Skip to content
  • About
  • Contact
  • Contribute
  • Book
  • Careers
  • Podcast
  • Recommended
  • Speaking
  • All
  • Physician
  • Practice
  • Policy
  • Finance
  • Conditions
  • .edu
  • Patient
  • Meds
  • Tech
  • Social
  • Video
    • All
    • Physician
    • Practice
    • Policy
    • Finance
    • Conditions
    • .edu
    • Patient
    • Meds
    • Tech
    • Social
    • Video
    • About
    • Contact
    • Contribute
    • Book
    • Careers
    • Podcast
    • Recommended
    • Speaking

Why hospitals have to dramatically change their missions

Tommy Prewitt, MD
Policy
December 15, 2014
Share
Tweet
Share

shutterstock_157424303

I think I will become a neurosurgeon. Tomorrow.

It shouldn’t be too hard, right? I’m a breast cancer surgeon, and that is kind of like being a neurosurgeon, isn’t it? I wear scrubs and know how to tie knots really well. OK, maybe I don’t know much about the brain, and the last time I was on a neurosurgical team was during my internship, but does that matter? Certainly my experience in surgery should easily translate to neurosurgery, right?

Of course not! It is ridiculous to think I could snap my fingers and declare myself a neurosurgeon. But that scenario is much like what we are expecting from hospitals regarding population health. Hospitals have thrived in the fee-for-service environment for decades, and for our younger readers, there was a time when Medicare paid 101 percent of costs. Now how sweet was that? It’s hard to lose in that environment — that is until the money runs out, and that is where we are today. We’ve worried about having no more money, but now we are in a state of no more — no more money. We are tapped out. Broke.

These are really difficult times for hospital executives. The system (and I use this term loosely) is rapidly shifting from a volume-based, fee-for-service business model to a population model that puts providers at financial risk. This means that hospitals have to rethink their core business. Instead of filling hospital beds with patients who need complicated treatments and expensive procedures, hospitals must now try to keep patients out of the hospital and do so with low costs.

Some areas of the country are more accustomed to HMOs and managed care models, but they are in the minority. For the rest of the country, this is disruptive stuff, particularly the part about taking on risk. When you take on risk, you agree to take care of x patients for y dollars. If you can improve quality and reduce costs, you will do fine. On the other hand, if you spend too much caring for people and get bad outcomes, you will be underwater. Both scenarios involve the flow of funds, and I am interested in where the funds will flow.

So the question is: Who gets the dollars? Docs need a livelihood; hospitals have to support an infrastructure.

The docs will see cuts in income, but they will be alright. We can expect a couple of decades of new doctors becoming primary care providers instead of interventional specialists. There will also be more focus on physician extenders because they do a great job with more repetitive, maintenance care than diagnostics and interventions.

The issues with hospitals will not be easy. The average national hospital bed occupancy rate in 2012 was 61 percent. How far will occupancy rates decline when a hospital bed becomes a liability? I hope that hospital strategists are looking out 10 to 20 years as their business changes dramatically. One thought: Smaller facilities could embrace the move to population health by reimagining their mission to short stays, diagnostics, and rehabilitation.

As for me, forget that neurosurgeon idea.

Tommy Prewitt is director, Healthcare Delivery Institute, HORNE LLP.

Image credit: Shutterstock.com

Prev

How to introduce palliative care to patients

December 15, 2014 Kevin 0
…
Next

Top stories in health and medicine, December 16, 2014

December 16, 2014 Kevin 0
…

Tagged as: Hospital-Based Medicine

Post navigation

< Previous Post
How to introduce palliative care to patients
Next Post >
Top stories in health and medicine, December 16, 2014

ADVERTISEMENT

More by Tommy Prewitt, MD

  • a desk with keyboard and ipad with the kevinmd logo

    These are the clinicians you want for your ACO

    Tommy Prewitt, MD
  • a desk with keyboard and ipad with the kevinmd logo

    Can doctors afford to ignore the changes in medical practice?

    Tommy Prewitt, MD
  • a desk with keyboard and ipad with the kevinmd logo

    Why you should help your local hospital improve

    Tommy Prewitt, MD

More in Policy

  • Healing the doctor-patient relationship by attacking administrative inefficiencies

    Allen Fredrickson
  • The hidden health risks in the One Big Beautiful Bill Act

    Trevor Lyford, MPH
  • The CDC’s restructuring: Where is the voice of health care in the room?

