An interesting article in Modern Healthcare (In-home emergency care cuts costs, but needs more payer buy-in – it’s behind a paywall) raises an issue that I’ve explored in several articles on the blog in the past: the disintermediation of hospital services.
For decades, the chief example of this disintermediation is the ambulatory surgery center. An ASC is, at its essence, a waiting room, operating room, preop, and postop pulled out of a hospital and plopped down in a building near you. Depending on where you are in the country, there could be 10 of these in a midsize office building close to you.
The same could be said in respect of freestanding imaging centers and, for those states that permit them, freestanding emergency rooms.
But why require a facility at all?
I explored that in my 2021 blog post, The Future of Healthcare Is Functions, Not Places, as well as in my 2014 post, Driverless Cars and the Death of Hospitals, in which I predicted both mobile pod surgery in which the ASC comes to you, as well as, coming soon, surgery at home.
The Modern Healthcare article cited at the start of this post references ventures such as the arrangement between healthcare technology company Medically Home and Optum Health’s primary care provider Atrius Health (part of UnitedHealth Group) through which emergency department care is provided at patients’ homes. The article cites a New England Journal of Medicine study that found that more than 83% of patients receiving care in the ER didn’t actually require a trip to the hospital.
Of course, although the immediate impact is on the services provided by the hospital that the insured patient avoided, there are a number of secondary effects on physicians, other providers, and other healthcare facilities. If patients are kept out of any particular hospital’s referral universe, they can be directed such that they never end up there or such they end up someplace else (i.e., a hospital controlled by the insurer). And, of course, it’s not just hospitals that would be affected.
How’s might your business model be impacted?
What will be left after many more services are pulled out of the hospital? That question is easier to answer: the building and, of course, the debt.
