MicroHospitals and fast service by St Vincent in Indiana

An article in IndyStar (https://www.indystar.com/) describes a micro-hospital by St Vincent in Noblesville, Indiana. These micro-hospitals are around 60,000 sq ft, cost $12 million, have seven emergency rooms including one for trauma, four in patient rooms and eight overnight beds. The goal is to get customers to the emergency rooms within 3 to 5 minutes, and seen within 15 minutes. The ideal time from dock back to door – turnaround time for patients is claimed to be 15 minutes. With a small staff (one nurse, a paramedic, an emergency room physician) these micro-hospitals are intended to provide the quick response patients demand.  These hospitals are also expected to avail of telemedicine tools to consult with specialists. Will such smaller facilities  replace the large hospital models in use currently? Will hospitals evolve into a hub and spoke system with the spokes being represented by these smaller hospitals that will feed only the more complicated cases to the large hospitals ? How will hospitals ensure adequate capacity utilization to make these micro-hospitals sustainable ?

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33 Responses to MicroHospitals and fast service by St Vincent in Indiana

  1. Huili says:

    Yes, I believe the hospitals will evolve to this hub and spoke system. The smaller hospitals can be closer located to the patients and the larger hospitals can deliver more complicated care and treatment. There will be a balance in the number of smaller and larger hospitals depending on the number of patients in the area and distance to the hospitals.

    To ensure adequate capacity utilization the hospitals can setup a communication network with other caregivers in the area. For example an ambulance can see which hospital has spare capacity so that the ambulance can decide to go there. Or a general practitioner can refer a patient to a hospital somewhat further away, but that has spare capacity.

  2. Camilo Rodriguez says:

    In first place, I definitely don’t believe that these small hospitals will replace larger ones because smaller ones will not be able to absorb the fixed costs associated with having and maintaining highly specialized equipment. As a an example, the costs of buying, maintaining and running an MRA machine would probably exceed the capacity of a small hospital. Nevertheless, I think the model is interesting to alíviate congestion in larger hospitals, and I believe that an adequate triage system can definitely alleviate some of the capacity issues. The problem, in my opinion, will be dealing with critical emergency cases where stopping first at a micro-hospital might be the difference between life and death.

    • Sarah Rosnick says:

      I’m a fan of this particular comment only because it illustrates the real complexity behind running a mini-medical practice without incredible demand for this kind of service. I don’t believe that a lack of demand at the larger hospitals automatically implies a higher demand for this lesser level of service. In this day and age and in the United States, a decrease in demand is unlikely due to a lack of transportation. It’s actually probably tied to the availability of information and people’s ability to diagnose themselves (—perhaps not accurately, but still….)

  3. Freddy Horn says:

    I agree that the “hub and spoke” system would allow more flexibility. If more microhospitals are located closer to the patients, this would also accelerate response time. However, at the same time, smaller hospitals have smaller individual service capacities. If urgent care for more patients than expected (e.g. after accidents, natural disasters, disease outbreak, etc.) is required, mircohospitals might quickly reach its capacity and could not offer the necessary care during those peak times, or at least delay the response demanded by patients. Although Huli’s suggested communication network might be a solution for this problem, an infrastructure of more microhospitals and fewer large hospitals will most likely also increase total costs, because just like in other businesses, there are economies of scale in health care as well. Shifting from few large hospitals to many small hospitals will most likely only redistribute capacity. In my opinion, this will only make sense if this de-bottlenecks the whole system or in other words, if factors like transportation to the hospital, patient registration, etc. are the real bottleneck of the system.

  4. Sarah Rosnick says:

    We had a really interesting group discussion on this today. I had previously worked in the healthcare information exchange realm and part of our work was connecting smaller clinics to the larger ones with technology in order to reduce risk, liability, and provide the patient with better continuity of care. From the prescriber or provider point of view, there is increased risk functioning from these smaller clinics when you’re treating patients with a complex history of care but without the detailed notes to support. I had made the observation that this model might not be successful in our current environment and would probably be more successful in third world countries. Camilo had commented that this model was relatively successful in areas outside of the United States – and especially in the countries where there is a single point of payer. I think my personal struggle in seeing this be a successful venture in the US lies largely around the idea that small clinics will struggle to find enough efficiency and synergies to sustain their business models. They won’t be able to offer much in terms of diagnostics because the cost of the equipment would be too much.

