7 ms·

We should welcome the advances that are making hospitals less important

173 points by dr_ 9y ago

tyler_larson 9y ago
No. Next story.
drivingmenuts 9y ago
As opposed to?
cperciva 9y ago
Hospitals aren't becoming obsolete, but their role is changing. Hospitals were once a place where patients were kept for extended periods of time; now for reasons of cost, sanitation, improved surgical techniques, and patient preference they're increasingly places where patients go for medical treatment but unless they're on the verge of death (and thus may need further treatment in very short order) patients then return to the community. More surgeries; less meals and laundry. Rather than becoming obsolete, I'd say that hospitals are gaining an increased focus.
- jacobolus 9y ago
  What’s the relative cost of in-patient vs. out-patient care?
  - lojack 9y ago
    I don't have an answer to your question, but I recently spent some time at the hospital taking care of my daughter, and my understanding is that a lot of it comes down to the fact that hospitals are able to provide good enough care to be comfortable discharging patients earlier. It used to be more common to keep patients at the hospital just in case, but they now send patients home in many of those cases. In my (unprofessional) opinion, this is a good thing. Recovery is much easier in the comfort of our own home, without the stress of being woken up at all hours of the night for tests. We're also completely avoiding a huge risk -- hospital borne infections.
  - chimeracoder 9y ago
    > What’s the relative cost of in-patient vs. out-patient care? They're not directly comparable, because the care delivered is fundamentally different, but inpatient care is about two orders of magnitude more expensive. That's not to say that reduction of inpatient care is always a goal, though, because it's only a good tradeoff when the outpatient care actually would provide equivalent or better clinical outcomes. Sometimes that's true, sometimes it's not.
    - maxerickson 9y ago
      Are the costs 100x or are the chargemaster prices 100x? What are a couple of the major factors driving such a huge difference?
  - kurthr 9y ago
    To give you a very round number it is several $k per day depending on where in the country ($2-5k) and what hospital for a bed in a two person room with 24h nursing floor care. That does not include doctors, meals, medications, tests, etc. If you're in an ICU or surgery it is easily 2-20x higher than that so you can't compare it. A skilled nursing facility or hospice can be less than $1k per day. In home care even with 8 to 24h nursing can be had for a similar price or lower than a skilled nursing facility ($50-100/hr) with much better quality of life and lower risk of infection if you go to reasonable efforts to keep it clean.
    - Blahah 9y ago
      This doesn't make sense to me. Please correct me if I'm wrong. A hotel can easily provide room and board (essentially the services of a hospital's basic in-patient care) for <$100 a night. The hospital also has a ton of equipment and staff that are additional, but how can it possibly be as much as $1900-$4900? I feel like in-patient care is similar to a hotel but with extra stuff that might increase the cost by a factor of (perhaps) 2-5. But not 10-25. That would suggest that there's some major inefficiency in hospitals causing the cost bloat. You said the price is before doctors, medications, tests, etc. so the service is essentially just accomodation. How can it be so expensive?
      - tetrazine 9y ago
        Hospitals have needs that hotels don't from the ground up. They have different architecture, interior design, and HVAC needs, they have different real estate needs, they need to be robust to natural disasters, they maintain services like ambulances and a vast records and bookkeeping system. Sanitation requirements are much higher, there's no reason to assume costs there scale linearly - think about night shifts. Hospital workers usually are more unionized than hotel workers (should a hotel room be <$100 a night?). I believe nurses do a lot of work that lower trained/skilled/paid workers would do in a hotel. Then you can start throwing in the inflated costs due to the American insurance system, the higher liability hospitals have compared to hotels, and other factors. I'm sure people more familiar with the medical profession could add even more exacerbating factors that I don't know about. All of this isn't to say that the hospital or healthcare system isn't inefficient, but simply that hospitals and hotels are apples and oranges.
