M., Ball M. (eds) The History of Medical Informatics in the United States. Health Informatics. Springer, London 42.
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