As healthcare payers encourage providers to keep patients out of hospitals, health systems nationally are constructing a new generation of facilities with many fewer beds

Here’s a trend that should catch the attention of every clinical laboratory manager and pathologist working in a hospital. New hospitals are being designed and built around a new treatment paradigm: that tomorrow’s patient will get sophisticated treatment, then mostly go home to sleep in their own beds! That means fewer inpatient beds in service and shorter hospital stays.

Healthcare Reform and Better Ambulatory Care Are Shaping This Trend

The broad-spectrum capabilities of these new facilities explain how clinical services will be organized to provide hospital-level, high-tech healthcare delivered in an ambulatory setting, according to a story published by Modern Healthcare (MH).

Two new facilities recently built by hospitals reflect this general shift toward proactive medical care. One is the $142-million Montefiore Ambulatory Care Center in the Bronx. The other is a $451-million replacement naval hospital at Camp Pendleton, near San Diego.

The needs of hospital systems have shifted significantly in recent years, suggested Joseph Simone, President of Simone Development, in a Montefiore news release. Simone’s company, which specializes in healthcare facility development, is building Montefiore Medical Center’s new “hospital of the future” in the Bronx.

“We are reshaping outpatient care and establishing leading practices that provide [healthcare services] through multidisciplinary teams at a hospital without beds,” added Steven Safyer, M.D., President and CEO of Montefiore Medical Center.

Consistent with the trend toward building “bedless hospitals,” Montefiore Medical Center in the Bronx, New York, is constructing a new ambulatory care center. It will be 11 stories high and encompass 280,000 square feet. Construction will be completed sometime in 2014. (Image copyright Montefiore Medical Center)

Consistent with the trend toward building “bedless hospitals,” Montefiore Medical Center in the Bronx, New York, is constructing a new ambulatory care center. It will be 11 stories high and encompass 280,000 square feet. Construction will be completed sometime in 2014. (Image copyright Montefiore Medical Center)

According to the press release, Montefiore’s new building will be state-of-the-art and 11 stories high. The 280,000-square-foot building will include:

• An ambulatory surgery center with 12 operating rooms and four procedure rooms.

• An advanced imaging center,

• Onsite clinical laboratory services

• A pharmacy, and

• New primary and specialty care practices.

The story at Camp Pendleton is just as interesting. A 497,000-square-foot naval hospital is currently under construction at Camp Pendleton. It is scheduled for completion in January 2014, MH reported. The bed count—a mere 67 beds! By contrast, the navy projects 2,000 outpatient visits daily at the facility.

At Camp Pendleton, California, the U.S. Navy is constructing a new 497-square-foot hospital. However, when it opens in January 2014, it will have only 67 beds. The emphasis will be on outpatient services, and its clinical laboratory will be organized to support that mission. (Graphic copyright EllingtonCMS.com.)

At Camp Pendleton, California, the U.S. Navy is constructing a new 497-square-foot hospital. However, when it opens in January 2014, it will have only 67 beds. The emphasis will be on outpatient services, and its clinical laboratory will be organized to support that mission. (Graphic copyright EllingtonCMS.com.)

“This is all a response to healthcare reform, and it’s going on throughout the country,” declared Bruce Crowther, CEO of Northwest Community Healthcare in Chicago, in a story published by the Daily Herald. “We can anticipate lower [Medicare] payments, and we can anticipate a shift in incentives to less inpatient work and more outpatient work.” According to Crowther, inpatient volumes at Northwest are falling, and outpatient volumes are rising.

‘Bedless Hospitals’ are Response to Focus on Wellness

Healthcare systems are evolving into integrated delivery systems, noted Richard Taylor, Managing Director of the Health Care Solutions Group at Jones Lang Lasalle (JLL), in a story published by Hospitals & Health Networks. JLL is a real estate services firm based in Chicago. “It’s all part of that overall trend that you can track back to the healthcare legislation and consumer preferences,” Taylor observed. He pointed to lower cost of delivery and competition as two key factors in the trend.

The bottom line in the new trend is that the hospital C-suite is looking to flatten the cost curve, echoed Henry Chao, a principal and Healthcare Design Director in the New York office of HOK, a global architectural firm, MH reported.

Chao considers the reduction in numbers of hospital beds a natural evolution. The “bedless hospital” concept is part of the larger trend of focusing on wellness care, instead of episodic sick care, he pointed out in MH story.

“This is sort of a natural outcome of what they are trying to create in healthcare reform.” agreed Crowther in the Daily Herald. “We’re really just re-sizing to the demand for beds that we have today. The hospital becomes a place for only those very expensive, really acute kind of episodes. Over time, there will be a reduction in the number of beds used.” Crowther noted, pointing out that outpatient services will continue to grow as the need for hospital beds declines.

In fact, as a result of the increasing sophistication of ambulatory care, the concept of using bed count as a way to measure hospital size could be heading for obsolescence, MH suggested.

Trend to Reduce Inpatient Clinical Lab Testing in Favor of Outpatient Tests

The common element that pathologists and clinical laboratory managers can expect from these new care delivery models is greater integration of clinical care. The medical laboratories and pathology groups that succeed in the coming cycle of proactive healthcare will be those that develop innovative ways to add value to the swiftly evolving models of integrated clinical care.

—Pamela Scherer McLeod

Related Information:

Shedding beds: New hospital projects are taking ambulatory care to the extreme

Camp Pendleton Hospital Project $270 Million Strong

Montefiore Medical Center Announces Plans to Build the Hospital of the Future

‘Bedless hospital’ marks sign of the times

Hospital CEO: Emphasis shifting to outpatient care

First Health Park Opens in Georgia: Brings Integrated Clinical Services to the Community, Including Clinical Pathology Laboratory Testing

New Healthcare Business Model Outpatient Zones Generate Rising Revenue for Hospitals