Megamergers, Microhospitals Upend Care Models

Marcia Frellick

April 13, 2018

ORLANDO — Recent healthcare megamergers and new hospital models are changing the traditional way hospitalists practice, Laurence Wellikson, MD, said here at the Society of Hospital Medicine 2018 Annual Meeting.

As hospitals merge and populations change, the traditional model of the full-service acute care hospital is being phased out, said Wellikson, an internist in Dana Point, California, and chief executive officer of the Society of Hospital Medicine. Some hospitals are morphing into specialty hospitals, such as psychiatric hospitals or postacute care facilities.

And things are changing quickly. In the past year alone, a $69 billion merger of CVS and Aetna has been proposed; an agreement to merge Dignity Health and Catholic Health Initiatives, which would build an organization with operations in 28 states, has been signed; and Walmart is in talks to buy Humana, which could lead to combined total revenues of $554 billion.

"Humana is the second-largest Medicare Advantage insurer," Wellikson reported. When you think about all the places Walmart is in this country, it is poised to become "a major player in delivering healthcare to the senior population."

And in January, Amazon, JPMorgan Chase, and Berkshire Hathaway announced plans to form an independent healthcare company to improve care and cut costs for the hundreds of thousands of people employed by those companies in the United States.

"Amazon is currently — or will be — the largest supplier of hospital supplies in the country, and I predict that within the next 5 years, it will be the largest pharmacy benefit manager in the country," he said.

Microhospitals Popping Up

Microhospitals, seen in an increasing number of states, are also changing healthcare options. These small, typically low-trauma facilities often cater to the needs of a particular community.

For example, Emerus holdings, based in Woodland, Texas, is in microhospital partnerships with entities such as Baylor Healthcare, Dignity Health, and Baptist Health, said Wellikson.

"They have this short-stay recovery, where about 92% of patients stay 90 minutes or less and only 8% are kept overnight," he reported.

And Michigan Medicine, owned by the University of Michigan in Ann Arbor, is completing a microhospital in Brighton, a suburb of Detroit, to extend its reach.

"The new facility is expected to have multiple exam and operating rooms, a pharmacy, and specialty services in both pediatric and adult healthcare, musculoskeletal health, ophthalmology, radiology and diagnostic imaging, and pathology and comprehensive cancer services, including radiation oncology," according to a statement released by the university.

"Big Trouble" for Some Specialties

Changes in the healthcare landscape mean "big trouble" for some specialties and challenges and opportunities for hospitalists, said Wellikson.

Anesthesiologists are "running for their lives," he said. "If hospitalists are doing the preop care and the postop care and if nurse anesthetists or machines are pumping the gas, what's exactly left for anesthesia?"

And the outsourcing of radiology and, in dermatology, the use of artificial intelligence to read scans are threats to those specialties, he added.

"It is not science fiction to think that dermatology will be stepping into a machine that will scan your body and tag the areas that will need to be biopsied, stepping into another machine that will perform the biopsy, and then having the pathology read by a facial recognition program," he explained.

Two areas are particularly suited for an expanded reach, Wellikson pointed out.

Postacute care presents the largest opportunity for hospitals to improve the overall cost per episode. "There isn't any other specialty as equipped to go in, take what we've learned over the past 20 years in the acute care hospital, and make those changes in the postacute care world," he said.

Palliative care is another area suited to the core competencies of hospitalists. "The board-certified palliative care membership is less than 5000, and there are 5000 hospitals in the United States," he said. "This is an opportunity for hospitalists to up their game."

Akbar Nassiry, MD, a community hospitalist at Citrus Valley Medical Center in West Covina, California, told Medscape Medical News that he agrees with many of Wellikson's points.

There is a huge demand for hospitalists at his own hospital. "Per physician, we see around 25 to 30 patients a day," said Nassiry, who is board-certified in palliative care.

Wellikson is "dead on" when he describes the critical need for more hospitalists in that area, he pointed out. However, he is not convinced that artificial intelligence will soon diminish the need for dermatologists and radiologists.

"I don't care how good the AI is, it's not going to be able to take care of that patient," Nassiry said. "The humanistic aspect can't be lost."

Wellikson and Nassiry have disclosed no relevant financial relationships.

Society of Hospital Medicine (HM) 2018 Annual Meeting. Presented April 10, 2018.

Follow Medscape on Twitter @Medscape and Marcia Frellick @mfrellick

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