    As a patient, I’d be hesitant to use a clinic that didn’t provide enough services and coverage to be able to support my needs with confidence.

  5. Kim Coldiron says:

    While I think this is an interesting concept, I echo Sarah’s concerns regarding my personal level of confidence that the micro-hospital would have the necessary equipment and background on my medical history to meet my need unless it was very minor, in which case a walk-in clinic may suffice. I also agree with Freddy that this model could result in more cost unnecessarily, especially if there are alternatives within the larger facilities to better manage the possible bottlenecks without new brick and mortar facilities and potentially redundant equipment. The truth is, “no two micro-hospitals provide the same services or are built on the same design.” While we might all agree that efficient care and treatment is of value, the downside of possibly being sent to another facility for further diagnosis or treatment due to specialized equipment needs or capacity is not appealing to me from a cost or efficiency perspective. Additionally, the limited opportunity for doctors to practice key procedures in these micro-hospitals has raised questions about the safety and care of the patients compared to the proficiency of doctors who perform a higher volume and frequency.
    I view this as less of a response to consumer demand and more of a desire for larger hospitals to increase their share of the market that may be slipping away to the urgent care clinics and other competitive alternatives. The VP of strategy and development from Emerus said, “we want to capture that patient in the system and align them with a medical home, preferably our partner.” I can’t fault the logic, they are attempting to provide easier access to the consumer in hopes of maintaining them throughout the full cycle of care from minor to more serious needs but I’m not sure it’s in the best interest of the consumer.
    To Sarah’s point, I believe this model has merit in specific geographies but where larger hospitals exist, I would rather see them improve their internal service model and partner with existing alternative care options if they want better access to the consumer. In the US we are familiar with many large retailers now offering walk-in care (CVS Minute Clinic, Walgreens Clinics…). These services already exist with access to pharmacy needs and minimal equipment. The consumer knows what to expect from these clinics and the cost is minimal. This is an opportunity for hospitals to add value to the clinic and consumer while gaining access to the consumer. St Vincent has entered into such an agreement with Kroger’s Little Clinic to provide care at 10 in-store clinics in Indianapolis.
    Ultimately, I these micro-hospitals cannot replace the larger full-service facilities and I believe there is an existing outlet for the hub and spoke model to better serve the provider and consumer.

    • Jordan McCroskey says:

      I agree with your comments. While the concept of a micro-hospital is an interesting experiment I don’t believe it will become the future model for healthcare. It’s hard to find any industry where the little players survive, it’s almost always consolidation and operational efficiency through mid-size to the largest.

  6. Viktoria Kiss says:

    I don’t think that such smaller facilities will replace large hospital models; they don’t intend to do so. They have different goals. According to the article „The goal is to get customers to the emergency rooms within 3 to 5 minutes, and seen within 15 minutes. The ideal time from dock back to door – turnaround time for patients is claimed to be 15 minutes. With a small staff these micro-hospitals are intended to provide the quick response patients demand.”
    I guess the idea is to deliver certain emergency services in place where people work and live. This approach can identify the local market need (demand) and then fill that need (supply) by:
    – Providing easier access to emergency services for local communities instead of having limited or overcrowded options for emergency care in a large hospital.
    – Offering faster hospital discharge times and reduced waiting times.
    – Allowing providers to focus on fewer patients (to help patients feel more taken care of).
    These small formats could deliver higher quality care and higher patient engagement.

    I also believe that hospitals should evolve into a hub and spoke system in order to bring a higher level of service that ensures a more cost- and operationally efficient health care delivery system and higher patient satisfaction. Otherwise the overall delivery system fails to achive adequate capacity utilization; the result would be still overcrowded major hospitals with capacity shortages and unsustainable micro-hospitals with excess capacities.

