The Future of Hospitals: Visions of the Healthcare Landscape in 2035

Healthcare industry experts share their predictions about hospital care in 2035.

Picture what would happen if physicians from 20 or 30 years ago travelled through time to the present day and wandered into a modern hospital. They probably wouldn't recognize a lot of what was happening around them, especially when it comes to technology, says Mitch Morris, MD, vice chairman and national leader of the healthcare provider sector for Deloitte.

HospitalDr. Morris — an oncologist with experience in healthcare administration — says major changes have taken place during the last few decades, such as the use of robotics and precision equipment in the operating room, the development noninvasive cardiovascular procedures and the ability to perform MRI and CT scans in a much shorter amount of time while obtaining a higher level of detail. Physicians of the past would be amazed, he says.

The same would likely be true if today's providers took a trip forward in time to 2035.

"In another 20 years, given how fast technology is moving, a physician today would be awed," he says.

Still, in the midst of all the transformation taking place in the healthcare arena today, he says it's difficult to predict what exactly that awe-inspiring hospital environment will look like.

Responding to pressure to contain skyrocketing costs, healthcare providers and policymakers have begun to dramatically change how care is delivered and paid for in the U.S. Under the Patient Protection and Affordable Care Act and other policy changes, provider reimbursements are shifting to reflect the value of care rather than volume. Hospitals and health systems are looking for ways to lower readmission rates and administer higher-quality care more efficiently, among other reform efforts.

"It's definitely a pivotal time in healthcare right now," says Stacey Empson, JD, MHA, FHIMSS, managing director of health services for CTG Health Solutions. "I think we have an opportunity as healthcare providers, facilitators and consumers of healthcare to improve the model."

Although it's not easy to discern how all of today's reform efforts will play out, Dr. Morris, Ms. Empson and others involved with the healthcare industry still have some predictions concerning what hospital care will look like two decades from now.

Moving out: Inpatient care's continued decline
During the past several years, hospitals have witnessed a decline in inpatient volumes along with a corresponding rise it outpatient utilization. In 2011, there was an average of 111.8 hospital admissions per 1,000 people, compared with 123.2 on average in 1991, according to an Avalere Health analysis of American Hospital Association data. This ongoing shift to the outpatient setting has been driven largely by advances in minimally invasive surgical techniques and advanced anesthesia techniques that allow patients to recover more quickly.

Healthcare analytics firm Sg2 has forecast that this trend will continue. According to Sg2, outpatient volumes will grow 17 percent in the next five years, while inpatient discharges are expected to go down by 3 percent.

In line with this pattern, Dr. Morris predicts that only the sickest patients will receive inpatient care in 2035, as elective procedures and services people can pay for in advance move to the outpatient environment.

"Hospitals will be places for people who are very, very sick and need intensive attention that can't be given in another environment," he says. "Hospitals will basically become intensive care units because medical technology will have advanced to the point where so many things can be done on the outside."

Bill Woodson — senior vice president and national thought leader for Sg2 — says he also expects a continued shift toward outpatient and ambulatory services.

"Our forecast at Sg2 emphasizes a decline in the utilization of inpatient care," he says. "In many markets, the decline in demand for inpatient services will be far more dramatic. We expect that to be redefining for the industry. That means fewer hospitals and fewer beds. "

Looking decades into the future, the real question is which service lines will remain in the inpatient setting, says Matthew Sappern, CEO of obstetrics technology provider PeriGen.

"Hospitals will always have ERs for severe trauma," he says.  "I think they'll always support highly complex and risk-oriented service lines such as intensive and cardiac care,perinatal and NICU . But time spent in those units is going to become very transitory, much more so than it is today."

Population health: Taking center stage
Providers will focus primarily on population health management as new payment systems give them an incentive to contain costs by keeping people out of the hospital setting, according to Michael Rothberg, MD, vice chair for research at the Cleveland Clinic Medicine Institute. That will include caring for people with one or more chronic conditions.

"There's a recognition that we need to take care of people not just when they're acutely ill but before they become ill," he says.

Hospitals will likely accomplish that through tactics such as giving people access to health coaches and pharmacists who can help them manage their medications. These developments will also require additional payment system reforms so providers can afford to enact them on a large scale, he says.

"What there's going to be is some kind of enhanced payments for primary care," he says. "With those additional payments, providers will be able to hire additional staff to do things that we don't do right now."

Personalized medicine: The future is here
Individualized or personalized medicine — which involves using genomic information in treatment decisions — is already a part of the current healthcare landscape in many ways, says Gianrico Farrugia, MD, director of the Mayo Clinic Center for Individualized Medicine.

For instance, Vanderbilt Health System in Nashville, Tenn., has integrated genomic markers and drug efficacy into physicians' daily work flow through its Pharmacogenomic Resources for Enhanced Decisions in Care and Treatment initiative.  Mayo Clinic has a similar program. Furthermore, the Food and Drug Administration recently allowed marketing efforts to start for four diagnostic devices that can be used for throughput, or "next generation," gene sequencing.

Treating cancer is another emerging use of personalized medicine. Right now, it's accepted as a late effort if a patient with advanced cancer runs out of traditional options. However, Dr. Farrugia says  groups including Mayo Clinic are moving toward introducing it as a treatment option earlier on in the disease's progression if it's clear the patient will have a less than optimal outcome with more traditional treatments.

Another developing area of individualized care involves using genomics to diagnosis patients with diseases that escape easy identification, he says. For example, it can be used to identify conditions in pediatric populations whose symptoms don't fit a known syndrome.

Based on the rapid pace of adoption, Dr. Farrugia predicts individualized medicine will become a widespread routine part of hospital care by 2020. Technological advances and the decreasing price of technology will partly drive that transition, he says.  

Another main driver will be competition between healthcare providers, he says.

"At the moment, individualized medicine is seen as a differentiating factor," he says. "You can turn on NPR, and you can hear different hospitals touting their ability. If you're in that area and that person advertising is your neighbor, you're going to move forward a little faster."

On the move: The virtual, mobile hospital
Moving forward, medical technology will keep advancing in the direction of tools becoming smaller and more mobile, allowing for their use in the home setting, says Dr. Morris.

He says we're not that far away from having medical equipment like the tricorder, a hand-held device from the TV series "Star Trek" that can read a person's vital signs in a matter of seconds as a physician waves it over their body.

"We are not that distant from those types of approaches, where we can monitor the functions of our bodies and then plan treatments and monitor the impact of those treatments without being in an acute setting like a hospital," he says.

Siva Subramanian, PhD, founder and COO of CareInSync, a mobile care collaboration platform for coordinating evidence-based patient care across care teams, says he envisions the hospital of the future as "hyperconnected" in being completely mobile and virtual.

That doesn't necessarily mean the patient will receive care in a home setting from clinicians at a hospital, though. He says providers will often be the ones working remotely.

"As inpatient care becomes increasingly complex, providers will become even more specialized, meaning more disciplines involved in the care of the patient in conjunction with more challenging care coordination needs," Dr. Subramanian says. "In the hospital of the future, we're going to see this reversal of telehealth, where the patient is immersed in a virtual world and has a care team virtually connected surrounding that individual  at whatever location and time."

What we know as telehealth today will also likely expand in the future, according to Ms. Empson. She says providers will work to meet the need to reach broader communities with their best clinicians, and the solution will involve virtual communication.

"The best way, in many cases, to do that is through technology and through telemedicine," she says.

Conclusion
Whatever the hospital of 2035 ends up looking like, it will surely be drastically different from what we have today, Dr. Morris says. And the changes we can't foresee might have the biggest impact.

"When I was growing up in the '60s, I figured by now I'd have a flying car," says Dr. Morris. "I don't, but, on the other hand, some things I would have never expected are commonplace today. It's the disruptive technologies we can't predict that will probably make the biggest change to healthcare."

More Articles on the Future of Healthcare:
Success Requires Risk: 5 Ways Health System Leaders Should Undertake Risk and Uncertainty to Succeed
The Future of Medicine: 6 New Technologies Transforming the Field
Chuck Lauer: The Future of Healthcare Demands Proactive Leaders 

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