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Micro-Hospitals Provide Health Care Closer to Home

Micro-hospitals are smaller and have fewer numbers of beds than major hospitals. (GETTY IMAGES)

Original article on U.S. News & World Report

Small-scale inpatient facilities, known in the industry as micro-hospitals, are popping up across the country to offer medical care in underserved communities and provide provide a local alternative to the potentially long waits for emergency care at major hospitals.

The size of small ambulatory-surgery centers, micro-hospitals have an average of eight to 10 short-stay beds each and provide some of the simpler acute and emergency services commonly performed in much bigger hospitals.

Already in 19 states, according to company research, these hospitals continue to grow and are becoming a trend in health care. One of the most noteworthy aspects of this trend is that it's unfolding In the midst of the biggest upheaval in health care in decades, with health reform proposals swirling in Washington and hospitals and other facilities merging into ever-expanding systems. Nevertheless, health officials say, micro-hospitals fill a critical gap.

"We can offer quick service for any type of problem that walks through the door, you will receive the same care you would in a large facility," says Dr. James Nichols, medical director at Baylor Emergency Medical Center at Aubrey, Texas.

However, critics are wary about the facilities and safety they provide to the patients and how much experience doctors get while practicing in such a small facility.

Countless medical studies show that the results achieved in any medical setting vary – and patients treated by doctors who perform more procedures fare better than those treated by doctors who do too few to sustain their proficiency.

Health care authorities warn prospective patients to probe deeply into the micro-hospital's track record and capabilities by asking explicit questions about how many procedures its doctors perform and what results they get.

"In some cases, they may be perfectly capable of doing the procedure as long as they do enough of them and have the experience have a plan for follow-up care. They should have a plan," says Leah Binder, president and CEO of The LeapFrog Group, one of the nation's leading patient-safety organizations.

By providing 24/7 care that includes inpatient and surgical options, these micro-hospitals serve as a middle ground between freestanding emergency departments that may not offer all the required services and major hospitals that offer more than the community needs.

Built by existing major hospitals or groups of doctors by partnering with external organizations, they are placed in areas that have service gaps: areas that have specific medical needs but lack the necessary facilities and resources to support a full-service facility.

Emerus, a Texas-based company, operates more than 20 micro-hospitals across the country. "Emerus picks locations that have a need for additional emergency room beds," says Richard Bonnin, Emerus' communications director. "Increasing access to high-quality emergency care and focusing on the patient-physician relationship has provided a strong foundation for our growth."

These acute-care hospitals conform to the same federal and state licensing and regulations as a major hospital system.

Facilities and services: No two micro-hospitals provide the same services are built on the same designs, although most of them are typically low-trauma facilities (level 4 or 5) with advanced surgical capabilities that differ from one micro-hospital to the next, according to Robert Garcia, vice president of health care advisory services at Transwestern, a commercial real estate firm. Their facilities depend on the needs of the surrounding area, he says: In an affluent growing community with a younger population, for example, you may build a hospital that meets the needs of the local population, offering more orthopedic procedures than, say, heart disease care.

"That's the beauty of it: You can tailor the hospital to the needs of the community, so if it's an older community it may be more catheterization lab, and if it's a younger community it may have more orthopedic procedures," Garcia says.

According to the Advisory Board, a research, technology and consulting agency on health care, these buildings are usually around 15,000 to 50,000 square feet and typically are licensed for a minimum of eight inpatient beds for observation and short stays. (The average major hospital is typically 74,600 square feet.) These facilities provide board-certified, emergency room-trained physicians and outpatient ambulatory clinical services on site, as well as in patient beds, allowing patients to stay closer to their homes in less-severe circumstances.

"Patient volume ranges widely, depending on the market," Bonnin says. "Typically, we see 25 to 80 patients a day in our emergency departments. Of those who receive inpatient care, the average length of stay is two days."

Micro-hospitals can offer a range of services that may include onsite imaging services such as X-ray, CT scanning and ultrasound; and certified and accredited laboratories that provide immediate results. Procedures may also include spinal surgery, orthopedic surgery, endoscopic procedures, plastic surgery, ENT surgery, GYN surgery, cardiac catheterization and podiatric surgery.

"Short of the major trauma, we've delivered babies, had walk-in gunshot wounds, we do transfers of organs or stabilize just like any large facility," Nichols says.

Cost: Compared to full-service hospitals, micro-hospitals are cheaper and faster to build and take up less space, Garcia says. Although the cost varies, depending on the additional services offered, the Advisory Board estimates building a micro-hospital can cost anywhere from $7 million to $30 million.

The most costly part of the health care system is the care of a patient after surgery on which hospitals spend millions of dollars on equipment, raising insurance and room costs, according to an article by ProPublica.

"With minimally invasive procedures cutting down healing time, overnight stays in hospitals have become less frequent," Garcia says. "To reduce costs and improve delivery, micro-hospitals are becoming more and more popular."

Advantages: Apart from being located in underserved areas and being tailored to suit the local demographics, these hospitals have a range of advantages over other major full service hospitals, according to Jason Lisovicz, senior vice president of marketing and communication at Emerus.

They offer convenience and speedy access to care that might not be as readily available in a bigger facility. Bigger hospitals can't offer the same patient-centered care as a micro-hospital, because the larger facilities are responsible for so many patients with so many different problems, Garcia says.

"If you're in a big hospital you run the risk of a gunshot wound coming into your ER and you're schedule procedure may be delayed because anesthetist gets taken away in an emergency situation, whereas if you're in a micro-hospital those situations are less likely to occur. People will typically go to the big downtown facility as opposed to a micro-hospital," Garcia adds.

Nichols decided to shift from a full-service hospital in east Texas hospital to micro-hospital after 40 years of high-intensity practice had pushed him beyond the brink of burnout. He says he wanted to slow down and transition into a place where he could still practice clinically.

"Basically in a busy hospital setting [hospital administration is] just trying to get your head above water. I could no longer answer to the administration who wanted improved patient satisfaction, wanted quicker times," Nichols says. "We get things done quickly in the micro-hospital, we make the decisions medically and there are no administrative folks that are trying to me how to practice medicine. Everyone knows their position well."

Disadvantages: Micro-hospitals are equipped to deal with a range of health care problems. However, due to their small scale, they cannot handle all medical situations. Some patients might need to be transferred to larger facilities that are better equipped to handle their situation for continued care and treatment.

"Not every hospital is a Level 1 Trauma Center or Cardiac Center of Excellence. It's up to the smaller hospitals to diagnose, stabilize and transfer patients as appropriate," Emerus' Bonnin says. They will send patients to the best trauma center, the best heart hospital, the best stroke center without a lengthy emergency room wait, depending on what the most immediate needs may be.

"We can offer them [patients] quicker and more personalized care, of the same or higher quality they will get in any other facility," Nichols says.

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