AGING POPULATION, and Lack of MENTAL HEALTH SERVICES Spur Hospital Investments
It used to be that every time someone came into the hospital, the hospital got paid. So the more patients in the beds, the bigger the payday for hospital coffers.
"We're really sort of moving away from that now," says
The health care landscape across the country and in the state is changing rapidly. As the state's population is getting older, hospitals need to cater to the aging demographic by adding services they need, such as vascular and rheumetological care. Further, hospitals are seeing more patients, but fewer reimbursement dollars. In response, the care model has shifted from filling hospital beds to finding efficiencies, focusing on prevention and beefing up technology in order to keep more people as outpatients. Add to all of this a dearth of mental health and addiction services that puts hospitals on the front lines of a growing behavioral health crisis.
In response, many of the 26 hospitals across the state are making investments-either in dollars or through strategic partnerships and affiliations-in both long-term planning and short-term fixes to keep everyone afloat in the changing tides of health care.
Between the aging population and studies showing that cancer diagnoses could jump by as much as 45 percent within the next 12 years, many hospitals are directing investments toward strengthening cancer care programs.
There isn't a hospital in the state that has not been affected to some degree by the lack of mental health services and the surge of opioid addicted patients. That comes down to a systems problem, Ahnen says.
"There are not enough inpatient services to deal with people when they get into crisis and there aren't enough outpatient services to keep them from escalating to the point where they need those inpatient services," Ahnen says. "And with drug misuse, it's the same kind of thing."
Those services used to exist, Ahnen adds, but they weren't self-sustaining. That means patients experiencing a mental health crisis wind up in an emergency room. "It's quite common for behavioral health patients to be kept in emergency rooms for days and weeks at a time," says
To address this, Hughes says the hospital opened in April a | dedicated area for behavioral health patients. "It's a five bed area [in the emergency department] that allows us to focus on providing much better care, in a much better environment than they had before," he says.
Ingold says one of the two biggest investments
The Elliot is not alone. During its emergency room redesign that took place between 2013 and 2015,
In addition to changes to emergency departments, hospitals are adding more outpatient behavioral health services. Curti says
Starting two year ago,
Similarly, administrators at the Elliot addressed the lack of outpatient mental health services by creating an integrated care program at three of its sites in 2015. Like
Outpatient Services
This trend toward outpatient services isn't relegated to behavioral health. Outpatient services are expected to accelerate over the next several years, says Ahnen of the
Whether it's improved technology and drugs or the explosion of high deductibles and dwindling reimbursements, hospitals are focusing on managing chronic disease and prevention as a way of ultimately keeping people healthy and out of a hospital bed. To that end, hospital officials are investing in urgent care services and satellite primary care practices that can handle the management of common diseases like diabetes, heart disease and obesity.
Ingold says The Elliot is in the process of opening a new medical office complex in
Geriatric Care
Granite State hospitals are also responding to an aging population that has specific care needs.
That's going to mean hospitals will have to respond with more specialized services, says
For CMC, that has meant enhancing its heart and vascular program with new procedures and technologies such as implants that help with atrial fibrillation and heart failure monitoring, respectively.
Hughes says
Frisbie has doubled the number of acute care geriatric psychiatric beds from 10 to 20 and added geriatric psych specialists, nurse practitioners and physicians. Frisbie also developed an outpatient psychiatric care program.
Partnerships and Affiliations
With health care costs on the rise and fewer reimbursement dollars to go around, Ahnen of the
One such affiliation has enabled four North Country Hospitals to not only stay open but offer OBGYN, urology, general surgery and orthopedics throughout the region, which could not have been possible previously.
"Small critical access hospitals across the country are closing every month," says
The affiliation, among the first in the nation of its kind for critical access hospitals, created a health system with 1,400 employees, making it the largest employer in the North Country and among the largest health systems in the state. "Our job is to really take the cost out of the system so we can be market competitive," West says. "By joining forces, we can take advantage of economies of scale, take advantage of shared services and group purchasing as a larger unit rather than four individual hospitals."
West says in its first six months of operation, this has translated to
Similarly, Walker says CMC officials have spent the past four years expanding CMC's footprint around the state simply by solidifying strategic partnerships. Most recently, CMC joined forces with
Walker says these affiliations have allowed CMC to bring its cardiovascular services-once relegated just to the greater
"What it does for local hospitals is it gives them access to really high quality specialists, close to home in local community hospitals in an outpatient setting," Walker says. "We're not looking to have every single case or procedure be done at CMC, we recognize the value of delivering health care locally. We're not looking to command and control."
Ultimately, Ahnen says, these collaborations allow smaller hospitals and individual practices to leverage resources of partner institutions, invest in infrastructure and technology updates and deliver needed services to their communities.
"When I think about the blue and white 'H' signs we see in communities, yes, it's a sign that says there is a hospital nearby. But it's really a promise that that hospital holds out to the community," says Ahnen. "They are promising that [the hospital] is going to be there whatever their need is, no matter what you are, where you've been, what's [in] your wallet. At the end of the day, we have to be ready to serve that community."
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