- xaldir 9y ago
  >patient preference As a patient, I'm always suspicious when I see this. When I'm in a bad enough shape to go to the hospital, going home is not my priority, getting better is. As someone who also work in an hospital, pushing patients out as quickly as possible has more to do with financial objectives than anything else. (e.g. we were told that our hospital should have 25% less beds by 2020)
  - kingkongjaffa 9y ago
    how and why would you plan to have less beds in the future? Is that backed by population growth and average hospital utilisation per person or some other metric?
    - frobozz 9y ago
      If you can do more outpatient work, you can reduce the bed count, the cost of having a patient taking up a bed in a hospital is very high, even if they are as close to perfect health as possible and are just waiting to be discharged. This is money that could employ another doctor or buy another piece of health-giving equipment. The sooner you can kick a patient out of hospital, the sooner they become someone else's problem, coming out of someone else's budget. In a publicly-funded system, the local authority may pay for in-home care visits and the patient's GP may be responsible for post-hospital outcomes. Stupid PFI deals can mean that the cost-per-bed is ludicrous, and that money that could be going towards patient care is being funnelled to failing companies like Carillion. In an insurance-funded system, the relationship between costs and fees comes down to negotiation between the hospitals and the insurance companies, rather than from the hospital simply coming up with the fees and the insurance companies paying them. This may mean that the income per-bed-per-night is less than it costs, whilst the income per procedure is higher than it costs. Even if the hospital is still responsible for post-discharge care, they may be able to make more profit out of expensive home visits by low-paid carers than in-ward rounds by higher-paid nurses.
  - fifteenforty 9y ago
    >> patient preference > As a patient, I'm always suspicious when I see this. There are many practices in medicine that exist only because of patient perference and despite their harm. I think this is because of ongoing poor health education amongst the general public, physicians who are worn out and choose their battles and that private health care systems (at least in Aus) reward practitioners who get good feedback from patients better than those who have the best health outcomes.
iamdave 9y ago
I came here prepared to walk away from this article being reminded once again of Betteridge's Law[1], but then I got to thinking once I did finish it... ...decoupling certain aspects of healthcare from gigantic, expensive hospital systems may actually work for patients and medical care providers couldn't it? Article points out how we do to an extent already, and paints an interesting argument for why we could see more of it. I think I'm on the "want to see more of it", but unsure what the drawbacks would be aside how the expected parties would like to see those traditionally centralized services remain so. I am not a medical professional, the article just got me thinking on the topic...which means, Betteridge be damned-if a piece of writing gets you thinking about something you wouldn't ordinarily think about, article succeeded. --- [1] https://en.wikipedia.org/wiki/Betteridge%27s_law_of_headlines https://en.wikipedia.org/wiki/Betteridge%27s_law_of_headline...
- ZeroGravitas 9y ago
  For those, like me, confused by this comment, the article's real title, which I guess was changed on HN after this comment is "Are Hospitals Becoming Obsolete?".
thedailymail 9y ago
