The Future of Care Starts with a Renewed Focus on the Patient

Gregg Miller, MD, June 2, 2021

For hospitals and health systems intent on thriving in the emerging consumer-based healthcare landscape, a broad-based and encompassing focus on acute care needs is a must.

It’s critically important that we step into our communities to meet patients where they are—wherever they are. This renewed and frankly refreshing focus on patient-centered care will continue to de-emphasize physical practice locations and even our own narrowly focused specialties with which we as clinicians have long identified as we deliver care to our communities.

Some healthcare modalities have thrived over the past year as a result of their adoption of virtual care—mental health appointments and urgent care consults, for instance. But for the most part, acute care remains entrenched in our traditional physical spaces. Even our specialty names are tied to a specific geography— “emergency department” physician and “hospitalist.” To meet the increasingly complex needs of our patients, we must expand our mindset to focus on how we’re delivering acute care to the patient—not necessarily where it’s being delivered.

An inflection point in care delivery

Hospitals are not going away. Since the very first hospitals were built, they have been a critical organizing principle for complex communities to serve the ever-changing health needs of our evolving communities. Today, hospitals still serve an irreplaceable function for acute care needs—and the 2020-2021 pandemic won’t alter that.

However, we have a convergence of consumer preference for convenience and the ability to actually meet patients where they are with virtual and hand-held technologies that were science fiction only 20 years ago. Clinicians and health systems must think outside traditional silos and even the hospital walls in our new convenience-centered world.

Since many primary care and outpatient clinicians have heavily invested in virtual care and feel quite comfortable with the technology, their patients have quickly grown accustomed to the virtual visit. But what happens if a patient actually needs acute care but settles for booking outpatient care because of its supposed convenience? Needless to say, patient outcomes would suffer.

Embracing a mind shift as providers

The first step in changing this dynamic begins with us as individuals identifying with what we do rather than where we do it. One example of this new paradigm in action is the hospital-at-home model. To expand inpatient capacity during the pandemic, health systems and the hospitalists within them are delivering an inpatient level of care to patients in their own homes and skilled nursing facilities. They are providing superior care continuity while challenging the traditional view that acute care happens only in hospitals.

Another example of care innovation is virtual follow-up for discharged patients. This alleviates the need for patients to physically return to a care setting for routine follow-ups for certain conditions and could lead to greater post-treatment adherence and reduced rates of bounce-backs and readmissions. The result is optimized and more integrated patient care that delivers on both quality and convenience.

Virtual care is just one tangible model that brings us into those communities with relative ease and agility—but only if we’re ready. As our healthcare delivery system realigns and reimagines itself after the acute phases of the pandemic, now is the time to invest in a new vision for the future. Patient-centered care starts in our hearts and minds, and we joined this noble profession to help those most in need—in the communities where those needs most arise.

To learn more about trends driving the transformation of care delivery, click here.

The Evolution of Hospital-Based Care: Learnings From the Pandemic

Gregg Miller, MD, March 1, 2021

The hospital’s role in healthcare is shifting as we begin to emerge from the pandemic.

Existing hospitals are designed to operate near capacity. And over time, we’ve built our finances, floor plans, staffing models, and workflows around a high patient census.

However, the role of hospitals is changing before our eyes. Although it’s hard to believe while we are in the middle of the COVID-19 pandemic, acute care will shift toward community-based virtual delivery, and only the sickest patients will require face-to-face inpatient care. As a result, hospitals will serve a smaller but “super-acute” population. This raises the question: How can health systems adapt to this new paradigm?

Rethinking staffing

As the patient population trends sicker, hospitals that rely on staffing benchmarks from a bygone era could quickly find their teams overwhelmed. These highly acute cases will require more intensive nursing care. Clinicians will require additional time at the bedside and afterward to document more complex encounters. This population will also demand more patient education and assistance with social support like food, shelter, and transportation.

Clinging to outdated staffing models could also stoke the fires of burnout. In the past, acute care clinicians could rely on having a few “easy” patients on every shift. Spending just half an hour on a simple case freed them to spend two hours on a more complex one. But as our inpatient census grows more acute, these opportunities will disappear. It’s therefore imperative that hospitals start planning for the future before it’s thrust upon them.

From competition to coordination

The burden of caring for a highly acute patient population could incentivize hospitals to work together. To some degree, COVID-19 has already kick-started this trend. To better weather the pandemic, hospitals created pathways to report test results, positivity rates, hospital capacity, and other key metrics. A standout example is the state of Arizona, which established a centralized network to allocate beds, which likely saved lives during their summer surge.

This spirit of solidarity was apparent even among competitors. In the Seattle area where I practice, leaders from Swedish Health Services, UW Medicine, and EvergreenHealth coordinated information and agreed to share ventilators, protective equipment, and other resources. I sincerely believe this goodwill helped us to successfully weather the nation’s first COVID-19 surge and could serve as a blueprint for future hospital partnerships.

The possibilities of such networks are endless. To concentrate resources and expertise, tomorrow’s hospitals might organize into high-volume “centers of excellence” specializing in certain acute conditions. What’s more, community hospitals could improve their finances by pooling staffing, back-office, and infrastructure costs.

Taking hospital care to the community

For as long as most of us have been working in acute care, we’ve defined ourselves by practice location. Even the names of our specialties (ED physician, hospitalist) reflect this narrow geographic focus. In other words, we limit our impact to a piece of earth a little bigger than a football field.

