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Ambulatory Care Trends: New England & Beyond

Posted by Jennifer O'Donnell on Feb 17, 2017

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Two months ago, I posted a blog about a roundtable with Boston-area hospital leaders. Two major takeaways were the ambulatory care trends in the industry and the challenges about expanding services. In this blog, I outline the trends, which I believe many regions will draw similar conclusions. Boston Roundtable_Array Architects
  1. Systems are rethinking healthcare delivery models. A Doc-in-a-Box managing the patient panel is going away. Systems are now much more concerned with how they can deliver care in a model where the physician is acting as the quarterback and managing a much larger patient panel through an entire team including practitioners, RNs, behavioral specialists, etc. They are looking at ways to reconfigure their space so they can manage those teams to be much more efficient.

  2. Systems look at which physicians to put out in the suburbs. It’s programmatically-based and it’s about cachement area and how many patients they would capture and then the square footage is determined from that. They try to be conservative with square footage, but can’t be so conservative that they are lacking adequate space when they first open.

  3. Systems see the need to push services out to where their patient populations live because people are getting tired of coming into the city. Prior to the legislative restrictions on reimbursements, this suburban care model had broad-based acceptance. This approach is now questionable.

  4. Primary care services are being moved out of the hospital to create space for higher acuity services. Putting primary care in an MOB has caused a lot of systems to then expand critical services at the hospital.

  5. Surviving against the competition by acquiring physician practices to build the system. Physician practices are seen as an arm of the mothership, providing the right mix of services to treat patients wholly.

  6. Independent physician practices work with hospital groups acting as feeders.

  7. The movement of ambulatory care beyond the current market through affiliations in order to prevent leakage. If they don’t have services close to the patient, then systems have to pay other entities where the client visits for services. Retaining customers so they don’t have to pay the competition for handling their patient is key.

  8. Regarding the physicians in the suburbs, hospitals are trying to make them feel as though they are truly a part of the system.

  9. Analyze utilization and apply lean operation principles in order to be able to build less space.

  10. For-profit systems are moving into areas and taking market share. In states such as New Hampshire, the state's certificate of need program ended June 30, 2016. Non-Profit hospitals are concerned because they see it as losing their protection and having to differentiate themselves against the For-Profits competing for market share.

Topics: ambulatory care, healthcare, trends

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