Advertisement

The Role of the Hospital in the Healthcare System

  • Renee Garrick
  • Janet (Jessie) Sullivan
  • Maureen Doran
  • June Keenan
Chapter

Abstract

Ancient hospitals were shelters for the needy. Hospitals continue to provide overnight care for patients too ill to stay home, but advances in science, technology, and training have made modern hospitals not only sites of care but also sites of cure. This chapter focuses on the role of hospitals, particularly Academic Medical Centers, in the US healthcare system.

Today patients are less likely to be admitted to the hospital, and those admitted stay a shorter time, while the intensity and cost of the services provided have risen dramatically. Academic Medical Centers play a particularly important role in providing highly technical services based on their tripartite mission to educate students and residents, conduct basic and translational research, and provide direct clinical care.

Fewer hospital admissions and competition from free-standing providers of ambulatory services have placed hospitals in an economic squeeze, exacerbated by increased accountability for outcomes during and after hospitalization, and economic pressures to implement technology, expand training, and maintain research while containing costs. In response to these pressures, many previously independent organizations have begun to consolidate into more integrated delivery systems including alliances of larger Academic Medical Centers with community and rural hospitals and primary and specialty care physician practices. To achieve the goals of providing efficient and effective care to populations, these alliances can adopt the models of patient-centered primary care within a network of clinically integrated specialty providers and affiliated hospitals. Hospitals can also play a key role as economic and civic institutions working with other stakeholders to maintain community vitality.

In the modern hospital, highly trained professionals provide very technical, intensive services which will remain an essential element of care for some patients ensuring that hospitals will continue to be a critical component of the future healthcare delivery system.

Keywords

Academic Medical Center US healthcare system Hospital consolidation Hospital utilization trends Horizontal and vertical integration Patient-centered medical home Medical neighborhood Anchor institution Value-based payment 