Bad headline, but the article itself gives some nice insights into the current trajectory of medical care in the US. Important to note that the trend is not the same in all countries though. In Japan, where hospital stays are frequently used as a stopgap measure in cases where elderly patients can't afford or can't find a long term assisted living facility, hospitalization shows only moderate declines from historic highs in the 90s.
deleted 9y ago
[deleted]
Izkata 9y ago
> Through the 19th century, most Americans were treated in their homes. Hospitals were a last resort, places only the very poor or those with no family went. And they went mainly to die. Sort-of related: Why would anyone ever think putting "memorial" in a hospital name was a good idea? "A place to go to die" is the first thing that has always popped into mind when I see that.
- mattkrause 9y ago
  If 'memorial' bothers you, you are going to love the an archaic French term: 'Hôtel-Dieu', or hotel of God.
zaroth 9y ago
"Hospitals are no longer seen as therapeutic." That's putting it mildly! I think we generally do a piss poor job of providing truly therapeutic environments as a service.
aaavl2821 9y ago
For those in the industry, the continued consolidation and increasing power of hospital systems seems a given, despite the problems that entails. It is refreshing to see this perspective voiced As I said in another thread, hospitals are the largest component of US healthcare cost. They make money by increasing the number of hospital visits, especially for surgeries. Even non profits have been consolidating and seeking profit, and the largest non profit systems have dramatically increased their incomes over the last few decades Hospitals are devouring outpatient clinics to get their patient volume into the hospital system. These practices are loss leaders for the hospital profit centers in many cases Sadly, many hospital systems fight improvements in care that decrease inpatient admissions by making people healthier, because fewer admissions means less hospital revenue. Having hospitals in charge of US healthcare is like having the fox in charge of the henhouse
- Eridrus 9y ago
  What is the thing about hospitals that distinguishes them from other facilities? Is it just that they have beds and everything else is a clinic? Why is having beds such a big factor? Is it just that they are a large fixed cost which makes it hard to turn a profit? I don't particularly like hospitals, but the healthcare system in the US is hugely fragmented and piecing together all the providers you need is a pain in the ass, why are hospitals unable to capitalize on their broad experience and expertise to help?
  - hkmurakami 9y ago
    ER. In most areas hospitals are the only facilities providing emergency care. (And boy is it expensive)
    - jiggunjer 9y ago
      Given how many people go there with a minor fever or stomach ache, it isn't expensive enough.
      - maxerickson 9y ago
chime 9y ago
Seeing as how the infant/mother mortality rate is so high in the US compared to other developed nations, I don't think home births should be encouraged as much in non-rural areas. Birthing Centers are better than home births though not suitable for high-risk cases.
- deleted 9y ago
  [deleted]
- vonmoltke 9y ago
  > Seeing as how the infant/mother mortality rate is so high in the US compared to other developed nations 6.2 in the US versus 5.7 in the EU doesn't really back that statement up. https://www.infoplease.com/world/health-and-social-statistics/infant-mortality-rates-countries https://www.infoplease.com/world/health-and-social-statistic...
themodelplumber 9y ago
Is there a framework that could communicate the most appropriate role of a given hospital for those trying to evaluate their care options? For example, "given the individual's parameters X and Y and Z, the hospital in question is in quadrant N of the individual's sphere of care options. This implies a role of [e.g. emergency use only, etc]." It just seems like we need a more objective idea of _what a given hospital really is and can be_ for a given individual. Such a model would naturally expose economic opportunities for providers who have the resources to open small competitor clinics, while conserving resources like money, energy, etc. for care seekers who can only be excused for thinking "sick = hospital". If we can't get needed anti-monopoly regulators to do their job, we can at least start to find points of leverage with which to educate the public on the cost-benefit and alternatives in a more straightforward way.
