By James X. Stobinski
Molly Gamble, in a recent article in Becker’s Healthcare Review (2023), spoke to the Brick and Mortar Paradox facing American health care. Gamble refers to entities invested in buildings and infrastructure used in the provision of American health care today and in the near future.
An evolution to virtual care and a shift of health care away from a physical location speaks to the brick and mortar issue at the center of Gamble’s article. This transition in care was jump-started during the COVID-19 pandemic and shows no sign of re-trenching. Two things are clear however, inpatient care and the infrastructure needed to support it is not going away soon but more health care is being delivered outside traditional settings. These facts bring us to a conundrum in health care planning.
For the near future we will still need the physical buildings such as hospitals and clinics which are so familiar to current providers who trained in such facilities. Gamble, referencing data from the consultancy Sg2, tells us that the case mix index (CMI) is up 5% over the past 4 years and length of stay, a key financial benchmark, is also up over 10%. Thus, those who are receiving care now in a hospital are sicker, require more complex care and stay longer in the facility once admitted. For these patients, a physical space such as a hospital is needed now.
The amount of brick and mortar needed to deliver American health care in its present state is influenced by many factors. We must also acknowledge that not all current health care facilities are used at optimal capacity. There is a relative oversupply in some areas/regions secondary to recent population shifts. I have spoken to the closures of rural health care facilities in other columns, a trend accelerated by ongoing merger and acquisition activity. Reports of closures of rural facilities and bankruptcies are common occurrences in sources such as Becker’s Healthcare Review. Gooch (October 2023) spoke to this very recently as hospitals were realigned in Oregon.
More American health care is shifting away from hospitals to ambulatory settings which may leave a hospital with excess capacity within their building. In example, many hospitals invested in inpatient facilities to support orthopedic and spine procedures which formerly had longer postoperative inpatient stays. As technology and surgical procedures are refined more of these cases are done in the ambulatory setting leaving the dedicated hospital sites underutilized.
A shift to telehealth and new models of care also has implications for the facilities needed to deliver health care. As technology evolves more care can be delivered in a home setting with the workforce, such as nursing staff, being physically distant from the patient. It is plausible that some patients will engage with a facility for an urgent episode of care and then return to their home to be monitored by a remote workforce versus being admitted to a hospital. This scenario summarizes the dilemma for American health care. How do we plan long term for rapidly evolving health care?
There are multiple stakeholders in play and not all of those stakeholders are pulling in the same direction. Strategic planning in this environment is a challenging, high-stakes endeavor. There are implications for the availability of surgical care as operating rooms are expensive to build and once built have high fixed costs. There are also implications for workforce planning as we must also educate the health care workforce with an eye to the future. New training sites and experiences may be needed for the American health care of the future. The brick and mortar paradox which is manifesting at present has numerous implications for the future of our health care system.
– James X. Stobinski, Ph.D., RN, CNOR, CNAMB(E), CSSM(E), is the director of education with the National Institute of First Assisting.
References
- Gamble, M. (OCT 16, 2023). Hospitals’ brick-and-mortar paradox. https://www.beckershospitalreview.com/capital/hospitals-brick-and-mortar-paradox.html?utm_medium=email&utm_content=newsletter
- Gooch, K. (October 23, 2023). PeaceHealth files layoff notice ahead of Oregon hospital closure. https://www.beckershospitalreview.com/finance/peacehealth-files-layoff-notice-ahead-of-oregon-hospital-closure.html?origin=BHRE&utm_source=BHRE&utm_medium=email&utm_content=newsletter&oly_enc_id=4467F0926923B3Y
