A patient sits in the ICU at Banner Health’s Fairbanks Memorial Hospital in Alaska.
It’s late, many of the staff have gone home. He watches the glowing blinks of the machines monitoring his vital signs lighting the room in little blue and green bursts. Suddenly, a nurse is beckoned to his bedside by an abnormal fluctuation in his stats. The patient’s physician is notified and, if off-duty, with the press of a button, a critical care specialist or nurse sitting in what’s affectionately called “the bunker,” staffed 24/7 by highly specialized physicians known as intensivists at Banner Desert in Mesa, can appear on a two-way video communications system to assist.
This is the future of medicine. Though Banner Health has been working on its eICUs in the seven states where its located since 2006, telemedicine is continuing to affect change throughout real estate.
Behind the Screen
A COMPACCS study found that patients who would need critical care require, on average, 45 minutes of an intensivist’s time per day, according to “The Critical Care Workforce.” After crunching the numbers, the report claims ICU patients use 18 million ICU days every year. This is on the condition that only a third of ICU patients are seen by an intensivist. To meet this demand, 3,100 intensivists would have been required to treat the patient demand in 2000. That’s more than 65 percent of those who were available in the U.S.
There’s a shortage of these critical care specialists, even 15 years later. This has a direct effect on care.
Mortality rate in ICUs is between 12 and 17 percent, according to U.S. Department of Health & Human Services’ “The Critical Care Workforce: A Study of the Supply and Demand for Critical Care Physicians.”
“If demand grows only as a result of the growth and aging of the population, demand for intensivists will increase from about 1,880 in 2000 to 2,600 in 2020 (an increase of about 38 percent),” according to “The Critical Care Workforce.”
“Every ICU could hire a specialist, but it would outstrip the supply in the entire country,” Bollinger says.
With the Affordable Care Act, hospitals are seeing inpatient days decrease. The reimbursement methodology has turned toward value and outcomes at affordable costs versus being reimbursed for doing more, says Kathy Bollinger, vice president of academic delivery at Banner Health.
“There is a change in incentives to provide the right care in the right setting at the right time,” Bollinger says.
Inpatients are spending fewer days in hospitals, and bed and room quantity focuses are now on quality rooms with the appropriate infrastructure.
When Banner Health renovates the patient tower at the existing University Medical Center in Tucson, it will only add 10 additional beds.
“The hospitals are not getting bigger, but they need to get smarter,” said Bollinger.
Banner Health has 500 of its senior patients participating in a pilot program. They are provided an iPad and home technology that facilitate e-visits from their physicians.
“Our early evidence on that project is we’re decreasing those patients’ trips to the emergency department,” Bollinger says.
Bollinger says hospitals need to get smarter, and DPR’s national healthcare leader Hamilton Espinosa agrees.
“Their payer mix is getting thrown off skew by the amount of Baby Boomers and reimbursement rates offered by Obamacare,” he says. “The need to be smarter…part of that is leaner, smarter operation.”
The amount of technology used by a hospital requires a larger amount of data that must be managed. This requires updates. Hospitals have also been upgrading their presentation.
“Banner is (Arizona’s) largest hospital system, so they have been moving the fastest and doing the largest amount of work in terms of positioning themselves to streamline and provide healthcare in more efficient manner,” says GPE Commercial Advisors Executive Vice President Julie Johnson. She is referring to the number of satellite Banner clinics that have popped up in the East Valley. There is a grab for market share, she says.
“Dignity has been looking at several different clinics,” she says. “I don’t think they have been implementing them as quickly as Banner.”
These large hospital care providers can afford to expand. However, clinics that have been traditionally geared toward lower income patients are now in a market where these patients have Obamacare and the power of choice. Johnson says Adelante and Mountain Park facilities have expanded their programs to compete. Most recently, Adelante Healthcare in Peoria moved into a retail center and put a huge emphasis on outfitting the space with attractive interiors.
“Real estate is a really expensive part of healthcare delivery,” says Johnson. “(Telemedicine) changes how real estate is delivered. It may not change quickly. People still need to be touched and seen, but it will definitely evolve and change.”
In addition to the adoption of telemedicine, the healthcare industry is seeing aesthetic changes.
There is a greater emphasis on patient care and reducing the amount of time a patient stays at the hospital as well as return trips.
“I think the hospital campus is always going to be a hub of activity, but there is more and more being done at these outpatient clinics,” says Johnson. “Heart surgeries will soon be done in outpatient settings. There is less of a need for hospital beds and more of a need for ambulatory settings. It’s cheaper to provide (care) in those settings. The synergies of proximity around hospital campuses will always be there. Even though the trend is for clinics to be off-campus in the hub and spoke method from 12 years ago, there will always be a synergy.”
For example, HonorHealth, formerly John C. Lincoln, built Sonoran Health and Emergency Center that is an emergency department with an attached clinic. In the event of needing a hospital, patients are transferred to Deer Valley.
“The actual patient is going to have a lot more choice in today’s market,” Johnson says. “There is going to be more hospitality element in providing healthcare. People want to choose it because of health care but also because it has a nice hospitality setting. As more people are having the ability to control their healthcare, if their first $5K is out of pocket and they have a choice of where to get an MRI or where to have my baby, they’re going to go where they’re most comfortable.”