More than 1,000 hospitals have closed in 35 years. Ezekiel Emanuel says that’s a good thing.

More than 1,000 hospitals have closed in 35 years. Ezekiel Emanuel says that’s a good thing.

In the past 35 years, hospitalizations have declined by more than 10% as more patients migrate to urgent-care centers, physicians’ offices, and at-home care—and the disappearance of hospitals is “inevitable and good,” Ezekiel Emanuel writes in a provocative op-ed for the New York Times.

Emanuel, a prominent physician and vice provost at the University of Pennsylvania, writes that U.S. hospitalizations reached their peak more than 35 years ago, in 1981. There are now fewer hospitalizations than in 1946.

Due to this decline, the number of hospitals has fallen as well, from 6,933 in 1981 to 5,534 this year.


Why hospitals are disappearing

One reason hospitals are disappearing, according to Emanuel, is that patients increasingly view hospitals as potentially dangerous places to be—”less therapeutic,” he writes, “and more life-threatening.”

In 2002, there were 1.7 million cases of hospital-acquired infections, resulting in nearly 100,000 deaths, according to CDC research. Plus, hospitalizations create risks of medical errors and falls—and constant interruptions in the middle of the night “are not conducive to recovery,” Emanuel writes.

Further, providers increasingly can provide complex care outside of the hospital, Emanuel writes. For example, anti-nausea medications and new forms of treatment mean that many cancer patients no longer have to receive their chemotherapy at hospitals. Similarly, hip and knee replacements are often performed at ambulatory surgical centers rather than at the hospital. Births frequently happen either at home or at birthing centers.

These trends will continue, Emanuel contends, and as they do, more hospitals will downsize, merge, close, or turn into doctors’ offices or outpatient clinics. The hospitals that remain, he writes, will focus on their ED, complex procedures like organ transplantation or brain surgery, and similarly urgent and high-complexity services.

Emanuel’s provocative argument about how hospitals will respond

Emanuel writes that, while he believes the shift away from hospitals will benefit patients, special interest groups within the hospital business may find it threatening. As such, he argues that hospitals are likely to lobby for higher payments from the government and insurers “to retain the ‘good’ jobs hospitals offer.”

But Emanuel argues that “the shift of medical services out of hospitals will create other good jobs—for home nurses, community health care workers and staff at outpatient centers.”

Further, revenue pressures will lead even more hospitals to consolidate and merge into massive health systems. Emanuel writes that the hospitals will claim that these mergers will create cost savings for the consumer, but he argues that these “mergers create local monopolies that raise prices to counter the decreased revenue from fewer occupied beds.” Federal antitrust regulators, he argues, should oppose these mergers.

“Instead of trying to forestall the inevitable, we should welcome the advances that are making hospitals less important,” Emanuel writes. “Any change in the healthcare system that saves money and makes patients healthier deserves to be celebrated” (Emanuel, New York Times, 2/25).

Source: More than 1,000 hospitals have closed in 35 years. Ezekiel Emanuel says that’s a good thing. | Advisory Board Daily Briefing

How an Intermountain pilot program cut participants’ readmission rate by 65% | Advisory Board Daily Briefing

A pilot program at Intermountain Healthcare that empowers family members to help care for their loved ones enhanced care for patients—and cut readmissions among participants by 65%, according to a study in CHEST.

For the study, nurses informed the family members of patients about the pilot program, called Partners in Healing, and invited them to participate. Nurses then taught those who opted in a handful of basic skills related to the specific needs of the patient. Participants received a badge that indicated to the staff that they were part of the care team, entitled to access blankets, drinks, ice, and snacks on behalf of the patient.

Staff then taped a checklist to the patient’s door, where participants recorded their contributions to the patient’s care, such as helping the patient go to the bathroom, performing breathing exercises, or measuring urine output. The nurse then input the data from the checklist into the patient’s computer record.Best practices for reducing CV procedural readmissions
The tasks participants can perform were pre-determined by the patient’s care needs and the family member’s capacity as a caregiver, HealthcareFinance reports. The tasks given to the family members were simple, “but they give families a sense of control and knowledge about what they can and can’t do,” Michelle Van De Graaff, an RN at Intermountain Medical Center who created the pilot program and led the study, said.

Positive results
For the study, researchers compared about 200 adult heart surgery patients who had family members participating in the program with a control group whose family members did not participate in the program. The researchers assessed:

30-day all-cause readmissions;
30-day all-cause mortality;
Length of stay; and
Number of ED visits.
After controlling for age, gender, and severity of illness, the researchers found that 30-day readmission rate was 65% lower among patients whose families participated in the program than among those whose loved ones did not.

The researchers did not find any significant differences in other metrics.

The researchers also garnered participant feedback and found that 92% of the patients whose family members participated in the program said it helped their transition from hospital to home—and 94% of family members said they’d recommend the program to other families. Further, family members said they acquired relevant caregiving skills and felt empowered and integrated into the care team, curbing their feelings of anxiety and helping them participate in the patient’s recovery at home. Families recommended that Intermountain integrate the program for all patients at all phases of care, including intensive care.

“The vast majority of families like to have something to do and they like to participate in patient care. They’re often the most motivated member of the care team,” Van De Graaff said in a statement. “We’ve found that families not only want to promote healing, but patients benefit from someone who knows their preferences, and the result is, the rate of readmissions is reduced after patients are discharged from the hospital.”

Intermountain has announced that it intends to expand the program from the seven acute-care facilities where it was piloted to all other 21 facilities. Mayo Clinic has also implemented the program, according to Patient Engagement HIT (Lagasse, Healthcare Finance, 2/13; Science Daily, 2/12; Heath, Patient Engagement HIT, 2/12; Knowles, Becker’s Hospital Review, 2/14).

Source: How an Intermountain pilot program cut participants’ readmission rate by 65% | Advisory Board Daily Briefing