majidazimi 9y ago
The title should be: We should welcome the advances that are making hospitals less important in US. There is nothing wrong with hospitals in EU.
- 24gttghh 9y ago
  I'm sure there is something wrong with hospitals in the EU. They're run by humans, after all.
Steven_Evans 9y ago
Here's all you need to know at the bottom of the article: "Ezekiel J. Emanuel is ....a partner at Oak HC/FT, a health care investment company." Shabby nonsense from the Times.
- maxerickson 9y ago
  So someone with enough expertise to manage investments in the area is automatically disqualified from having and sharing an opinion about it? Ezekiel Emanuel was also one of the architects of Obamacare, which hey, lots of people will hold that as an even bigger point against him. But he may have an interesting opinion about health care policy.
setgree 9y ago
"Hospitals will also continue consolidating into huge, multihospital systems. They say that this will generate cost savings that can be passed along to patients, but in fact, the opposite happens. The mergers create local monopolies that raise prices to counter the decreased revenue from fewer occupied beds. Federal antitrust regulators must be more vigorous in opposing such mergers." This interrupted the flow of the piece for me...it has nothing to do with hospital visits diminishing overall and it's an empirical claim that would have benefited from a citation. It seems that Times op-eds often go for these sorts of flourishes at the end. I learned some interesting facts/stats from this piece and enjoyed it overall.
- Spooky23 9y ago
  It is absolutely relevant as these hospital networks are gobbling up medical practcies, nursing facilities, and other providers (acute rehab, pt, hospice, etc). The results are predictable. Prices are going up and medical providers are marketing funnels. In my little area (Albany-Schenectady-Troy NY), 90% of the providers are now affiliated with two medical systems. One is a former Catholic medical system that was absorbed by a national system and the other is a federation of joint ventures headlined by the local trauma/teaching hospital. 10 years ago, we had 5 networks in the region. Even as an outsider looking in, you can see the monopolist behaviors. Nursing and other medical staff are taking 20% salary haircuts, doctors are forced to sell practices or lose referrals and go out of business, and the quality and costs are not moving the right way.
joshgel 9y ago
As a physician, one of the things not touched on in this discussion and only briefly mentioned in this article is the harm associated with hospitalization. For many of my patients discharge planning is one of the toughest conversations to have. Patients are often reluctant to leave the hospital and I have to tell them why its better that they continue care at home. The reasons they want to stay are many and varied, but include the long emergency department wait times (if they get sick again and have to come back they don't want to deal with that again), clean sheets on a comfortable bed with 3 meals a day for my poorest patients, staff to take care of their needs and that they probably feel safer in the hospital because of all the beeps and bops and scurrying about of the staff. But, they can't see all the patients who had bad outcomes from staying in the hospital too long: they get confused or delirious, there is a medication error, they fall getting out of bed in the middle of the night, they get a new infection, etc. Trying to get people to see those risks is hard, especially since they shouldn't happen, so no one expects them to happen.
vermontdevil 9y ago
And yet a hospital chain is in the works to build a $1 billion facility mere 3 miles from their current one. [1] Carmel (pop 90,000) has 2 hospitals already pluz a gazillion medical centers. [1] https://www.indystar.com/story/news/local/hamilton-county/2018/02/19/developers-propose-1-billion-hospital-development-carmel/351119002/ https://www.indystar.com/story/news/local/hamilton-county/20...

