People are used to seeing an industry change its service now and then. It’s just not usually after they had their knee replaced.
For decades, it was the norm to stay overnight at a hospital following a surgery. But today, outpatient clinics have become the default sites for procedures ranging from mastectomies to bariatric surgeries, along with tonsillectomies, hysterectomies, pacemaker implants, hernia repairs, and joint replacements. The trend will only grow, with outpatient volumes expected to increase by 8 percent over the next five years, compared to a 1 percent decline for inpatient volumes, according to real estate and investment firm JLL.
For patients, this can be alarming news: How will they manage their own walkers, compression stockings, ice packs, wound drainage, and pain medications on the night of their surgery? Some are shocked to be sent home after complex procedures. But healthcare is just the latest industry trying to nudge its customers in a more modern direction—think banks trying to get people to use ATMs. The key, say experts, will be how the industry goes about the change, and how it’s communicated. “This shift has already happened for us,” says Robert S. Bray, Jr., a neurological spine surgeon and founding director of DISC Sports & Spine Center.
In this case, the message is simple: namely, that as these procedures improve, people do better at home than in a hospital. Indeed, ample research suggests that low-risk patients enjoy lower complication rates at outpatient clinics, as well as more positive experiences. Meanwhile, decades of data indicate that for each night a patient spends in the hospital, the risk of infection and adverse events increases by roughly 1.6 percent and 6 percent, respectively.
With more procedures happening in outpatient clinics, hospitals say they are able to focus on high-risk and acutely ill patients. New hospitals are being built to provide higher-revenue, complex procedures, with little available clinic or operating space for simple surgeries. The shift is spurring a relative boom in medical real estate, which has a nationwide occupancy rate of between 92 percent and 93 percent, compared to 82 percent for office space, according to recent figures.
Still, getting accustomed to change can take time. Some patients do struggle in the hours or days after discharge. “They don’t have the same immediate critical care available should they experience complications,” says Dr. James J. Chao, chief medical officer of wellness brand VedaNu. He notes that a patient who develops post-operative complications 48 hours after surgery will likely land in an ER. For this reason, ambulatory centers seek out reasonably healthy patients, and put a premium on screening them. “The key question is whether outpatient centers will be efficient over the long haul,” says David Vied, global sector leader for medical devices and diagnostics at Korn Ferry.