    • April King says:

      I completely agree with Viki’s comment – the micro hospitals have different goals and are not intended to replace larger hospitals. I also believe hospitals should evolve into a hub and spoke system to effectively utilize resources, reduce bottlenecks, and to reduce queuing times. I am unsure of worldwide statistics, however, Emergency Rooms (ERs) in US hospitals in urban or more densely populated areas are notorious for extreme wait times (https://projects.propublica.org/emergency/) and poor customer service. Micro hospitals would certainly help with reducing queuing times, and providing more direct, efficient care to patients. If used in conjunction with existing telemedicine tools and with cohesive partnerships and communication with the larger hospitals (hubs), the hub and spoke system would work- however, real-time and clear communication would be key.

  7. Viktoria Kiss says:

    Just one more thought regarding your concerns mentioned above. I don’t know how this system works (does not work) in the US, but we have a kind of similar concept (the mixture of a walk-in clinic and a micro-hospital) in the suburban area of Budapest. These smaller facilities are organized on a microregional basis. I believe that we shouldn’t just think about a serious traumatic situation. If you have kids or elderly relatives you know that anything can happen anytime (Literally!). In case of these kind of situations instead of driving 20 kilometers to Budapest in the rush hours (which can take one and a half hours) to an overcrowded major hospital where you have to wait at least another hour to finally meet an often exhausted doctor (whom you have never met before), you just have to drive 10-15 minutes to either have a medical consultation/check or a complete medical service. This solution makes everybody’s life much easier: significantly less time and stress for the patient and more spare capacity in major hospitals.

    • vijay raisinghani says:

      I like Viki’s context based on Geographic area. One thing to consider is the healthcare system and how it is managed WW. In USA, we are drifting away from the old school USA thinking of what our govt should provide to something different. I am not sure how much the system is changing WW but that would play a role.

    • April King says:

      We have something similar in California – they are called Urgent Care clinics and are walk-in facilities that can provide various types of urgent care, xrays, tests and screenings, and occupational health needs. My brother-in-law was visiting from Georgia for a 24-hour period and was headed overseas; he had a bad cough and was able to get immediate treatment and antibiotics at one of these clinics before heading off to his flight. I had never seen anyone use these clinics before, so I was amazed. I imagine microhospitals would be like these clinics, but with more equipment and staff suitable to address greater emergencies. This can work!

  8. Jordan McCroskey says:

    This is an interesting topic to me because the recent trend in hospitals has been mergers and acquisitions to increase the size of the network. In Illinois the hospitals have reduced the different networks to less than 10 (used to have independent hospitals in almost every midsize town). Healthcare costs continue to increase and new technologies bring increased costs for hospitals to keep the latest technology in the hospital. Having the latest technology is how they attract the best doctors and ultimately insurance providers and patients.

    Especially in the departments that drive the most profit for hospitals (chemo, radiation, heart care, ortho) size is extremely important. The larger the department, the more beds they can hold and therefore they increase revenue. For these hospitals it’s about operational efficiency – as they get larger they bring in business managers to handle the operations of the department. We explored this in week 1 readings regarding wait times and inventory.

    In Illinois, Rush and Edwards are two of the largest networks south of Chicago. Both networks have created small “spoke” clinics that focus on a particular profitable service (like chemo/radiation) or emergency room services. This allows them to reach smaller communitites and expand the reach of their most profitable units. Customers still have to drive to the large hospitals for surgeries, and other services that tend to be less profitable, or more complex, for the hospital.

    I think that outpatient centers that can provide services and attract additional patients to the network will continue to grow. I also expect to see hospital systems continue to expand into the clinic model providing basic care using nurse practitioners to reduce cost. I don’t believe that the model of a micro-hospital will prove cost-effective. The technology necessary is too expensive, and they won’t achieve the number of patients needed to spread the costs out among all patients. This will require the hospital to charge more for use of these smaller hospitals. I believe that the current activities of M&A and expansion that we see in the industry actually point to a larger model with even larger hospitals to increase operational efficiencies and allow for amortization of technology costs over more beds.

  9. Michael Minor says:

    In my opinion, the micro-hospital will never replace large hospital because that’s not its intent. The Noblesville location is strategically located along highway 69 a significant inlet to Indianapolis and close to many housing developments including my own. Traffic coming from Michigan and Fort Wayne bottleneck through Noblesville stretch of the highway, making it a high-volume accident area. I will point out there is a significant hospital IU Health Saxony Hospital located less than a half-mile from the St. Vincent location that continues to support its patients with typical medical services and long-term care.

