A hospital without patients

Nov. 14, 2017

Located off a superhighway exit in suburban St. Louis, nestled among locust, elm, and sweetgum trees, the Mercy Virtual Care Center has a lot in common with other hospitals. It has nurses and doctors and a cafeteria, and the staff spend their days looking after the very sick―checking their vital signs, recording notes, responding to orders and alarms, doing examinations, and chatting with them.

There’s one thing Mercy Virtual doesn’t have: Beds.

Instead, doctors and nurses sit at carrels in front of monitors that include camera-eye views of the patients and their rooms, graphs of their blood chemicals, and images of their lungs and limbs, and lists of problems that computer programs tell them to look out for. The nurses wear scrubs, but the scrubs are very, very clean. The patients are elsewhere.

Mercy Virtual is arguably the world’s most advanced example of something gaining momentum in the healthcare world: A virtual hospital, where specialists remotely care for patients at a distance. It’s the product of converging trends in healthcare, including hospital consolidation, advances in remote-monitoring technology and changes in the way medicine is paid for. The result is a strange mix of hospital and office: Instead of bright fluorescent lighting, beeping alarms, and the smell of chlorine, Mercy Virtual Care has striped soft rugs, muted conversation, and a fountain that spills out one drop a minute. The mess and the noise are on screens, visible in the hospital rooms the staffers peer into by video—in intensive care units far away, where patients are struggling for their lives, or in the bedrooms of homebound patients, whose often-tenuous existence they track with wireless devices.

The virtual care center started as an office in Mercy’s flagship St. Louis hospital in 2006, but got its own building and separate existence two years ago. It is built on many of the new ideas gaining traction in U.S. healthcare, such as using virtual communication to keep chronically ill patients at home as much as possible, and avoiding expensive hospitalizations that expose patients to more stress, infections, and other dangers.

But perhaps the most important factor driving Mercy Virtual isn’t technology or new thinking but new payment systems. In the near future, the hospital’s administrators believe, instead of earning fees for each treatment administered, insurers and the government will pay Mercy Virtual to keep patients well. A visit to the hushed carrels and blinking monitors is a glimpse into a future in which hospital systems are paid more when their patients are healthy, not sick.

Even now, Mercy Virtual is in the black, because of existing Medicare payment reforms that have already converted some of the agency’s payments into lump sums for treating specific illnesses. Mercy can get its patients out of the hospital much faster than average, so it pockets the money it doesn’t need for longer stays, says Mercy Virtual President Randy Moore.

One weird thing about thinking this way is that it reimagines traditional notions of medical care—not just how it’s delivered, but when. Most hospitals wait for a sick person to walk through the doors or come into the ER. Mercy Virtual reaches out to patients before they’re even aware of symptoms. It uses technology to sense changes in hospitalized patients so subtle that bedside nurses often haven’t picked up on them. When the computer notes irregularities, nurses can turn a series of knobs that allow them to “camera in” on the patient; they can get close enough to check the label on an IV bag, or to observe a patient struggling for breath or whose skin is turning gray.

There are those who say that even an intensive care unit could, in principle, be brought to a patient’s home. But for now, the future looks like this: Hospitals will keep doing things like deliveries, appendectomies, and sewing up the victims of shootings and car wrecks. They’ll also have to care for people with diseases like diabetes, heart failure, and cancer when they take bad turns. But in the future, the mission of the hospital will be to keep patients from coming through their doors in the first place.

As the country moves to brake escalating healthcare costs, hospital systems that want to stay in business will have to follow this heavily software-dependent model, say Moore and others. “One night in the hospital in the U.S. costs $4,600 on average, just for the bed,” said Eric Topol, director of the Scripps Translational Science Institute and author of several books on the future of medicine. “You can get a lot of data plans and devices for that amount of money.”

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