Reverse Migration of Outpatient Services to the Hospital Campus (An Update)

Many medical services are provided both in hospital and community settings, such as physician offices and freestanding imaging or ambulatory surgical centers (ASCs). Services commonly provided in both settings include laboratory tests, physical therapy, outpatient surgery, routine and advanced imaging, physician visits, and noninvasive and invasive procedures, such as endoscopy or cardiac catheterization. When the Centers for Medicare & Medicaid Services (CMS) originally developed the hospital outpatient department (HOPD) designation to establish a higher reimbursement rate for hospital-based outpatient services, hospitals started purchasing physician practices, freestanding imaging centers, and ambulatory surgery centers and rebranding them as hospital outpatient departments to collect the higher Medicare payments. Now CMS is considering site-neutral payments which may result in another 180 degree shift from an on-campus to an off-campus location.

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Physician Offices and Outpatient Clinics: How Many Exam Rooms?

Patient With DoctorPhysician offices and outpatient clinics typically consists of a patient intake area with space for reception, check-in/check-out, and waiting; exam/treatment space with a number of identical exam rooms, several office/consultation rooms, and one or more special procedure rooms; and associated clinical and administrative support space. Physician office space may be located in a medical office building (either freestanding or connected to a hospital), co-located with diagnostic and treatment services in a comprehensive ambulatory care center, or part of an institute or center organized along a specific service line — such as a Sports Medicine Center, Heart Center, or Cancer Center. Planning space for physician offices (also referred to as physician practice space) and outpatient clinics begins with determining how many exam rooms are needed and two different approaches are commonly used.

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Transforming Primary Care With the Patient-Centered Medical Home Model

The patient-centered medical home (PCMH) model ― also referred to as advanced primary care and the healthcare home ― holds promise as a way to improve American healthcare by transforming how primary care is organized and delivered. This team-based model of care is led by a personal physician who ideally provides continuous and coordinated care throughout the patient’s lifetime to maximize health outcomes. The PCMH practice is responsible for all of a patient’s healthcare needs or appropriately arranging care with other qualified professionals. This includes the provision of preventative services, treatment of acute and chronic illness, and assistance with end-of-life issues.

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Case Study: Planning an Ambulatory Care Facility

Prudent Health System planned to construct a new ambulatory care facility on its main hospital campus to provide space for urgent care, ambulatory surgery, and various hospital-sponsored clinics. The organization needed space to accommodate the following ten-year workload projections and corresponding clinical services:

  • Urgent care center with 32,000 annual visits
  • Ambulatory surgery center with 4,200 annual surgical cases
  • Hospital-sponsored clinics: medicine (23,000 annual visits), surgery (15,000 annual visits), neurosciences (6,000 annual visits), orthopedics (16,000 annual visits)

In addition, Prudent Health planned a small express testing area to consolidate routine, quick-turnaround outpatient testing in a single area—including X-ray, electrocardiogram, and specimen collection — along with a small satellite laboratory.

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Case Study: Planning a Prototype Health Center

Northern Health Authority delivers healthcare to the residents of 20 different communities that are a mix of settlements, towns, and villages. With many of the existing remote health centers in need of replacement, Northern Health decided to develop a prototype community health center that could be replicated to serve communities of less than 1,500 people — some of which are accessible only by air.

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Shared Medical Appointments Are Becoming a New Outpatient Care Option

Most patients wait alone in a cramped exam room for a scheduled appointment as their physician rushes through back-to-back individual patient visits lasting an average of 22 minutes each. With the growing trend of shared medical appointments, a patient and his/her peers spend a full 90 minutes with their personal physician. Shared medical appointments are a small but growing part of primary care as well as for a variety of medical specialties. According to the American Academy of Family Physicians, the percentage of its members offering shared medical appointment more than doubled, to nearly 12 percent, between 2005 and 2012. At the Cleveland Clinic, nearly 10,000 group appointments were logged between 2002 and 2014. Promoted as the wave of the future in outpatient care, group appointments are changing the way physicians and patients view medical treatment.

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