House Calls and the Future of Hospitals

February 1, 2016

A study recently published in Health Affairs, that anyone sane would hope wasn’t funded with taxpayer money, has revealed that house calls can help reduce preventable emergency room visits and hospital readmissions.

At least they didn’t waste time and money on another study of Swedish massage on rabbits, as did the National Center for Complementary and Alternative Medicine.

Hospitals came into existence in the American colonies in 1751 courtesy of Dr. Thomas Bond and Ben Franklin – yes, he had time to devote to electricity, printing, politicking, eyeglass lenses, stoves, etc. . . . and hospital administration — as a substitute for those who couldn’t receive care at home because they were poor and didn’t have homes.

Over the next 150 years, physicians advocated for the creation of community hospitals and they grew their own medical practices into clinics that morphed into hospitals. By the early years of the 20th Century, hospitals became large healthcare factories due to the size and expense of what was then cutting edge tech and due to the fact that it was efficient, in a Tayloristic sense, to have fewer nurses monitor large groups of patients housed in a concentrated location.

But now tech is getting smaller and independent facilities (e.g., ASCs) can deliver care at a far better price point. And, more and more of that care will move back to where it began, to patients’ homes or, at a minimum, to independent sites closer to them.

The problem with the house calls study (setting aside its humor value) is that it’s based on a paradigm that is quickly becoming outmoded: the paradigm of the hospital as the central location for the treatment of patients.

The real issue is that “house calls” are a growing part of physician (and physician assistant, and nurse practitioner, and fill-in-the-blank) services outside of hospitals and outside of office sites, and that patients needing “readmission” won’t necessarily be heading back to a hospital, at least as we currently conceive hospitals to be.

The future of healthcare is quickly becoming detached from hospitals, which will probably continue to exist only as centers for the sickest.

How are you focusing your future to compete in that world?

Leave a Reply