"Doctors now are asking hospitals to employ them, and not own them like they did in the 1990s, but help them run their practices. That is where the hospitals are stepping up. They are pulling the doctors back into the fold and they are going to get the money for EMR and things will start to refocus on the hospitals."
Bachman concedes that healthcare reform is the "wildcard" in any debate. While the expansion of health insurance could mean more short-term business for hospital emergency departments, Bachman says most of the new demand will be for primary care services, most of which is more effectively provided outside the hospital.
"There are something like 500 million primary care visits in the U.S. annually. And you can assume that the vast majority of those are coming from the insured population, who can schedule a primary care visit instead of going to the ER," Bachman says. "If we expand coverage for primary care across all the population you could see another 85 million primary care visits. By definition, those are outpatient visits. The sorts of services that come along with that like follow-on or diagnostic or imaging work happen in the outpatient setting. I really think that healthcare reform, first and foremost, accelerates the trend to outpatient setting."
In my opinion, hospitals will remain a central part of healthcare delivery in this country, but not in the way that they have been. Hospitals are already expanding their primary care, walk-in clinics, and urgent care and specialty ambulatory services, either through affiliations or direct ownership.
Hospitals will have to accelerate the move toward retail-friendly care delivery. We no longer live in the 1950s. Most of the United States is on a 24/7 clock, and right now the only place providing that level of access is the emergency department. If you can access a pharmacy at 2 a.m., you should be able to access a physician outside of an ED. Healthcare delivery has to adapt to the demands of the population, even if that means working late and on weekends, as millions of Americans already do.
The healthcare sector will continue to grow jobs as the population grows, and grows older and sicker. One constant will be the need for hospital staff, although their duties, work hours, and even their location within the hospital setting will be subject to constant change as hospitals adapt to the nation's healthcare needs.