References

  1. 1.
    Askitopoulou H, Konsolaki E, Ramoutsaki I, Anastassaki E. Surgical cures by sleep induction as the Asclepieion of Epidaurus. The history of anesthesia: proceedings of the fifth international symposium, by José Carlos Diz, Avelino Franco, Douglas R. Bacon, J. Rupreht, Julián Alvarez. Elsevier Science B.V, International Congress Series 1242(2002), pp. 11–17.Google Scholar
  2. 2.
    Online etymology dictionary. www.etymonline.com. Accessed 4 May 2018.
  3. 3.
    Morton TG, Woodbury F. The History of Pennsylvania Hospital, 1751–1895. Philadelphia: Times Printing House; 1897. p. 32.Google Scholar
  4. 4.
    Trueman CN, Semmelweis I. The history learning site, 2015. [cited 2018 May 18]; Available from: https://www.historylearningsite.co.uk/a-history-of-medicine.
  5. 5.
    Robinson DH, Toledo AH. Historical development of monitored anesthesia. J Investig Surg. 2012;25(3):141–9.CrossRefGoogle Scholar
  6. 6.
    Richardson R. Joseph Lister’s domestic science. Lancet. 2013;382:e8–e9, 28.CrossRefGoogle Scholar
  7. 7.
    Beck AH. The flexner report and the standardization of American medical education. JAMA. 2004;291(17):2139–40.CrossRefGoogle Scholar
  8. 8.
    Guterman S. Specialty hospitals: a problem or a symptom. Health Aff. 2006;25(1):95–105.CrossRefGoogle Scholar
  9. 9.
    Grove A, Slavin PL, Willson MP. The economics of academic medical centers. N Engl J Med. 2014;370:2360–2.CrossRefGoogle Scholar
  10. 10.
    Dobson A, DaVanzo J, Haught R. The financial impact of the american health care act’s medicaid provisions on safety-net hospitals, The commonwealth fund. 2017. [cited 2018 May 23]; Available from: http://www.commonwealthfund.org/publications/fund-reports/2017/jun/financial-impact-ahca-on-safety-net-hospitals.
  11. 11.
    2018 Edition AHA Hospital Statistics, Publisher: Health Forum LLC, Chicago, Ill, 2018, pp 8, 9.Google Scholar
  12. 12.
    CMS Fast facts for US hospitals 2018 [cited 2018 May 15]; Available from: https://www.aha.org/statistics/2018-01-09-fast-facts-us-hospitals.
  13. 13.
    CMS Fast Facts Archives. 2013 [cited 2018 May 15]; Available from: https://www.cms.gov/fastfacts.
  14. 14.
    American Hospital Association. 2018 edition AHA Hospital statistics, publisher. Chicago: Health Forum LLC; 2018. pp 2,3.Google Scholar
  15. 15.
    US Census Data: Cited June 5, 2018: Population estimates program, population division, US Census Bureau: Historical National Population Estimates: July 1, 1900 to July 1, 1999; Release Date: April 11, 2000, Revised date: June 28, 2000 [cited 2018 June 5]; Available from: https://www2.census.gov/programs-surveys/popest/tables/1900-1980/national/totals/popclockest.txt.
  16. 16.
  17. 17.
    2017 (NST-EST2017-01) Source: US Census Bureau, population division; Release Date: 2017 December [cited, 2108 June 5]; Available from: https://www.census.gov/data/tables/2017/demo/popest/nation-total.html.
  18. 18.
    Weiss AJ (Truven Health Analytics), Elixhauser A (AHRQ). Overview of Hospital Stays in the United States, 2012. HCUP Statistical Brief #180. October 2014 Agency for Healthcare Research and Quality, Rockville, MD. [cited 2018 May 29]; Available from: http://www.hcup-us.ahrq.gov/reports/statbriefs/sb180-Hospitalizations-United-States-2012.pdf.
  19. 19.
    2018 Edition American Hospital Association: Hospital statistics. Health Forum LLC, Chicago. 2018, P 13.Google Scholar
  20. 20.
    Bureau of Labor Statistics CPI Inflation Calculator: [cited 2018 May 27]; Available from: https://www.bls.gov/data/inflation_calculator.htm.
  21. 21.
    Papanicolas I, Woskie LR, Jha AK. Health care spending in the United States and other high-income countries. JAMA. 2018;319(10):1024–39.CrossRefGoogle Scholar
  22. 22.
    Dieleman JL, Squires E, Bul AL, Campbel LM, Chapin A, Hamavid H, et al. Factors associated with increases in US health care spending, 1996–2013. JAMA. 2017;318(17):1668–78.CrossRefGoogle Scholar
  23. 23.
    Fay B, Hospital and surgery costs. Debt.org. [cited 2018 May 31]; Available from: https://www.debt.org/medica. Available from: l/hospital-surgery-costs.
  24. 24.
    Dzau VJ, Cho A, Ellaissi W, et al. Transforming academic health centers for an uncertain future. N Engl J Med. 2013;369:991–3.CrossRefGoogle Scholar
  25. 25.
    CMS Statistics National Health Expenditure Data, 2016 Highlights. [cited 2018 May 24]; Available from: https://www.cms.gov/research-statistics-data-and-systems/statistics-trends-and-reports/nationalhealthexpenddata/nationalhealthaccountshistorical.html.
  26. 26.
    Berwick DM, Nolan TW, Whittington J. The triple aim: care, health, and cost. Health Aff. 2008;27(3):759–69.CrossRefGoogle Scholar
  27. 27.
  28. 28.
    Japsen B. Medicare, commercial insurers agree on uniform health quality measures. 2016 [cited 2018 May 14]; Available from: https://www.forbes.com/sites/brucejapsen/2016/02/16/white-house-says-medicare-commercial-insurers-agree-on-health-quality-measures/#416a23711d9e.
  29. 29.
    Herrin J, St. Andre J, Kenward K, Joshi MS, Audet AJ, Hines SC. Community factors and hospital readmission rates. Health Serv Res. 2015;50:20–39.CrossRefGoogle Scholar
  30. 30.
    Muhlestein D. Assessment-of-the-hospital-value-based-purchasing-program. [cited 2018 April 29]; Available from: https://www.accountablecarelc.org/sites/default/files/VBP-whitepaper-11.13.2015-FINAL1.pdf.
  31. 31.
    Matlin Gilman M, Hockenberry JM, Adams C, Milstein AS, Wilson IB, Becker ER. The financial effect of value-based purchasing and the hospital readmissions reduction program on safety-net hospitals in 2014: a cohort study. Ann Intern Med. 2015;163(6):427–36.CrossRefGoogle Scholar
