6 Growing Service Lines to Monitor Over the Next 5 Years

Hospitals looking to adapt and maintain a positive bottom line in their service lines want to make sure they are focusing on the right needs of the community. The older Medicare crowd will always remain a force, especially in the dawn of the baby boomer stampede, and the main revenue-generating service lines will soon pick up even more momentum.

"If you think about the aging population, the baby boomers, we're starting to see the first part of baby boomers hitting the Medicare age," says Anthony Tedeschi, MD, CMO of Vanguard Health Chicago, part of Nashville, Tenn.-based Vanguard Health Systems. "But there are a lot of people, like me, catching up behind them."

Dr. Tedeschi explains there are several service lines that will become more important to hospitals within the next five years, most notably geriatrics, orthopedics, cardiology, oncology and the neurosciences. However, one newer "service line," for lack of a true category, is tying the baby boomer crowd and aforementioned service lines together: chronic care management.

Dr. Anthony Tedeschi is CMO of Vanguard Health Chicago.The geriatrics service line, by its nature, includes many high-risk patients. Geriatrics focuses on patients who are 75 or older, who generally need the most advanced care. The U.S. life expectancy rate in 78 years old, according to 2010 figures from the World Bank, and as more patients enter that criteria, hospitals will need to invest heavily into geriatric and palliative care.

"When we try to project the future, we do it based upon responding to what the healthcare markets needs will be," Dr. Tedeschi says. "We're experiencing an increasing number of elderly individuals, which really leads us to a focus on general geriatric care but also other care that helps support elderly needs."

The geriatric service line encompasses several clinicians and professionals, including physicians who are board certified in geriatric medicine as well as nurses, social workers, physician therapists and other hospital employees. It's very much a "continuum" service line, Dr. Tedeschi says.

Several orthopedic surgeons within the healthcare industry have seen how baby boomers are revolutionizing orthopedics: Because they want to remain active, they are willing to dig in, do research and find providers that offer the most advanced orthopedic care.

Vanguard Health Chicago is comprised of four hospitals in the Chicagoland area: MacNeal Hospital in Berwyn, Weiss Memorial Hospital in Chicago, Westlake Hospital in Melrose Park and West Suburban Medical Center in Oak Park. Dr. Tedeschi says each of those hospitals have placed a heavy emphasis on orthopedics and recruiting the right orthopedic surgeons to make sure they are prepared for the influx of orthopedic patients.

Joint replacements, such as total knee and hip replacements, as well as spine care are the major areas of specialization within the orthopedics departments.

Cardiology has always been a staple for a hospital's Medicare crowd, as older patients typically incur more heart-related events than younger patients. For hospitals looking to keep their cardiology revenues consistent, a focus on limiting readmissions and improving quality metrics will help limit Medicare reimbursement reductions.

"There are major efforts to build the ability to provide surgical, interventional and diagnostic [cardiac] care," Dr. Tedeschi says. "The major focus of care is ensuring patients that come in for cardiac catheterization or coronary bypass grafting are getting care that is absolutely best in class."

A report from the Centers for Disease Control and Prevention in March showed death rates from all cancers among men, women and children have fallen in the United States between 2004 and 2008. However, hospital oncology will not go extinct anytime soon, especially for the Medicare population, as healthcare continues to search for cancer cures. Consequently, hospitals must be able to manage their cancer care both in-house and through innovative collaborations and affiliations with other healthcare facilities.

"Cancer care, from my eyes, is: What would I want as a patient?" Dr. Tedeschi says. "When I come into a cancer care system, I'm assured I can get the appropriate cancer care at the appropriate place. If that means great chemotherapy in local community hospitals, that's where I want to have it. At the same time, you need to build a system so you have great relationships with academic medical centers for care that's more complex."

Hospitals, as of late, have been focusing on neuroscience centers of excellence, and Dr. Tedeschi says this is because of the growing demand. Neurosurgery has typically been one of the most profitable and intensive components of neuroscience departments, but neurology cases are growing as well.

A recent report from the McGovern Institute at the Massachusetts Institute of Technology found that brain disorders such as Alzheimer's disease, Parkinson's disease and others are some of the leading contributors to a "global disease burden" — and these cases are most prevalent among the elderly. This means hospitals are starting to place a bigger emphasis on providing better care around those types of brain disorder cases as well as stroke management and spine care.

Chronic care management
Chronic disease usually refers to many diseases that are treated in the aforementioned service lines, such as diabetes, congestive heart failure, cancer and other disease that stems from a lack of physical activity and poor nutrition/behavior. Dr. Tedeschi says the geriatric, orthopedic, cardiology, oncology and neuroscience service lines are all connected in today's hospital because of their interdependence on older patients. They also meld perfectly with one of the healthcare reform law's primary objectives: providing the right care for patients at the right time in the right place with lower costs and better quality.

"Our focus, as an organization, is about helping patients achieve health for life," Dr. Tedeschi says. "In doing so, one of the major issues that we're facing is how we help patients help manage chronic diseases. Chronic diseases connect our patients to a lot of the service lines we've been talking about."

"For me personally, when we talk about service lines, we're focused within an episode of care," Dr. Tedeschi adds. "Often it's inpatient. What's important, though, is to build service lines across the continuum both before and after an episode of care."

More Articles on Hospital Service Line Growth:

Structuring Hospital Service Line Management for Success

9 Recent Hospital Strategies for Growth

Ideas and Concepts to Improve Cardiovascular Program Profitability

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