How Big, How Soon?

Philip Betbeze, for HealthLeaders Media , January 13, 2012
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Volume estimates, shifts
For decades, hospitals invested in inpatient care. That was where the highest reimbursement was, and much more work was centered there. More recently, as more complex procedures are being effectively moved out of the hospital to lower-acuity settings, hospital leaders have invested in outpatient care. Many hospitals have simply followed the revenue that moved out of the hospital setting by building out their network to include more ambulatory surgery centers, imaging, and lab work. But the shift has been haphazard and tailored to existing patients.

New patient volume growth is expected to occur most strongly among the part of the population that has previously been uninsured. Many of them are used to getting their care in the emergency room, the only place they previously were guaranteed care because of federal requirements that prevented hospitals from refusing treatment there to the uninsured. As more patients move onto the health insurance exchanges between now and 2014, hospitals, for a variety of reasons, are working to encourage such patients to pursue strong primary care relationships.

"We expect to see significant increases in primary care volume," says Frank J. Cracolici, president and CEO of St. Luke's-Roosevelt Hospital Center, a 1,076-licensed-bed hospital that's part of New York's Continuum Health Partners. To deal with it, St. Luke's-Roosevelt Hospital Center is investing in physician talent and new outpatient facilities, and is developing contracts with existing providers in many cases, rather than owning other pieces of the care continuum.

"We're developing a very strong primary care network," he says. "Rather than patients visiting the ED, they can go to primary care networks that will give them more consistent and less episodic care."

Just last year, St. Luke's-Roosevelt completed construction of a primary care site in Central Harlem, St. Luke's Medical Group, with five physicians, as a method of encouraging people to stay in their community for care and avoid the emergency rooms. Others are in the planning stages, but all rest on the presumption that what most of these patients need is primary care.

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