Big hospital ‘obsolescence’ may be nigh, but new care centers have woes, too

jetsons-300x231Although big, rich hospitals and their sprawling campuses jammed with shiny new buildings may be reaching a point where they’re unsustainable for competitive cost, safety, and efficiency reasons, a rising health care alternative already may be hitting its own major woes that can’t be ignored.

The Wall Street Journal and New York Times have put up pieces with intriguing projections about the future of hospitals, including how economics may force them, as is occurring now, to spin off major functions, including many kinds of surgery, which will be handled, instead, in smaller, free-standing surgical centers.

At the same time, USA Today and the independent and nonpartisan Kaiser Health News Service have presented their investigation into dangers and deaths that patients encounter at the such centers, which already are burgeoning nationwide.

The news organizations pored over autopsy records, legal filings, and more than 12,000 state and Medicare inspection records, and interviewed dozens of doctors, health policy experts and patients throughout the industry of more than 5,600-plus surgery centers, finding:

  • More than 260 patients have died since 2013 after in-and-out procedures at surgery centers across the country. Dozens — some as young as 2 — have perished after routine operations, such as colonoscopies and tonsillectomies.
  • Surgery centers have steadily expanded their business by taking on increasingly risky surgeries. At least 14 patients have died after complex spinal surgeries like those that federal regulators at Medicare recently approved for surgery centers. Even as the risks of doing such surgeries off a hospital campus can be great, so is the reward. Doctors who own a share of the center can earn their own fee and a cut of the facility’s fee, a meaningful sum for operations that can cost $100,000 or more.
  • To protect patients, Medicare requires surgery centers to line up a local hospital to take their patients when emergencies arise. In rural areas, centers can be 15 or more miles away. Even when the hospital is close, 20 to 30 minutes can pass between a 911 call and arrival at an ER.
  • Some surgery centers are accused of overlooking high-risk health problems and treat patients who experts say should be operated on only in hospitals, if at all. At least 25 people with underlying medical conditions have left surgery centers and died within minutes or days. The cases include an Ohio woman with out-of-control blood pressure, a 49-year-old West Virginia man awaiting a heart transplant and several children with sleep apnea.
  • Some surgery centers risk patient lives by skimping on training or lifesaving equipment. Others have sent patients home before they were fully recovered. On their drives home, shocked family members in Arkansas, Oklahoma, and Georgia discovered their loved ones were not asleep but on the verge of death. Surgery centers have been criticized in cases where staff didn’t have the tools to open a difficult airway or skills to save a patient from bleeding to death.

This deep dig into these centers, including their accepted practice of encouraging surgeons to steer patients to them and to benefit economically from them by ownership that they could achieve in many hospitals, is timely, worrisome, and thought-provoking, even as the Journal and New York Times dissect why the big hospital model may have reached its tipping point toward obsolescence.

Ezekiel J. Emanuel, an oncologist, a vice provost at the University of Pennsylvania, the author of “Prescription for the Future,” and an architect of the Affordable Care Act, aka Obamacare, points out in a New York Times Op-Ed that big hospitals are ebbing because, “more complex care can safely and effectively be provided elsewhere.” He wrote:

What year saw the maximum number of hospitalizations in the United States? The answer is 1981. That might surprise you. That year, there were over 39 million hospitalizations — 171 admissions per 1,000 Americans. Thirty-five years later, the population has increased by 40 percent, but hospitalizations have decreased by more than 10 percent. There is now a lower rate of hospitalizations than in 1946. As a result, the number of hospitals has declined to 5,534 this year from 6,933 in 1981. This is because, in a throwback to the 19th century, hospitals now seem less therapeutic and more life-threatening. In 2002, researchers from the Centers for Disease Control and Prevention estimated that there were 1.7 million cases of hospital-acquired infections that caused nearly 100,000 deaths. Other problems — from falls to medical errors — seem too frequent. It is clear that a hospital admission is not a rejuvenating stay at a spa, but a trial to be endured.

Reporter Laura Landro picks up this idea in her Journal story on hospitals’ future, writing:

Traditional hospital care is too costly and inefficient for many medical issues. Inpatient pneumonia treatment, for example, can cost 15 to 25 times more, yet many low-risk patients who could be safely treated as outpatients are hospitalized, studies have shown. And being hospitalized carries its own risks: With the rise in antibiotic-resistant bacteria, at any given time one in 25 patients in the U.S. is battling an infection acquired in the hospital, according to the Centers for Disease Control and Prevention — at a cost of $10 billion annually for the five most common infections.

Landro sees industry trends, more serious say, than Jetson-like projections, in which, “health-care providers are investing in outpatient clinics, same-day surgery centers, free-standing emergency rooms and micro-hospitals, which offer as few as eight beds for overnight stays. They are setting up programs that monitor people 24/7 in their own homes. And they are turning to digital technology to treat and keep tabs on patients remotely from a high-tech hub.” They’re also figuring innovative ways to put all those shiny buildings they have now to new uses.

Both Landro and Emanuel — don’t forget he’s from the gifted family that includes his politician brother Rahm (the mayor of Chicago and onetime chief of staff to President Obama), and Ari, a noted Hollywood agent — offer a cautiously optimistic take on hospitals’ future.

Even as their pieces make the case that change is coming and should be embraced because it could offer a more affordable, accessible, safer, higher quality, and less costly health care than what’s available now, the USA Today and Kaiser Health team make the harsher assessment that huge profits, as can be made in surgical centers, can have corrosive effects on patient treatment.

In my practice, I see the significant harms that patients can suffer while seeking medical services — at outpatient surgery centers, community hospitals, academic medical centers, or the startlingly luxe and expansive medical complexes that even dominate parts of some cities. It is unacceptable that hospital infections and other medical errors in fancy medical buildings kill an estimated 685 Americans daily. We must do so much better than to allow medical errors to rank as the third leading cause of death in the U.S., behind only heart disease and cancer.

I also know that patients endure painful struggles to access and afford safe and quality medical care, even if they’re neighbors of wealthy, flourishing hospitals. Many of these institutions seem painfully out of touch with reality, booming now and patting themselves on the back for the purported community benefits they deign to bestow in exchange for huge tax breaks.

The wheel turns, as they say, and what we have in hospitals and health care isn’t working as it should. But let’s all keep a close eye on what these pillars of our communities are up to, so we don’t carry into the future the health care evils, like profiteering and poor treatment, that we should be ending now.

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