173 points by dr_ 9y ago

tyler_larson 9y ago

No. Next story.

drivingmenuts 9y ago

As opposed to?

cperciva 9y ago

Hospitals aren't becoming obsolete, but their role is changing. Hospitals were once a place where patients were kept for extended periods of time; now for reasons of cost, sanitation, improved surgical techniques, and patient preference they're increasingly places where patients go for medical treatment but unless they're on the verge of death (and thus may need further treatment in very short order) patients then return to the community. More surgeries; less meals and laundry. Rather than becoming obsolete, I'd say that hospitals are gaining an increased focus.

jacobolus 9y ago
What’s the relative cost of in-patient vs. out-patient care?
- lojack 9y ago
  I don't have an answer to your question, but I recently spent some time at the hospital taking care of my daughter, and my understanding is that a lot of it comes down to the fact that hospitals are able to provide good enough care to be comfortable discharging patients earlier. It used to be more common to keep patients at the hospital just in case, but they now send patients home in many of those cases. In my (unprofessional) opinion, this is a good thing. Recovery is much easier in the comfort of our own home, without the stress of being woken up at all hours of the night for tests. We're also completely avoiding a huge risk -- hospital borne infections.
- chimeracoder 9y ago
  > What’s the relative cost of in-patient vs. out-patient care? They're not directly comparable, because the care delivered is fundamentally different, but inpatient care is about two orders of magnitude more expensive. That's not to say that reduction of inpatient care is always a goal, though, because it's only a good tradeoff when the outpatient care actually would provide equivalent or better clinical outcomes. Sometimes that's true, sometimes it's not.
  - maxerickson 9y ago
    Are the costs 100x or are the chargemaster prices 100x? What are a couple of the major factors driving such a huge difference?
- kurthr 9y ago
  To give you a very round number it is several $k per day depending on where in the country ($2-5k) and what hospital for a bed in a two person room with 24h nursing floor care. That does not include doctors, meals, medications, tests, etc. If you're in an ICU or surgery it is easily 2-20x higher than that so you can't compare it. A skilled nursing facility or hospice can be less than $1k per day. In home care even with 8 to 24h nursing can be had for a similar price or lower than a skilled nursing facility ($50-100/hr) with much better quality of life and lower risk of infection if you go to reasonable efforts to keep it clean.
  - Blahah 9y ago
    This doesn't make sense to me. Please correct me if I'm wrong. A hotel can easily provide room and board (essentially the services of a hospital's basic in-patient care) for <$100 a night. The hospital also has a ton of equipment and staff that are additional, but how can it possibly be as much as $1900-$4900? I feel like in-patient care is similar to a hotel but with extra stuff that might increase the cost by a factor of (perhaps) 2-5. But not 10-25. That would suggest that there's some major inefficiency in hospitals causing the cost bloat. You said the price is before doctors, medications, tests, etc. so the service is essentially just accomodation. How can it be so expensive?
    - tetrazine 9y ago
      Hospitals have needs that hotels don't from the ground up. They have different architecture, interior design, and HVAC needs, they have different real estate needs, they need to be robust to natural disasters, they maintain services like ambulances and a vast records and bookkeeping system. Sanitation requirements are much higher, there's no reason to assume costs there scale linearly - think about night shifts. Hospital workers usually are more unionized than hotel workers (should a hotel room be <$100 a night?). I believe nurses do a lot of work that lower trained/skilled/paid workers would do in a hotel. Then you can start throwing in the inflated costs due to the American insurance system, the higher liability hospitals have compared to hotels, and other factors. I'm sure people more familiar with the medical profession could add even more exacerbating factors that I don't know about. All of this isn't to say that the hospital or healthcare system isn't inefficient, but simply that hospitals and hotels are apples and oranges.
xaldir 9y ago
>patient preference As a patient, I'm always suspicious when I see this. When I'm in a bad enough shape to go to the hospital, going home is not my priority, getting better is. As someone who also work in an hospital, pushing patients out as quickly as possible has more to do with financial objectives than anything else. (e.g. we were told that our hospital should have 25% less beds by 2020)
- kingkongjaffa 9y ago
  how and why would you plan to have less beds in the future? Is that backed by population growth and average hospital utilisation per person or some other metric?
  - frobozz 9y ago
    If you can do more outpatient work, you can reduce the bed count, the cost of having a patient taking up a bed in a hospital is very high, even if they are as close to perfect health as possible and are just waiting to be discharged. This is money that could employ another doctor or buy another piece of health-giving equipment. The sooner you can kick a patient out of hospital, the sooner they become someone else's problem, coming out of someone else's budget. In a publicly-funded system, the local authority may pay for in-home care visits and the patient's GP may be responsible for post-hospital outcomes. Stupid PFI deals can mean that the cost-per-bed is ludicrous, and that money that could be going towards patient care is being funnelled to failing companies like Carillion. In an insurance-funded system, the relationship between costs and fees comes down to negotiation between the hospitals and the insurance companies, rather than from the hospital simply coming up with the fees and the insurance companies paying them. This may mean that the income per-bed-per-night is less than it costs, whilst the income per procedure is higher than it costs. Even if the hospital is still responsible for post-discharge care, they may be able to make more profit out of expensive home visits by low-paid carers than in-ward rounds by higher-paid nurses.
- fifteenforty 9y ago
  >> patient preference > As a patient, I'm always suspicious when I see this. There are many practices in medicine that exist only because of patient perference and despite their harm. I think this is because of ongoing poor health education amongst the general public, physicians who are worn out and choose their battles and that private health care systems (at least in Aus) reward practitioners who get good feedback from patients better than those who have the best health outcomes.