However, even before the pandemic, small-scale programs demonstrated that hospitals could safely manage many “inpatients” at home with telehealth providers and mobile care teams. And throughout 2020, ER teams have used virtual care to screen, treat, and follow up with patients in mobile medical trailers, cars, fever clinics, homes, prisons, and skilled nursing facilities.

This shift toward virtual care could solve some of acute care’s toughest challenges—from access and costs to ED crowding. To succeed in a post-pandemic world, we must therefore shoulder the responsibility of stepping out into our communities, meeting patients where they are, and bringing them the care they need. Successful acute care teams will follow our primary care colleagues embracing telehealth.

What will we achieve in 2021?

2021 could be a watershed year for acute care. While I don’t have a crystal ball, experience suggests we’re moving toward implementation for virtual front door and ED triage models. These could help greatly increase hospitals’ ability to absorb COVID-19 and flu surges one winter from now. At the same time, programs like hospital at home and telefollow-up could greatly expand inpatient capacity.

I also expect acute care to accelerate its shift outside physical locations like hospitals, emergency departments, and medical pavilions. The sooner health systems begin adapting to this new reality, the more resilient they will be in a rapidly shifting healthcare landscape. It’s important to realize that there will be no return to normality and that our post-COVID-19 world will be a different ballgame. And as any good coach knows, it’s never too early to start preparing the players (and the fans) for change.

Learn how Vituity physician leaders are leading the future for their hospitals and health systems.

Empowering Emergency Departments to Deliver Compassionate Behavioral Healthcare

Gregg Miller, MD, November 1, 2018

At a time when healthcare conversations focus on cost reductions and value-based payment models, discussions about solutions for our overburdened emergency departments (EDs) are often sidelined.

In this interview, Vituity’s Chief Medical Officer, Gregg Miller, MD, shares his perspectives on how EDs can reinvent themselves and deliver improved outcomes to all patients through an integrated and collaborative approach to acute behavioral healthcare.

What has changed, why are EDs in the U.S. busier than ever before?

A primary reason is the increased demand for emergency services. ED teams deliver nearly half of all U.S. hospital-based medical care, more than 140 million annual visits. Meanwhile, the number of hospitals, hospital beds, and EDs has declined significantly. This has stretched resources beyond capacity which impacts the quality of patient care.

Adding to this pressure is the growing number of patients presenting to the ED with behavioral health emergencies. In the last ten years, this number has more than doubled to roughly 12 percent of all ED visits, and in many communities the number is much higher. This increased need for specialized ED care, and the strained resources typically available, has deep repercussions for hospitals and health systems.

How are EDs handling the growing volume of behavioral health patients?

It’s a challenge. ED teams know the steps to follow when dealing with physical emergencies, but most are not sufficiently trained to effectively care for patients with behavioral health conditions. All too often, the process for treating behavioral health patients is not clinically integrated, and providers are unprepared and unsure of the right course of action. This results in poorer clinical outcomes and a diminished patient experience.

What is being done to help fix this gap in care?

We have seen tremendous improvements over the past fifteen years, but there are still more mountains to climb and more work to be done to create solutions that serve the needs of all our patients. At the end of the day, as care providers, we are only as good as the systems where we practice.

What’s needed now is an approach that fosters collaboration between care delivery teams in the ED, empowering them to properly evaluate and treat all patients, including those experiencing a psychiatric emergency, from the moment they enter the ED through discharge.

How is Vituity helping EDs solve these challenges?

We have been reinventing emergency medicine to better serve patients since our founding, nearly 50 years ago. Today, we are excited about our new solution that integrates emergency and acute psychiatric care. Our front-line physicians and behavioral health clinicians work with existing ED teams, preparing them to be ready for all emergencies – behavioral and physical.  

The core of this solution is deep expertise in emergency department and psychiatric care delivery, linked by a comprehensive training program that delivers depth and context for the treatment of acute behavioral health conditions. Our training program covers the latest protocols for de-escalation, agitation, and restraint management, plus psychiatric and opioid medication management.

In addition, our coaching and leadership development programs solidify integration and affect positive cultural and operational change. Our expert clinicians utilize the latest care delivery tools, including telepsychiatry and EmPath units. These innovations help to personalize the treatment and care experience of behavioral health patients, with quick and accurate diagnoses as well as a calming setting. We also ensure coordinated treatment planning through an in-hospital psychiatrist presence dedicated to the admitted patient population.

What are the results of an integrated care delivery approach?

The positive impact for hospitals and patients is phenomenal. We’ve seen providers gain new confidence in their ability to heal and find joy in their practice. And most importantly, we’ve seen patients recognize that on a very human level they’re being properly cared for with dignity and respect.

Vituity’s culture is all about innovation and collaboration, and we use that to transform care delivery in more than 250 practice locations. We believe that empowering EDs to reinvent themselves and provide a higher standard of acute behavioral healthcare delivers improved outcomes for all patients.

About Vituity

As a physician-led and -owned, multispecialty partnership, Vituity has driven positive change in the business and practice of healthcare for nearly 50 years. Our more than 3,000 doctors and clinicians provide integrated acute care expertise across the country and serve over 6.3 million patients annually. Vituity’s acute focus and compassionate care are the driving forces that have placed us at the heart of better care. Visit us at www.vituity.com.