    A hub and spoke health care system could be on the horizon. The micro-hospital provides an in lieu of service when you can’t see your normal doctor and during emergencies. Through the micro-hospitals immediate services, the patient wait time can be significantly reduced from average emergency room wait times. This acute care model will enable a high bed turnover rate for the spoke and only feed local hospital when patient care falls out if its capacity or capabilities.

    I don’t believe hospitals will change the way they are currently doing business, because of in most cities they are already above capacity. If anything, hospitals will learn how to be more efficient in their operations. It will be the potential patient that will determine if micro-hospitals are sustainable. Will patients wait a week to see Dr. Bob for my stomach ache or go to the local micro-hospital for immediate care? There are many potential spoke customers but will our society break away from our norms concerning what proper health care is that will support the micro-hospital. I think it will work, one example is that we are getting flu shots from places like Wal-Greens so why not a micro-hospital.

  10. Marcya Carter-Sheats says:

    I do not feel that the micro-hospitals will ever replace the larger hospitals. I think that the goal, exactly as my classmates described, is to reach the communities that are located some distance away from the metro areas. It is probably more cost effective to treat cases at these micro-hospitals instead of flying in patients. In Nashville, TN we have several main hospitals and a number of patients from smaller communities from Kentucky and TN are flown in by helicopter because the communities are too far out to properly treat these patients. I volunteered at the Children’s hospital and several members of the staff said that some air lift patients were not trauma patients but simply required a bit more care. Knowing the cost for emergency visits for my daughter simply receiving Benadryl, I cannot fathom the cost for these air lift patients. In addition, large hospitals still have the diversity of talent. The beauty of places like the Mayo Clinic, is that you have all the experts in one place working together to solve complex health issues.

    Medical technology should continue to be a focus for large and small hospitals. The difference between a good and bad scanner could mean life or death for some patients. Healthcare will need to continue to improve and waste will need to be removed from the supply chain. Micro-hospitals will sustain only if the care provided is sufficient for that community. Any business today will be held up the same standards and social media will continue to make or break business. If micro-hospitals, like the ones described in the article offer good care, improved technology and a fast turn-around, then they will succeed. If they do not provide quality care, then they will cease to thrive. Of course insurance can mandate location and care, so they might be able to sustain in spite of quality care. There is great benefit to these micro-hospitals if they are established properly. They can also benefit the larger hospitals if they take more volume away. Large hospitals can then tailor their care to more extreme cases.

  11. Camilo Rodriguez says:

    Echoing on Sarah and Viktoria, this system is already implemented in many countries where there exists single payer systems such as Canada, UK and others. In Colombia, we also have a single payer system and these micro hospitals have been very effective in alleviating congestion at larger ones. The reason why this works is because the single payer system eases information sharing across the whole system , and because the mayority of cases that go to the hospital are actually simple to solve. In the us, I see this as a much more difficult process because private carriers and patients might not be as keen on this information sharing actually happening. The problem I mentioned above regarding choosing which type of clinic to take patients to stil holds no matter what system exists.

  12. Kevin Frasier says:

    I think the US healthcare model eventually moves more and more towards hub-and-spoke. The change will likely be slower than in other countries, but I think you already see this happening with the propagation of “urgent care” facilities and “minute clinics”. So the change is underway.

    This makes sense for a number of reasons. The “spokes” can be run with much lower staff and overhead and they are geographically closer to patients, who are mostly not suffering from a traumatic injury, but more often require triage, stabilization, or treatment of chronic conditions.

    I really like the ‘minute clinic’ model of co-locating medical services with pharmacies and general stores because this arrangement helps to maintain high capacity utilization. Primary care physicians already operate at ‘spokes’ away from main hospitals, so it makes perfect sense that the rest of ‘non-critical’ care moves away from hospital ‘hubs’ as well. Other medical practices where this is already seen: outpatient radiology, where imaging and radiology services are provided at much lower cost then hospitals and who have – to a large extent – solve capacity utilization by entering into agreements with insurance carriers on pricing and coverage that is far more competitive than hospitals.

    I’m confident that in the long run the US healthcare market moves this direction, because business leaders across the rest of the economy will grow frustrated with ever larger proportions of the US GDP being consumed by healthcare and begin clamoring for change so that they can grow their respective industries.