  32. 32.
    Guadagnolo G. Margin pressures for academic medical centers -Expert Perspective. 2018 March 30 [cited 2018 April 30]; Available from: https://www.eab.com/research-and-insights/business-affairs-forum/expert-insights/2018/segment-spotlight-academic-medical-centers.
  33. 33.
    85 rural hospital closures NC Rural Health Research Program [cited 2018 June 15]; Available from: http://www.shepscenter.unc.edu/programs-projects/rural-health/rural-hospital-closures/.
  34. 34.
    McKee M, Healy J. The role of the hospital in a changing environment. Bull World Health Organ. 2000;78(6):803–8.PubMedPubMedCentralGoogle Scholar
  35. 35.
    van Lerberghe W, Lafort Y, World Health Organi zation. Division of Strengthening of Health Services. In: Van Lerberghe W, Lafort Y, editors. The role of the hospital in the district: delivering or supporting primary health care? Geneva: World Health Organization; 1990. [cited 2018 May 27]; Available from: http://www.who.int/iris/handle/10665/59744.Google Scholar
  36. 36.
    Yanci J, Wolford M, Young P. What hospital executives should be considering in hospital mergers and acquisitions; [cited 2018 June 1]; Available from: https://www.dhgllp.com/industries/healthcare. Winter 2013.
  37. 37.
    Moore N. Difference between a vertically integrated company & a horizontally integrated production company [Updated, 2018 May 07; cited 2018 May 23]; Available from: http://smallbusiness.chron.com/difference-between-vertically-integrated-company-horizontally-integrated-production-company-32196.html.
  38. 38.
    Cheney C. Healthcare’s consolidation landscape. 2017; [cited 2018 June 1]; Available from: https://www.healthleadersmedia.com/strategy/healthcare’s-consolidation-landscape.
  39. 39.
    2017-in-Review-The-Year-M & A -Shook- the Healthcare Landscape.pdf [cited 2018 June 1]; Available from: https://www.kaufmanhall.com/sites/default/files/2017-in-Review_The-Year-that-Shook-Healthcare.pdf.
  40. 40.
    Darves B. Understanding the physician employment “Movement”. N EngJ Med Career Center. 2014 [cited 2018 June 1]; Available from: http://www.nejmcareercenter.org/article/understanding-the-physician-employment-movement.
  41. 41.
    Kacik A. Hospital-employed physicians drain Medicare. Modern Healthcare. 2017 [cited 2018 May 23]; Available from: http://www.modernhealthcare.com/article/20171114/NEWS/171119942.
  42. 42.
    Gamble M, Sachs B. |60 statistics and thoughts on healthcare, hospital and physician practice M&A. Becker Hospital Review. 2015 [cited 2018 May 23]; Available from: https://www.beckershospitalreview.com/hospital-transactions-and-valuation/60-statistics-and-thoughts-on-healthcare-hospital-and-physician-practice-m-a.html.
  43. 43.
    Livingston S, Bannow T. Hospital megamergers may lower overhead, but at what cost. Modern Healthcare. 2017 December 11[cited 2018 May 11]; Available from: http://www.modernhealthcare.com/article/20171211/NEWS/171219977.
  44. 44.
    Machledt D. Addressing the social determinants of health through medicaid managed care, 2017 [cited 2018 May 23]; Available from: Social Determinants of Health https://www.healthypeople.gov/2020/topics-objectives/topic/social-determinants-of-health.
  45. 45.
    Robert Wood Johnson foundation program what and why we rank. [cited 2018 June 1]; Available from: http://www.countyhealthrankings.org/. County health rankings and roadmap for Robert Wood Johnson foundation program what and why we rank.
  46. 46.
    Knettel A. The business case for academic health centers addressing environmental, social, and behavioral determinants of health. Washington, DC: Association of Academic Health Centers; 2011. [cited 2018 May 23]; Available from: www.aahcdc.org/portal.Google Scholar
  47. 47.
    Agency for Healthcare Research and Quality (AHRQ). PCMH: patient centered medical home resource center. AHRQ Website. [cited 2018 May30]; Available from: https://pcmh.ahrq.gov/page/defining-pcmh.
  48. 48.
    Taylor, E.F, Lake, T, Nysenbaum, J, Meyers, D. Coordinating care in the medical neighborhood: critical components and available Mechanisms White Paper (Prepared by Mathematica Policy Research under Contract No HHSA290200900019I TO2). Maryland: AHRQ Publication No 11–0064; 2011. [cited 2018 June 1]; Available from: https://pcmh.ahrq.gov/sites/default/files/attachments/Coordinating%20Care%20in%20the%20Medical%20Neighborhood.pdf.
  49. 49.
    Dubb S, McKinley S, Howard T. The anchor dashboard- aligning institutional practice to meet low-income community needs. The Democracy Collaborative at the University of Maryland. 2013 [cited 2018 June 1]; Available From: https://community-wealth.org/sites/clone.community-wealth.org/files/downloads/AnchorDashboardCompositeFinal.pdf.
  50. 50.
    Norris T, Howard T. Can hospitals heal America’s communities? The Democracy Collaborative; [cited 2018 June 1]; Available from: https://democracycollaborative.org/content/can-hospitals-heal-americas-communities-0.
  51. 51.
    Emanuel E. Opinion – are hospitals becoming obsolete? – The New York Times 2018 [cited 2018 May 3]; Available from: https://www.nytimes.com/.../opinion/hospitals-becoming-obsolete.html.

Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  • Renee Garrick
    • 1
  • Janet (Jessie) Sullivan
    • 2
  • Maureen Doran
    • 2
  • June Keenan
    • 2
  1. 1.Department of MedicineNew York Medical College, Westchester Medical CenterValhallaUSA
  2. 2.Center for Regional Healthcare InnovationWMCHealthHawthorneUSA

Personalised recommendations