- Experts say the move toward decentralized care is making hospitals more obsolete in the United States.
- They note urgent care clinics and expanded services at pharmacies are changing how healthcare is delivered.
- They also say there’s a trend toward people, especially older adults, being taken care of at home.
Typically, when you’re sick, hurt, or not feeling well, you go to a hospital to see a doctor.
In the near future, that won’t necessarily be the case: The United States medical system has become increasingly expensive and too often dangerous to one’s health.
That’s why some are actively trying to change things.
Dan Paull, MD, CEO of Easy Orthopedics based out of Colorado Springs, says the current U.S. healthcare industry is terrible for both patients and doctors.
He says his business involves transparent pricing and cash payments, a system that avoids the usual bureaucracy that typically comes with insurance companies and hospitals.
At his office, he says, no one gets surprised with paying $100 for an aspirin.
“Hospitals are using an old business model,” Paull told Healthline. “They want to trap as much care as they can while bankrupting people.”
That’s important to note, as two-thirds of all Americans who declare bankruptcy have cited medical reasons. Those can include cost of care as well as how their medical conditions left them unable to work.
In 2018, a third of the $3.6 trillion spent on healthcare went to hospitals, while 20 percent went to physicians and clinics, according to the Kaiser Family Foundation.
And while hospitals are often thought as places to heal, they’re also common sites where people get sicker or even die.
Johns Hopkins Medicine reported in 2016 that more than 250,000 people in the United States die each year from medical errors, making those mistakes the third-leading cause of death behind heart disease and cancer.
Those numbers are just some of the reasons why centralized, “everything under one roof” hospitals may become a thing of the past, as the U.S. healthcare system continues to transform itself to meet patient needs.
For some reason, as hospitals evolved to treat the whole body, the teeth and gums remained a specialty.
That’s why their care takes place in smaller, self-contained dentist offices that handle everything in-house, from X-rays to surgery.
It’s only one example of care long removed from hospitals that few would associate them. That’s because they’re outpatient procedures, meaning they don’t need beds to house people overnight.
Experts say populated areas still need hospitals, specifically for large-scale emergencies, that are primarily focused on immediate medical issues and traumas, such as a natural disaster or disease outbreak.
That would include an emergency room, some operating rooms, and an intensive care unit.
That’s because there are many common procedures that don’t require overnight stays but are still often associated with hospital visits.
These include imaging, dialysis, physical rehabilitation, inoculations, and simple IV transfusions.
The modern idea of centralized care in the United States didn’t begin until the 1800s, when hospice — caring for the dying — transitioned into improving care and helping people live longer.
Since then, hospital buildings have gotten bigger, and the costs have gotten higher.
To some experts, it’s an inevitable domino effect.
David Duncan, PhD, a faculty member for Walden University’s PhD in Health Services program, has worked in senior leadership positions in the healthcare industry for 40 years.
“The hospital industry isn’t even 200 years old and it’s dramatically changing,” he told Healthline. “It’s engaging in creative self-destruction, and they’re trying to pull themselves apart before anyone else does.”
Part of that self-destruction, Duncan says, are advances in medical hardware and software, along with artificial intelligence helping advance diagnostics.
They make simple procedures and screenings outside of hospitals easier and more affordable.
“Just about every service can be taken out of the hospital,” Duncan said.
That includes the emergence of critical care clinics in larger cities and the inclusion of health clinics inside Walmarts.
In addition, Amazon wants to keep its employee care in-house and routine things such as flu shots being available at Walgreens, CVS, and another pharmacies.
That’s part of the decentralization. Meanwhile, major health systems have been trying to keep a monopoly on care.
Louis Levitt, MD, MEd, vice president and orthopaedic surgeon for the Centers for Advanced Orthopaedics in Maryland and an assistant clinical professor in the department of orthopedics at George Washington University in Washington, D.C., says healthcare has already “radically changed in the last 5 years, even if patients didn’t notice.”
That includes large hospital systems merging and acquiring smaller systems.
“There’s a race to see who can roll up primary care physicians,” Levitt told Healthline.
But he says outpatient surgery centers, “concierge clinics,” and telemedicine can provide a better, faster patient experience at a lower cost to deliver evidence-based and data-driven medicine.
“It’s going to be quick in and quick out at the lowest price,” he said.
For care that isn’t meant to be quick, there’s meeting people where they are, just like the iconic image of the rural doctor showing up to someone’s bedside with a leather bag and stethoscope.
But there’s going to be a lot of technology in that bag.
Lenny Verkhoglaz, MBA, CFE, is the founder of Executive Care, a full-service home healthcare company serving seniors, disabled, and recovering individuals with the goal of keeping them safe and independent in their own home.
“We want to prevent people from going back to the hospital,” Verkhoglaz told Healthline. “The longer someone is in the hospital, the more likely they are to contract a disease they didn’t come in for.”
That’s because repeatedly visiting the hospital is not only expensive for the individual person and taxing on the healthcare system, but it often leads to
So, companies such as Executive Care look for red flags in people over the age of 65 who are readmitted to the hospital after they were last released.
Instead, they send skilled nurses into those people’s homes and use gadgets like pulse and blood pressure monitors linked to the internet.
“Cost is very important, but people don’t want to go to the hospital,” Verkhoglaz said. “They want to stay at home.”
Doctors can’t say how much most procedures will cost a patient, as it’s behind the scenes negotiating between the hospital and the insurance companies, but they also want to honor their oath to their patients.
Which is why some medical professionals in larger healthcare systems are actively finding ways to reclaim their lost autonomy and offer lower priced care because they operate with much less overhead.
That, many experts agree, is taking patient care outside of large hospitals and meeting people where they are to keep costs down.
“It makes sense that hospitals should decentralize,” Paull said. “You don’t need to go to the hospital for many things.”