    The micro-hospitals are sustainable, as evidenced by use and success in a wide variety of OECD countries.

  13. Randall Loomis says:

    I think the best model for the micro-hospital is in the form of providing immediate care that is routine in nature, or first response urgent care that can stabilize a patient then move them on to a larger facility where they can receive comprehensive treatment. A shift to this hub and spoke model is similar to a shift in how medical treatment has changed in the military over the last several decades.

    There was a television show, M*A*S*H, set in a Mobile Army Surgical Hospital during the Korean War. Surgeons were placed close to the front lines and attempted to save as many lives as possible by being able to perform complex medical procedures close to the fighting. In contrast, during the Gulf War, a totally different strategy was employed: casualties were triaged, stabilized with basic field procedures, then transported to more comprehensive care in large hospitals.
    The result was much greater recovery and survival rates.

    If micro-hospitals form of hub and spoke system that works effectively as part of a medical network, then it can certainly improve the efficiency and effectiveness of medical care. The danger, however, as the name “micro-hospital” implies, is that these facilities would attempt to operate outside of a network and could result in highly variable and inferior quality of care like the obsolete MASH units of the past.

  14. srinivas tadepalli says:

    Necessity spawns innovation. This is a nice initiative in Indiana. In fact this is not a new model. For example, an organization “Aravind Eye care” in India has been innovating with this hub-spoke model for a long time. This type of model is very useful especially in situations where there is pressing demand and constrained supply. I think this type of business model also has the ability to scale well. The spoke locations can focus on routine treatment, diagnostics, and basic patient follow up care thereby keeping the doctors busy and ensuring enough capacity for these “spoke” centers to be running. On the other hand, thanks to the advent of telemedicine which will allow more experienced doctors/physicians serve the needs of patients in the spoke remotely thereby aiding in lowering the overall costs to the patients. Local spokes can come up with innovation that suits local conditions

  15. bairdjb says:

    I think that everyone has delivered great points for both sides of the argument.
    However, in the US I do not think that these micro-hospitals will replace larger hospitals for several reasons. First and foremost, for the reason Mike noted, the geographical location of this facility is in the heart of one of the fastest growing areas in Indiana. This area is also separated from the main medical centers by a significant bottleneck in the current infrastructure. Without traffic delays, it could take up to 15 or 20 mins to make it to the main St Vincent facility on 86th street. I would not even want to guess how long it would take if an ambulance were stuck in one of the daily traffic jams. Plus, the amount of travel time to get from the point of origin to the bottleneck.
    Another reason I don’t see these facilities replacing the larger hospitals is shifting demographics. Currently, in Indiana, we have no population growth. However, the urban areas are growing because the younger population is moving from the rural area to major cities. Leaving the more elderly individuals in the rural environment that will need greater medical care than what the micro-facilities can provide. So I am not sure who they will be providing care for in the future if the young citizens are already gone and the elderly have to directly bypass these places.
    Also, a lot of these micro-hospitals have been created for financial benefits. Especially the more rural facilities. The hospital receives local and state tax advantages plus federal grants from the USDA department of economic development.

  16. Sara Moscato Howe says:

    As healthcare evolves, patient evaluations have become increasingly important in outcomes management. To that end, we continue to see more tele-health and hub-and-spoke models as described above. The likely reason is patient dissatisfaction with wait times – which this model aims to significantly reduce. This model could provide an excellent way to reduce those times in highly populated areas – yet that could also be a downfall because of the increased number of patients and smaller staff to address immediate needs. On the other hand, in rural areas, these smaller facilities could be an answer to riving long distances for immediate care. However, that may not impact wait times either of these are the only option within a great distance. I agree with a previous blogger that this will probably eventually occur over time, but it will take a while for it to work as planned because a true hub and spoke model needs multiple spokes working concurrently. When combining this model with tele-health, we can see the potential evolution of the US healthcare system. This will be very interesting to watch in the next few years!

