A lot of people are too young to remember family doctors making house calls, traveling to wherever their patients were located.
But what goes around comes around.
Now builders of medical facilities are looking to build where their patients are located, like in the suburbs or rural areas.
This is particularly noteworthy at a time when hospitals are closing or consolidating.
Emergency physician Dr. Ryan Stanton of Kentucky sees the consequences of those closures, as many counties in his state not only lack hospitals but also have no resident physicians.
“It means people have to travel longer or postpone care,” he told Healthline.
A shortage of emergency rooms
The closure and consolidation of hospitals have shrunk the number of emergency departments nationwide.
So, doctors at Kaiser Permanente of the Mid-Atlantic States are pointing to the “hub” model of care as a 21st century solution.
Dr. Robert Pearl and Dr. Bernadette Loftus spelled out the details in an article in the New England Journal of Medicine Catalyst.
“Specialty care hubs cost less to build and to operate than a hospital and serve as part of a more traditional, large outpatient multi-specialty center during regular business hours. A hub model offers the potential for newly formed accountable care organizations to expand and fill in a crucial missing piece in the care continuum,” they wrote.
The hubs are intended primarily for patients with problems that are too complex for a doctor’s office but don’t require many days in the hospital.
Often these patients have no choice but to use an emergency department, especially on nights and weekends.
Some experts in the field see the “hub” model as a viable solution.
According to Nancy Foster, the American Hospital Association’s vice president of quality and patient safety policy, “As hospitals and healthcare systems across the country strive to make care more accessible, less costly, and more in line with how people today want to receive healthcare, we see our members trying a wide variety of service arrangements.”
“This type of hub model is exciting because it means care is closer and more convenient for patients and still provides access to expert clinicians and advanced diagnostic and treatment tools,” she told Healthline.
Kaiser Permanente’s solution
Kaiser Permanente introduced its multispecialty hub model in 2012 with five full-service medical buildings in Virginia, Maryland, and the District of Columbia.
Each facility serves about 100,000 patients.
Officials at the healthcare giant estimate that 91 percent of the patients who would have gone to the emergency department could be taken care of at a hub that had advanced medical, diagnostic, imaging, and surgical services across multiple specialties.
Kurt Mosley, vice president of strategic alliances for Merritt Hawkins, a physician search and consulting firm, is an authority on the evolving healthcare system. And one of the places he sees healthcare going is toward a hub model.
“These hubs are trying to offer full service. And they’re cheaper,” he told Healthline.
Mosley cited as an example a patient having an asthma attack. It could probably be treated in a hub clinic, he said.
If a specialist, such as a pulmonologist, is needed, one can be summoned through telemedicine channels. That’s opposed to a hospital emergency department, which would need to keep such expensive specialists on staff.
“There’s an ease of service,” Mosley said. “You don’t have to recheck your admission because you’re already in the system.”
“The new mantra is to be everywhere all the time,” he added. “Medicine is coming to the public instead of the reverse.”
Stanton echoed that thought, saying, “We need a system where we can move patients to where they need to be, including before or after hours.”
He said the concept was particularly appealing in places where there isn’t enough money for an entire hospital.
Kaiser’s hub model has rolled out some impressive statistics, according to the NEJM Catalyst article.
It stated that 31 percent of the 700,000 patients treated in the Kaiser hubs over the past six years would have gone to an emergency department if the hub model were not available.
Only 2 percent of these patients were admitted to a hospital. There has also been a 23 percent decrease in hospital stays and emergency room visits per thousand members from 2009 to 2014.
The hubs have proven popular with patients, as 86 percent of hub visitors in 2015 reported a “very good” or “excellent” care experience.
Still, the hubs are neither a panacea nor inexpensive to operate.
They require the same sophisticated monitoring equipment, diagnostic machines, and operating room design as a hospital, so there is a major capital investment.
And because board-certified physicians and critical care nurses staff hubs at all hours, there are the same hiring challenges as emergency departments and hospitals.
If a healthcare organization doesn’t own its own hospitals, it needs to link with partner hospitals and require agreements governing such issues as electronic health record compatibility and guaranteed specialty coverage.
Foster said hubs aren’t the only solution to modern healthcare problems.
“Other health systems have chosen to open neighborhood urgent care clinics, convenient diagnostic centers, or partner with drugstores or shopping centers to better meet patient needs,” she said.