iamdave 9y ago

I came here prepared to walk away from this article being reminded once again of Betteridge's Law[1], but then I got to thinking once I did finish it... ...decoupling certain aspects of healthcare from gigantic, expensive hospital systems may actually work for patients and medical care providers couldn't it? Article points out how we do to an extent already, and paints an interesting argument for why we could see more of it. I think I'm on the "want to see more of it", but unsure what the drawbacks would be aside how the expected parties would like to see those traditionally centralized services remain so. I am not a medical professional, the article just got me thinking on the topic...which means, Betteridge be damned-if a piece of writing gets you thinking about something you wouldn't ordinarily think about, article succeeded. --- [1] https://en.wikipedia.org/wiki/Betteridge%27s_law_of_headlines https://en.wikipedia.org/wiki/Betteridge%27s_law_of_headline...

ZeroGravitas 9y ago
For those, like me, confused by this comment, the article's real title, which I guess was changed on HN after this comment is "Are Hospitals Becoming Obsolete?".

thedailymail 9y ago

Bad headline, but the article itself gives some nice insights into the current trajectory of medical care in the US. Important to note that the trend is not the same in all countries though. In Japan, where hospital stays are frequently used as a stopgap measure in cases where elderly patients can't afford or can't find a long term assisted living facility, hospitalization shows only moderate declines from historic highs in the 90s.

deleted 9y ago

[deleted]

Izkata 9y ago

> Through the 19th century, most Americans were treated in their homes. Hospitals were a last resort, places only the very poor or those with no family went. And they went mainly to die. Sort-of related: Why would anyone ever think putting "memorial" in a hospital name was a good idea? "A place to go to die" is the first thing that has always popped into mind when I see that.

mattkrause 9y ago
If 'memorial' bothers you, you are going to love the an archaic French term: 'Hôtel-Dieu', or hotel of God.

zaroth 9y ago

"Hospitals are no longer seen as therapeutic." That's putting it mildly! I think we generally do a piss poor job of providing truly therapeutic environments as a service.

aaavl2821 9y ago

For those in the industry, the continued consolidation and increasing power of hospital systems seems a given, despite the problems that entails. It is refreshing to see this perspective voiced As I said in another thread, hospitals are the largest component of US healthcare cost. They make money by increasing the number of hospital visits, especially for surgeries. Even non profits have been consolidating and seeking profit, and the largest non profit systems have dramatically increased their incomes over the last few decades Hospitals are devouring outpatient clinics to get their patient volume into the hospital system. These practices are loss leaders for the hospital profit centers in many cases Sadly, many hospital systems fight improvements in care that decrease inpatient admissions by making people healthier, because fewer admissions means less hospital revenue. Having hospitals in charge of US healthcare is like having the fox in charge of the henhouse

Eridrus 9y ago
What is the thing about hospitals that distinguishes them from other facilities? Is it just that they have beds and everything else is a clinic? Why is having beds such a big factor? Is it just that they are a large fixed cost which makes it hard to turn a profit? I don't particularly like hospitals, but the healthcare system in the US is hugely fragmented and piecing together all the providers you need is a pain in the ass, why are hospitals unable to capitalize on their broad experience and expertise to help?
- hkmurakami 9y ago
  ER. In most areas hospitals are the only facilities providing emergency care. (And boy is it expensive)
  - jiggunjer 9y ago
    Given how many people go there with a minor fever or stomach ache, it isn't expensive enough.
    - maxerickson 9y ago

chime 9y ago

Seeing as how the infant/mother mortality rate is so high in the US compared to other developed nations, I don't think home births should be encouraged as much in non-rural areas. Birthing Centers are better than home births though not suitable for high-risk cases.

deleted 9y ago
[deleted]
vonmoltke 9y ago
> Seeing as how the infant/mother mortality rate is so high in the US compared to other developed nations 6.2 in the US versus 5.7 in the EU doesn't really back that statement up. https://www.infoplease.com/world/health-and-social-statistics/infant-mortality-rates-countries https://www.infoplease.com/world/health-and-social-statistic...

