How Hospitals Are Changing

Experts offer a glimpse into hospitals of the future.


U.S. News & World Report's inaugural Hospital of Tomorrow event will gather top health care executives and leading health care innovators who will address the most complex issues facing America's hospitals in 2014. These include the real impact of the Affordable Care Act and hospital executives' expectations for the rollout of new technologies and business practices. To begin the conversation, U.S. News held a Twitter chat on "The Future of Hospitals: Their Challenges, Changes and Solutions." Experts included Mitchell Morris from the Deloitte Center for Health Solutions, Charlotte Howard from The Economist, Toby Cosgrove from the Cleveland Clinic, and Ashley Thompson from the American Hospital Association. They discussed factors that are contributing to changes in the current U.S. hospital model, how hospitals are cutting costs, the role of technology and alternate settings for treatment. The chat's 392 participants sent 1,064 tweets during the course of the discussion.

Reasons for changes in hospitals

The Affordable Care Act, cuts to Medicare, lack of Medicaid expansion in some states and hospital debts are contributing to transformations in hospitals. Payment models will increasingly reward for high-value care rather than the volume of services provided. "The goal is to keep people healthy so they are not admitted in the first place," Morris tweeted. Hospitals will have to reduce readmission rates in particular. "Now that a readmission is a trip to the penalty box instead of a bonus, hospitals are getting creative," Morris tweeted. "Hospitals will no longer be like hotels," he added. "The new goal with hospitals will be to keep the beds empty."

The government also is capping reimbursement rates for specific diagnoses and having hospitals pay to fix their own medical errors, including hospital-acquired infections. "Push for transparency, collaboration, coordination, safety and outcomes is driving change in hospitals," tweeted the Quality/Equality team at the Robert Wood Johnson Foundation. The changes are part of an effort to drive efficiency in health care. "Changes coming to hospitals include consolidation, integration, team care, more price transparency," Cosgrove tweeted.

[Read Is Obamacare to Blame for Hospital Layoffs?]

How hospitals are cutting costs

Hospitals are preparing for reimbursement changes by following up with patients. "Hospitals call patients after discharge to follow up on post-discharge needs and education," tweeted Thompson. This and other efforts resulted in decreased readmission rates by 14 percent, saving $100 million.

Charles Rosen, a surgeon at Mayo Clinic in Rochester, Minn., wrote, "There is increasing pressure to manage transitions of care more efficently – from outpatient, to inpatient, to follow-up care." Doctors also are shifting some of their work to nurses and physician assistants, tweeted Howard. Mayo has reduced blood transfusions. Eliminating early elective delivery rates has been another cost-cutting measure, according to Thompson. Hospitals saved $10 million when they reduced the procedure by 42 percent.

Other hospitals make their employees aware of costs. Cosgrove tweeted that Cleveland Clinic cut $180 million during the last two years from supply chain costs. "One way we've reduced costs is to post prices of surgical tools in operating rooms to raise awareness among surgeons," he wrote.

[Read Hospitals Seek to Avoid Penalties by Minimizing Readmissions]

The role of technology

Telehealth has allowed the monitoring of chronic diseases from home, a less expensive setting than a hospital or sporadic visits to the doctor, Morris and Howard noted.

Electronic medical records also can save costs and help patients communicate with their doctors. "Our caregivers have a closer relationship with patients by engaging online through [electronic medical records]," Cosgrove tweeted. The Robert Wood Johnson Foundation wrote, "Communication among a patient's care team is key for a smooth care transition and reducing the risk of readmission."

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