"Hospitals tend to be the highest-cost setting because of the intensity of services there," she said. "You see a dramatic difference in the payment for inpatient and outpatient services." The rise of bedless hospitals has also tracked the development of streamlined treatments. Several years ago, doctors at Memorial Sloan Kettering Cancer Center started brainstorming plans for more surgical space — an exercise that led to efforts to create standardize protocols for routine surgeries, such as mastectomies, that could be done without prolonged hospital stays. The end result was the Josie Robertson Surgery Center, a 16-story building on Manhattan's Upper East Side where doctors perform outpatient cancer surgeries. It has 28 short-stay beds, but most patients leave within hours of their procedures.
因为各种五花八门的检查,在医院的花费很高。而且门诊和住院所享受的服务也是截然不同的。“无床”医院的出现与所提倡的简化治疗的过程的理念是一致的。数年前,斯隆凯特灵癌症中心的医生们为了获得更多手术空间而做了一次头脑风暴,这也是将常规手术标准化的一次尝试,这些手术包括,乳房切除手术,术后不需要再医院过夜。终于在曼哈顿东北角建成了杰西罗伯森外科中心,一栋16层小楼,供门诊病人手术,有28张临时休息床,大部分病人都能在术后规定的时间内离开医院。
But under the Affordable Care Act and other reforms, reimbursement is linked more directly with the effectiveness of treatment, meaning providers are rewarded financially if they can deliver better care at a lower cost. For MetroHealth, building and buying bedless hospitals is part of a strategy to compete with Cleveland Clinic and University Hospitals. While a helipad at its new building offers the capability to treat patients facing medical emergencies, most people will come for the convenience of having all medical services — primary care and specialty services — in one location near their homes.
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