Wednesday, August 29, 2007

CHRISTUS’ Changing Portfolio: 1/3 Acute Care

As I mentioned in previous posts, there are several significant drivers that are rapidly shifting the delivery of health care. Much of the care that was traditionally delivered within hospital walls is now delivered in a more non-invasive and safer way in outpatient settings.

Therefore, it is appropriate to pause and reflect on what will be left in acute care settings and what the hospital of the future will look like. We know that there will be critical services that must be delivered in the inpatient setting because of the severity of illness and the safety factors involved. These—first and foremost—include trauma, which in the 1960s was the leading cause of death in children 7 years old and younger, and has now risen to the leading cause of death in people 51 years old and younger.

It is my prediction that trauma will become the leading cause of death in people 56 years old and younger by 2016. Why? Again, this reflects some other observations which we outlined in previous posts. Many deadly diseases have been eradicated or at least mitigated to some degree, cancer being a prime example. In addition, we have observed a shift in the health level of seniors as well as the baby boomers. And finally, we know that the growth of drug and alcohol addictions world-wide brings with it a large growth in violence and traumatic incidences. Consequently, healthier people are more vulnerable to a traumatic occurrence, and therefore a major percentage of inpatient stays will be related to trauma care, which is very expensive and has a low margin of profitability since it requires a high intensity of supplies and personnel.

A second area of growth in the inpatient setting will be neurosurgery. Many past neurosurgical diagnoses can now be treated with non-invasive interventional technologies such as stents and arterial occlusion devices. It is my belief that a new set of procedures, however, will be developed to treat memory and tremor illnesses such as Alzheimer’s and Parkinson’s disease, and these treatments will require open craniotomies. Any time the skull is invaded, even with minor procedures, inpatient settings are required for post-op monitoring.

A third category of patients who will continue to be treated in inpatient settings will of course be the elderly who need care in their final days. They will most likely succumb to a neurological event, such as a stroke, or a cardiac event, such as a terminal heart attack. However, their stay in the acute setting will be much shorter than in the past, and most of them will very quickly request to be transferred to inpatient hospice settings which may or may not be housed in the acute facility.

Because the cases that we see in the inpatient setting will be different in the future, this will also change the types of physicians and caregivers who will work in these acute settings. From my view, I see the predominant types of physicians that will staff inpatient beds will be predominately limited in the next decade to hospitalists, intensivists, (both pediatric and adult), neonatologists and perinatologists. Obviously, we will still have an array of general obstetricians and gynecologists, but with the advances in these areas, the women’s hospital of the future will much more parallel non-acute settings than they do the more intense acute setting which we described above.

If all of this is true—and we believe our data is proving more and more each day that our vision of 5 years ago is becoming reality—CHRISTUS Health should limit its acute care expansion in a very focused way. In fact, we are doing this by utilizing certain criteria to guide our expansion plans. If we are expanding acute services, they must meet one of the four following criteria:
1. The area must be organically growing, i.e., new populations must be entering the community.
2. The quality of the present services or new services at the facility must be so high that patients who were going to the competitor are demanding that they now be admitted to CHRISTUS facilities, and therefore the present facility needs more space.
3. We will explore the acquisition of facilities where we are called as potential buyers or partners. If they extend our mission, give us a more wide geographical distribution, provide distance from the hurricane-prone Gulf Coast region where many of our facilities are located, or enhance our fiscal stability (so we will have more funds to extend our care for the underserved), we will consider the partnership.
4. We will also consider replacing facilities where we have met our benchmark metrics in all four of our directions to excellence. Obviously, these replacements must be scheduled according to our capital capabilities and, when built, must be designed as hospitals of the future, which will take into consideration all the changes in acute care outlined above. In addition, these hospitals must understand the patient-centricity which the baby boomers will require, the diseases which are present today that will not be present in the future or require inpatient settings, and the importance of providing appropriate environments for end-of-life care which will be demanded—as we as previously discussed—by a large portion of seniors who will require limited acute care but want guaranteed hospice and palliative care with strong pain management.

One inpatient setting that we did not discuss at this time is that required for behavioral services, which will also be changed significantly because of our senior aging process. We will discuss this in detail on a future blog post.

No comments: