It was my pleasure again to catch up with a wonderful friend who I have worked with on several medical mission trips, Dr. Michael Elmore, a gastroenterologist from Indianapolis, IN.
As we chatted he asked, "Hey, did you know I had a knee replacement about eight weeks ago?" His follow up comment was surprising to me, with some insightful perspective from a career physician: "I intentionally wanted to go to a physician owned orthopedic hospital because I knew I would get better care."
It is intriguing that a physician would intentionally seek out a physician owned, more specifically a specialty hospital, outside of his practice; and so, I asked him as to the specifics behind his choice. He explained:
Standard hospitals have administrators that are often at odds with physicians [being that physicians are contractors to the facility as opposed to employees] and the nursing staff are then beholding to administration, not necessarily to their patients. In a physician owned hospital, the doctors are more vested as the administrators and/or investors, with the nursing staff wanting to please them with top level care delivery. My care was outstanding throughout the process with absolutely no complaints.
Specific differentiators of a specialty hospital to a standard-full service hospital.
1. There was better continuity of my care from the outpatient evaluation setting, into surgery, and then postoperative care. For example, the orthopedists contract with their own internists who do the pre- op evaluations as an outpatient. Since the internists work for them and know exactly what the ortho guys want, it gets done flawlessly as they followed me in the hospital; as opposed to some internal medicine group [or hospitalist in a standard hospital] who had never seen me, and where I would see a different doctor every day. A big difference!
2. Since the nurses and physical therapists (PTs) also work for the orthopedic doctors, they are highly motivated to please the doctors by pleasing the patients. They know the doctors want great outcomes - not just good outcomes. Hence, all healthcare providers on all levels are aligned. In the usual hospital setting the care is fragmented. Sometimes the PTs get busy and don't get around to all the patients and treatments don't get done. Some hospitals [large health systems now] are huge and a patient needs to be transported to PT – which is usually a long way away. In the Ortho hospital, I could walk down to PT the same day as my surgery!
3. I never had to wait very long for anything. The nurses were right there when I needed them and I always got my meds on time.
In the Ortho hospital, I felt like they had it all together. In a standard hospital, all the pieces are there but they don't fit well together. As a result: things don't get done in a timely fashion; sometimes they don't get done at all; or worse, sometimes things get done wrong because the providers don't know you very well.
I realize that standard hospitals need to take care of a variety of patients with a diversity of problems. But like the old saying, 'You can't do everything.' Or at least, if you try to do everything, you can't do everything well. Hence, how could a standard hospital ever compete with a smaller specialty hospital? That being noted, when a patient has a significant complication at a specialty hospital - like a pulmonary embolus or sepsis - they need to be transferred to a standard hospital.
The 2017 AHA Hospital Statistics does not specifically break out the number of specialty and/or physician owned hospitals, but they are not available in all areas. And it is not realistic for all hospitals to become specialty sites; therefore, there are observations made by Dr. Elmore that can be addressed within standard health systems as the purchasing of physician groups/hospitalists by health systems continues, with many surgeons remaining independent contractors.
• Enhancing continuity, coordination of care with hospitalists and nurses knowing the care delivery standards of surgeons, and cross training specific service lines, so as volumes fluctuate, 'floating' of personnel does not impede care coordination.
• Locating and streamline transportation for services such as PT with associated service lines e.g. unit therapists specifically for ortho.
• Leveraging nurse practitioners familiar to specific services and doctors to maintain responsiveness of nurses and hospitalists with personnel turnover, floating, agency, etc. to avoid lack of familiarity or training.
• Maintaining the focus of being accountable to the patient for great care (and not settling for good care.)
• Removing ever growing silos in standard hospitals by focusing on horizontals versus verticals, with planning scheduling, budgeting, and operational delivery, analysis and reporting staying patient centric (front line level) inclusive of pre & post transitioning and ancillary services.
Rose Rohloff is a 30+ year healthcare veteran with a background of nursing, business and information systems with success creating industry leading business intelligence solutions for meaningful analysis. Her focus is the removal of information silos within health systems, the expansion of the care continuum to a health maintenance continuum, and a speaker for healthcare consumer awareness. Rose Rohloff can be contacted at hcaware@outlook.com or rosemrohloff@outlook.com.
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