    Tarek Khrisat, MD
  • Choosing between care and country: a dual citizen’s Independence Day reflection

    Kathleen Muldoon, PhD
  • How fragmented records and poor tracking degrade patient outcomes

    Michael R. McGuire
  • U.S. health care leadership must prepare for policy-driven change

    Lee Scheinbart, MD
  • Most Popular

  • Past Week

    • Why are medical students turning away from primary care? [PODCAST]

      The Podcast by KevinMD | Podcast
    • Why “do no harm” might be harming modern medicine

      Sabooh S. Mubbashar, MD | Physician
    • Here’s what providers really need in a modern EHR

      Laura Kohlhagen, MD, MBA | Tech
    • How New Mexico became a malpractice lawsuit hotspot

      Patrick Hudson, MD | Physician
    • Why doctors are reclaiming control from burnout culture

      Maureen Gibbons, MD | Physician
    • A world without vaccines: What history teaches us about public health

      Drew Remignanti, MD, MPH | Conditions
  • Past 6 Months

    • Why tracking cognitive load could save doctors and patients

      Hiba Fatima Hamid | Education
    • Why are medical students turning away from primary care? [PODCAST]

      The Podcast by KevinMD | Podcast
    • What the world must learn from the life and death of Hind Rajab

      Saba Qaiser, RN | Conditions
    • Why “do no harm” might be harming modern medicine

      Sabooh S. Mubbashar, MD | Physician
    • Here’s what providers really need in a modern EHR

      Laura Kohlhagen, MD, MBA | Tech
    • How the 10th Apple Effect is stealing your joy in medicine

      Neil Baum, MD | Physician
  • Recent Posts

    • From Founding Fathers to modern battles: physician activism in a politicized era [PODCAST]

      The Podcast by KevinMD | Podcast
    • From stigma to science: Rethinking the U.S. drug scheduling system

      Artin Asadipooya | Meds
    • The gift we keep giving: How medicine demands everything—even our holidays

      Tomi Mitchell, MD | Physician
    • The promise and perils of AI in health care: Why we need better testing standards

      Max Rollwage, PhD | Tech
    • From burnout to balance: a neurosurgeon’s bold career redesign

      Jessie Mahoney, MD | Physician
    • Healing the doctor-patient relationship by attacking administrative inefficiencies

      Allen Fredrickson | Policy

Subscribe to KevinMD and never miss a story!

Get free updates delivered free to your inbox.


Find jobs at
Careers by KevinMD.com

Search thousands of physician, PA, NP, and CRNA jobs now.

Learn more

View 7 Comments >

Founded in 2004 by Kevin Pho, MD, KevinMD.com is the web’s leading platform where physicians, advanced practitioners, nurses, medical students, and patients share their insight and tell their stories.

Social

  • Like on Facebook
  • Follow on Twitter
  • Connect on Linkedin
  • Subscribe on Youtube
  • Instagram

ADVERTISEMENT

  • Most Popular

  • Past Week

    • Why are medical students turning away from primary care? [PODCAST]

      The Podcast by KevinMD | Podcast
    • Why “do no harm” might be harming modern medicine

      Sabooh S. Mubbashar, MD | Physician
    • Here’s what providers really need in a modern EHR

      Laura Kohlhagen, MD, MBA | Tech
    • How New Mexico became a malpractice lawsuit hotspot

      Patrick Hudson, MD | Physician
    • Why doctors are reclaiming control from burnout culture

      Maureen Gibbons, MD | Physician
    • A world without vaccines: What history teaches us about public health

      Drew Remignanti, MD, MPH | Conditions
  • Past 6 Months

    • Why tracking cognitive load could save doctors and patients

      Hiba Fatima Hamid | Education
    • Why are medical students turning away from primary care? [PODCAST]

      The Podcast by KevinMD | Podcast
    • What the world must learn from the life and death of Hind Rajab

      Saba Qaiser, RN | Conditions
    • Why “do no harm” might be harming modern medicine

      Sabooh S. Mubbashar, MD | Physician
    • Here’s what providers really need in a modern EHR

      Laura Kohlhagen, MD, MBA | Tech
    • How the 10th Apple Effect is stealing your joy in medicine

      Neil Baum, MD | Physician
  • Recent Posts

    • From Founding Fathers to modern battles: physician activism in a politicized era [PODCAST]

      The Podcast by KevinMD | Podcast
    • From stigma to science: Rethinking the U.S. drug scheduling system

      Artin Asadipooya | Meds
    • The gift we keep giving: How medicine demands everything—even our holidays

      Tomi Mitchell, MD | Physician
    • The promise and perils of AI in health care: Why we need better testing standards

      Max Rollwage, PhD | Tech
    • From burnout to balance: a neurosurgeon’s bold career redesign

      Jessie Mahoney, MD | Physician
    • Healing the doctor-patient relationship by attacking administrative inefficiencies

      Allen Fredrickson | Policy

MedPage Today Professional

An Everyday Health Property Medpage Today
  • Terms of Use | Disclaimer
  • Privacy Policy
  • DMCA Policy
All Content © KevinMD, LLC
Site by Outthink Group

Why hospitals have to dramatically change their missions
7 comments

Comments are moderated before they are published. Please read the comment policy.

Loading Comments...