New low-cost alternatives to emergency department and hospital visits could require flexibility from pathology groups and clinical laboratories to provide the best quality care

In response to the rising cost of conventional hospital services, innovative healthcare models such as micro-hospitals, bedless hospitals, and mobile and freestanding emergency rooms (ERs), are attempting to lower costs while maintaining quality of care by providing alternatives to traditional ER visits and hospital stays.

This means new challenges and opportunities for pathology groups and medical laboratories that can adapt to the different needs of these new healthcare delivery models. Each different care model will want clinical lab testing services and the reporting of lab test results to be handled in ways that enable these providers to achieve improved patient outcomes. 

Laboratory Diagnostics in New Healthcare Models

Clinical laboratories remain an integral part of these new healthcare continuums, which require similar diagnostic services as traditional healthcare facilities. Due to a lack of onsite labs, for example, there may be a need for increased use of remote diagnostic technologies to provide quality diagnoses and lab results. These technologies could take the form of advanced mobile point-of-care testing, use of telepathology and virtual consultations, and increased reliance on centralized medical labs that serve a wide range of facilities.

An article in Navigant suggests micro-hospitals, alongside other mobile and alternative healthcare models, could increase the use of “technology-enabling virtualization of healthcare.” This could include remote reading of imaging and diagnostic studies by pathologists as in telehealth and telemedicine.

Micro-hospitals Fill Gap in Rural and Suburban Healthcare

According to an article by Heather Punke in Becker’s Hospital Review, “While no micro-hospital is identical to another, most micro-hospitals are acute care hospitals that meet all federal and state licensing and regulatory requirements. They focus on treating low-acuity patients and providing ambulatory and emergency services, leaving more complex surgeries and service lines for their larger counterparts.”

On average micro-hospitals carry many of the same core services as their full-size traditional counterparts, but offer fewer beds (usually from 8-12). They focus on outpatient services and short-stay admissions only and refer patients to larger facilities as needed.

Micro-hospital core services generally include:

• EDs (emergency departments);

• surgery centers;

• Onsite pharmacies;

• Laboratory services; and

• Imaging services.

Micro-hospitals, such as the University of Missouri Health Care, Orthopedic Institute (above), offer many traditional hospital core services, but focus on outpatient care and short-stay admissions. (Photo copyright: CanonDesign.)

An article in Advisory Board reports that these micro-hospitals “don’t offer a complete breadth of services” as a full-scale hospital might, but serve as a “middle ground” between freestanding EDs and full-scale hospitals that can meet most of a community’s needs. This fills what Punke called, a “care gap” that is particularly beneficial for rural and suburban communities. The care they provide is often faster and significantly cheaper than equivalent services by a traditional hospital without sacrificing essential services or quality of care.

However, onsite laboratories in micro-hospitals could be limited and might rely on specimen transport and coordination with outside laboratories to be most effective.

Freestanding Emergency Departments Lack Clinical Pathology Units

Unlike micro-hospitals, freestanding emergency departments are not fully licensed hospitals. Sometimes called “bedless EDs” these facilities focus on immediate care and are tied to larger hospital networks that provide more advanced services for patients on an as-needed basis. They serve their communities by providing speedy, on-site service at reduced cost.

This type of facility often lacks clinical pathology units, limiting availability of testing. Freestanding EDs rely on their partner hospitals to provide lab testing and diagnostics. The rise of these bedless or freestanding EDs could mean an increased need for mobile diagnostics and telehealth via virtual consultations with partner hospitals.

Mobile ERs

A 2016 New York Times article reported that there are over 260 “mobile integrated healthcare” services in operation nationwide. A variation of Home Based Hospital Care (HBHC) and Hospital in the Home (HITH) services, travelling ERs are staffed with physicians, nurse practitioners, and other healthcare professionals. These on-call caregivers provide timely services for patients including coordinated care, postoperative care, and monitoring.

Jamaica Hospital Medical Center in Queens, NY, used their mobile ER (above) to triage swine flu patients away from the ED during the H1N1 Influenza A outbreak in 2009. (Photo copyright: Jamaica Hospital Medical Center.)

Mobile ERs are increasing in popularity due to their ability to provide timely diagnoses and quality care, reduce unnecessary hospital admissions, and lower healthcare costs. Like other in-home care initiatives, mobile ERs shift the point-of-care to outside traditional facilities that house laboratory services. This could increase needs for telepathology and coordination with freestanding labs, as well as the need for mobile point-of-care testing.

Bedless Hospitals Lack Overnight Space

Bedless hospitals provide outpatient care only. According to an article in Stat, bedless hospitals “have all the capabilities of traditional hospitals: operating rooms, infusion suites, and even emergency rooms and helipads. What they don’t have is overnight space.”

Bedless hospitals are one of the newest alternative healthcare models. They expand on urgent care center services to include outpatient surgeries and specialist care. With far fewer limitations on services, and an emphasis on streamlined treatment through standardized protocols, they serve as a “middle ground” between urgent care facilities and hospitalization.

An article in Lab Soft News, noted that the need for laboratory diagnoses in these hospitals may find a solution in technological advancement. This suggests an increased use of telepathology and e-consultations with clinical pathologists for primary diagnoses.

Clinical Laboratories Must Adapt to New Diagnostic Technology and Healthcare Models

There is wide recognition that the conventional community hospital is recognized as the most expensive site of healthcare. Thus, it is no surprise that hospital operators and others are experimenting with different models of providing care, but in facilities that are much less expensive to operate.

As alternatives to expensive, traditional hospital care become more commonplace in the healthcare field, these new healthcare models will increasingly rely on medical laboratories and pathology groups that can be flexible and supportive of emerging diagnostic and laboratory testing technologies. Clinical laboratories should remain adaptive to changes in treatment options, but adamant in their mission to provide expert testing and diagnoses.

—Amanda Warren

Related Information:

2016: The Year of the Micro-hospital and Emerging Service Lines

Going to the Emergency Room Without Leaving the Living Room

‘Micro-hospital’ Model Could Help Underserved Populations

Bedless Hospitals Treat Patients and Send Them Home the Same Day

To Grow Your Hospital, Think Micro

Sometimes Tiny is Just the Right Size: ‘Micro-hospitals’ Filling Some ER Needs

Micro-hospitals—Transforming the Healthcare Delivery Landscape

The Rise of the ‘Micro-hospital’: 7 Things to Know

Jamaica Hospital On-Air Coverage: Dealing with the Swine Flu

What is Urgent Care?

Micro-hospitals: A Win-Win for Patient Access and Financial Viabilit

Get a New Body Part and Go Home the Same Day: The Rise of the ‘Bedless Hospital’

The Design of Bedless Hospitals Continue to Evolve Based on Cost and Technology

‘Thinking Small’ May Be Next Big Innovation in Healthcare Delivery as Micro-hospitals Spring Up in Metropolitan Areas Across Multiple States

Two US Studies Show Home-based Hospital Care Lowers Costs While Improving Outcomes and Patient Satisfaction