Factors from COVID-19 to consumer preferences are driving healthcare out of traditional physicians' offices and hospital settings and into alternate sites of care, including outpatient, virtual and lower-acuity settings as well as home-based care.
During a roundtable session at Becker's Hospital Review's 12th Annual Meeting sponsored by Medtronic, the company's Jennifer Sarafin, MSN, director of consulting solutions, and Brian Asmussen, senior director of the global UNiD lab and customer engagement, facilitated a discussion about the changes, challenges and opportunities the migration to outpatient presents for health systems, from patient experience to financials.
With an understanding that each market in the U.S. is different and nuanced, there were six key takeaways:
1. The care setting is shifting toward virtual and other non-hospital/office settings. Increasingly, surgeries and other procedures are being performed in ambulatory surgery centers rather than hospitals, a continuing trend that accelerated during the pandemic. Meanwhile, emergency visits have shifted from hospital emergency departments to urgent care centers and retail clinics, and regular provider visits are increasingly virtual. Speaking broadly, the acuity of care continues to increase across all sites of care.
2. Reasons for the shift include the pandemic, consumer trends, payer and lawmaker policy changes, and technology advances. The pandemic caused a fast pivot to virtual care, Ms. Sarafin said, but consumer trends are a big factor too. "[Consumers] have new expectations," she said. "They want to see healthcare, as with other industries like banking and air travel, increase its focus on convenience." Meanwhile, lawmakers and payers have pushed for lower-cost services that can often be found outside of a traditional hospital setting.
3. While telehealth is here to stay, some visits may not be suited for the virtual environment. In some cases, patients realize they'd rather see a provider in person. "We're seeing more and more people that have had repeat virtual visits — two, three or four — and then they say, 'I need to see somebody, this isn't working,'" a participant from the Silicon Valley area in California said. "The challenge is to make sure that virtual care is really effective." Others agreed, noting they are continuing to develop and track use cases where in-person is more effective than telehealth.
4. Technology has helped the shift toward healthcare at home, but it doesn't work universally. Receiving care at home is often a patient preference, but providers are challenged in determining if patients have the right support and home environment for only once- or twice-daily nurse visits. Issues like social determinants of health are factors in determining the suitability of home-based care. "There's a very complex and in-depth social screening that needs to take place," a participant from a health system in Oklahoma said.
5. Striving for convenience presents new opportunities. A participant from a health system in Illinois said this health system has responded with urgent care "on-the-go" centers that offer convenience without a traditional physician. Other participants said their patients are happy to go to a care center closer to home rather than traveling farther to a hospital.
6. These shifts have created financial challenges. The shift to outpatient care means that inpatient care is more likely to be utilized by higher-risk patients — those who are older, sicker or who face community access challenges. Participants also noted the desire for reimbursement changes.
The future holds a lot of change for health systems as their services, locations and staff become more distributed. But innovation is taking place and healthcare leaders rising to the occasion, finding new ways to continue delivering quality care and a better patient experience.