  17. Jennifer Greminger says:

    To the question of the likelihood of these smaller facilities replacing the large hospital models in use currently…it doesn’t seem this is the end goal. The goal is to fill a gap that exists with access to larger hospitals, as well as get customers to emergency rooms (and seen) more quickly. There doesn’t seem to be evidence that suggests the need being filled is because as people wait for service or access service, their cost of care escalates. The article simply states it is to address customer demand. With the cost of health care in the US, it begs the question to what cost can customer demand be met, when the demand is being fueled by preservation of an individual’s discretionary time. I agree with previous submittals that it will take time to see the full effect of the hub and spoke – will customer demand change (again) before this infrastructure can be robust enough to be effective ?

  18. Jennie Dekker says:

    I struggle to believe that these micro hospitals will be able to take off and become the primary method of initial care delivery for many of the same reasons individuals have listed above namely the financial burden. However, a more clear barrier is the current setup of Emergency Room care in Indiana. Emergency rooms are run by private companies (For Example: IU’s Hospitals ER facilities are wholly run and staffed across Indiana by IEC, a physician owned care group) and these pop-up shops stretch their capacity was small businesses further causing financial and human resource strain. I believe the core issue the system is trying to address is response times and while this hub and spoke system is a good concept – a better option could be increased training and requirements of the initially responding paramedics. EMT’s receive very little technical training and by bolstering those positions education requirements we could better triage patients in the field, allowing for longer transport times.

  19. Mike Carter says:

    I do believe more and more hub-and-spoke facilities will be developed as we ll as tele-health initiatives. I think both of these concepts are unique alternatives to extensive wait times at hospitals or large medical practice facilities. In many cases, it takes weeks to schedule appointments with your family doctor unless deemed an emergency sick visit. So, I think these are great alternatives, but I also believe that most people will view these options simply as a “Med Check” type facility to be used only for sick visits and not conditions that most would consider critical. I think there would be trepidation from the public regarding the quality of the doctors at these facilities. In many cases, the comfort of knowing your family doctor is more important than the convenience of these type of options. So, although I think there will be a continued effort to create these options in most cases people will stick with their preferred family doctor because of the comfort and confidence of their relationship.
    Mike Carter

  20. Kenneth Janicke says:

    1. I would these smaller facilities to augment rather than replace current large hospital models. MicroHospitals will be able to provide more general emergency life saving services, and benefit from both speed due to the smaller local business bureaucracy, and by physical location spread out into communities for patient proximity.
    2. It does make sense that hospitals will evolve into a hub-and-spoke business model similar to airline or distribution businesses. The smaller hospital should have higher flow rates, lower inventory, and lower costs. These efficiencies will not only lead to better patient service, but should also translate to higher profits.
    3. Ensuring adequate capacity utilization will be the key to their success. I imagine these metrics will have to be carefully monitored and adjusted based on location (indicators of patient demographics and medical needs), and should make great use of existing population analytics that have been gathered over the past decades by hospitals, fire departments, etc.

  21. Paul Aoun says:

    Given the rapidly increasing cost of healthcare, especially in the traditional hospitals, it’s good to see this innovative approach.
    Here is California, we are seeing more and more layering of the healthcare services, which started with “Urgent Care”, defined as less than medical emergency but more urgent than waiting for a regular appointment, and more recently with “Express Care”, a layer below urgent covering minor illness, minor injuries and so on. In my opinion, this approach is akin to providing a supply chain of services starting with “Express Care”->”Urgent Care”->”Emergency/Hospital”, and the model being tried in Indiana is along the same lines of optimization the flow of customers through the healthcare system, while increasing throughput and reducing “inventory” (patients waiting).
    In my opinion, these micro-hospital will not replace the integrated hospital but will take away the more repetitive services that don’t require specialized service, and thus moving the potential bottlenecks out into the earlier steps of the process, in a hub and spoke model. To make sure utilization is high enough in the micro-hospitals, the main hospitals will have to stop providing those services and send the patients over to them, while focusing on the more complex healthcare services, which are usually much more expensive and require a hub to have the required efficiency and return-on-investment (ROI).