themodelplumber 9y ago

Is there a framework that could communicate the most appropriate role of a given hospital for those trying to evaluate their care options? For example, "given the individual's parameters X and Y and Z, the hospital in question is in quadrant N of the individual's sphere of care options. This implies a role of [e.g. emergency use only, etc]." It just seems like we need a more objective idea of _what a given hospital really is and can be_ for a given individual. Such a model would naturally expose economic opportunities for providers who have the resources to open small competitor clinics, while conserving resources like money, energy, etc. for care seekers who can only be excused for thinking "sick = hospital". If we can't get needed anti-monopoly regulators to do their job, we can at least start to find points of leverage with which to educate the public on the cost-benefit and alternatives in a more straightforward way.

majidazimi 9y ago

The title should be: We should welcome the advances that are making hospitals less important in US. There is nothing wrong with hospitals in EU.

24gttghh 9y ago
I'm sure there is something wrong with hospitals in the EU. They're run by humans, after all.

Steven_Evans 9y ago

Here's all you need to know at the bottom of the article: "Ezekiel J. Emanuel is ....a partner at Oak HC/FT, a health care investment company." Shabby nonsense from the Times.

maxerickson 9y ago
So someone with enough expertise to manage investments in the area is automatically disqualified from having and sharing an opinion about it? Ezekiel Emanuel was also one of the architects of Obamacare, which hey, lots of people will hold that as an even bigger point against him. But he may have an interesting opinion about health care policy.

setgree 9y ago

"Hospitals will also continue consolidating into huge, multihospital systems. They say that this will generate cost savings that can be passed along to patients, but in fact, the opposite happens. The mergers create local monopolies that raise prices to counter the decreased revenue from fewer occupied beds. Federal antitrust regulators must be more vigorous in opposing such mergers." This interrupted the flow of the piece for me...it has nothing to do with hospital visits diminishing overall and it's an empirical claim that would have benefited from a citation. It seems that Times op-eds often go for these sorts of flourishes at the end. I learned some interesting facts/stats from this piece and enjoyed it overall.

Spooky23 9y ago
It is absolutely relevant as these hospital networks are gobbling up medical practcies, nursing facilities, and other providers (acute rehab, pt, hospice, etc). The results are predictable. Prices are going up and medical providers are marketing funnels. In my little area (Albany-Schenectady-Troy NY), 90% of the providers are now affiliated with two medical systems. One is a former Catholic medical system that was absorbed by a national system and the other is a federation of joint ventures headlined by the local trauma/teaching hospital. 10 years ago, we had 5 networks in the region. Even as an outsider looking in, you can see the monopolist behaviors. Nursing and other medical staff are taking 20% salary haircuts, doctors are forced to sell practices or lose referrals and go out of business, and the quality and costs are not moving the right way.

joshgel 9y ago

As a physician, one of the things not touched on in this discussion and only briefly mentioned in this article is the harm associated with hospitalization. For many of my patients discharge planning is one of the toughest conversations to have. Patients are often reluctant to leave the hospital and I have to tell them why its better that they continue care at home. The reasons they want to stay are many and varied, but include the long emergency department wait times (if they get sick again and have to come back they don't want to deal with that again), clean sheets on a comfortable bed with 3 meals a day for my poorest patients, staff to take care of their needs and that they probably feel safer in the hospital because of all the beeps and bops and scurrying about of the staff. But, they can't see all the patients who had bad outcomes from staying in the hospital too long: they get confused or delirious, there is a medication error, they fall getting out of bed in the middle of the night, they get a new infection, etc. Trying to get people to see those risks is hard, especially since they shouldn't happen, so no one expects them to happen.

vermontdevil 9y ago

And yet a hospital chain is in the works to build a $1 billion facility mere 3 miles from their current one. [1] Carmel (pop 90,000) has 2 hospitals already pluz a gazillion medical centers. [1] https://www.indystar.com/story/news/local/hamilton-county/2018/02/19/developers-propose-1-billion-hospital-development-carmel/351119002/ https://www.indystar.com/story/news/local/hamilton-county/20...