  22. Sandeep Fernandes says:

    The hub and spoke model works well when the entities are in close proximity to each other. High priority transport (between locations), coupled with doctors specialized in emergency care can ensure that the treatment is continuous and patient risk is minimized. By breaking down services based off the treatment options, support and resources, patient care can be managed more efficiently with resources being allocated to different locations based off the demand and resources available.
    Also by providing a 24/7 telehealth/telemedicine service as an incentive (for non emergency patients), the telehealth doctor/nurse can help triage and redirect patients by educating them on the wait times, priorities and possible better options at that particular time.
    Finally, patients that are possible risks can be mitigated through options for remote monitoring where the doctors already have a proactive understanding of the patients vitals and can plan accordingly

  23. Matt Slane says:

    Large health systems continue to look for ways to own patient care. There is currently a large shift in site of care occuring with patients wanting to go to the outpatient surgery center environment where they can be treated in a better environment and experience faster turn times. Given that most ER visits don’t result in a high admittance rate, these micro triage centers will continue to grow. Additionally, ER visit typically cost more and the hospital can’t afford to lose that revenue source. These “spokes” can also be used for scheduled outpatient surgery, which will allow the large health systems to maintain their current procedural volume and compete with independant ASCs (Ambulatory Surgery Centers).
    Given the fact that the hospital systems generally have a robust relationship with insurance companies, they will naturally have access to a large portion of the population and allow them to maintain market share. Healthcare is going through major transformation and site of care is one of the largest areas of change.

  24. Jesse Arias says:

    Will such smaller facilities replace the large hospital models in use currently? Will hospitals evolve into a hub and spoke system with the spokes being represented by these smaller hospitals that will feed only the more complicated cases to the large hospitals ? How will hospitals ensure adequate capacity utilization to make these micro-hospitals sustainable ?

    I have seen where these spokes fall under the umbrella of the hospital. There is a comfort level when it is associated to a familiar care center. I agree with the dialog that these will micro hospitals will become more common and act as the spokes to the hospital hub.

    Jesse

  25. Rolando Saca says:

    I actually think these smaller hubs are more efficient in cost and patient turn-around. I like to compare this philosophy with the retail environment 10 years ago, where department stores thought the bigger spaces they got, the more they where going to sell but lost in profitability and efficiencies. Also, this hubs can be placed strategically depending on the demographics and population density, in order to have more hospitals per capita in any given city. This way, I believe you can have faster and more flexible ER’s and medical centers in a better environment and more efficient patient turns.

  26. Peter Rigakos says:

    Will such smaller facilities replace the large hospital models in use currently?
    This is an interesting model, but I believe it all depends on the technology offered by these micro hospitals. For example, if an MRI is required will this hospital be able to handle such a case, or is it then time to ship the patient to the larger hospital? Having said that, can such a hospital pay for its self by only offering “some solutions”. I feel if the cost is high, compared to a larger hospital, people may be willing to pay because of the fast service, however, this will not replace the need for larger emergencies. In countries that have longer than average emergency room waiting times, I feel this may be a great option to help with the congestion.
    Using the hub and spoke analogy, this seems to be a great option to help with bottlenecks, however, I feel it will only work if you make it mandatory to visit the micro hospital as the first step when going to the emergency. If not some may not want to take the chance of having the micro hospital send them to the larger hospital since it is two (2) stops, and therefore there is loss of time during a time of need.
    A method to ensure adequate capacity utilization may be to have this model work both ways, if a patient visits the large hospital but can be helped at the micro hospital, then the patient can be given the option to visit the micro hospital and vice a versa.

  27. Peter Rigakos says:

    This is an interesting model, but I believe it all depends on the technology offered by these micro hospitals. For example, if an MRI is required will this hospital be able to handle such a case, or is it then time to ship the patient to the larger hospital? Having said that, can such a hospital pay for its self by only offering “some solutions”. I feel if the cost is high, compared to a larger hospital, people may be willing to pay because of the fast service, however, this will not replace the need for larger emergencies. In countries that have longer than average emergency room waiting times, I feel this may be a great option to help with the congestion.
    Using the hub and spoke analogy, this seems to be a great option to help with bottlenecks, however, I feel it will only work if you make it mandatory to visit the micro hospital as the first step when going to the emergency. If not some may not want to take the chance of having the micro hospital send them to the larger hospital since it is two (2) stops, and therefore there is loss of time during a time of need.
    A method to ensure adequate capacity utilization may be to have this model work both ways, if a patient visits the large hospital but can be helped at the micro hospital, then the patient can be given the option to visit the micro hospital and vice a versa.

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