Micro-hospitals, also known as neighborhood or community hospitals, have been around for over 15 years and have become a major part of the healthcare conversation in the last decade. In short, they are fully licensed, 24/7 hospitals with footprints that are a fraction of a traditional hospital and equipped to respond to almost any medical issue, including critical care.
As adoption of this model has increased throughout the U.S., it has been continuously tested, changed and improved upon to support system needs while maintaining profitability. As the model continues to evolve to meet needs and reimbursement requirements, it holds true that effective operations are tied to effective design. Collectively involved with over 30 micro-hospital developments, here is what we see as five current trends for the future.
Five Trends in Micro-Hospital Operations and Design
1. System Adoption + Integration
There will be increased system adoption and integration as micro-hospitals support a spoke and hub system network — triaging patients to determine what care and which location is the best based on patient needs, staffing, availability and relieving pressure on other facilities.
2. Anchors to Medical Office Buildings (MOB)
The traditional micro-hospital model was intended to operate very separate from other system facilities. There is an increasing trend of using micro-hospitals as a complement or anchor to an MOB as opposed to a free-standing facility, acting as a low-cost entry into the market. This association allows for additional retail healthcare uses, as well as access to shared services like lab, radiology or specialty care such as ortho and surgery, and increased convenience for patients.
3. Integrating Specialty Care + Flexibility
Our healthcare clients are increasingly asking for micro-hospitals with more complexity and flexibility. A source of concern in micro-hospital development is always the ability to meet CMS requirements, by strategically incorporating components of specialty care, it can help meet the needs of specific patient populations. The challenge now becomes creating a design that maintains the essential efficiencies of the model. We often caution our clients from over-engineering or programming, but there are exciting ways that specialty care is being strategically introduced. We had one client consider pairing cancer care with the traditional emergency department (ED) and inpatient model. With cancer care as a top revenue draw, combined with the distance from the main campus, this idea supports competitive market positioning with more geographically accessible services.
4. Cross-Training Staff
Micro-hospitals are intended to operate on a lean and efficient staffing model. Staff is trained to the maximum ability of their license, supporting more efficient and nimble staffing and more time spent at bedside - allowing staff to own care of the patient from arrival to discharge. The variety of work in these settings also helps with nurse burnout. Oftentimes, burnout is not the results of nurses doing too much work, but too many barriers to getting their job done. While it seems counterintuitive, in a micro-hospital setting one nurse handles services ranging from meals to breathing treatments, and with each of these activities at the patient bedside, patient satisfaction is improved, and in turn the nurse experience.
5. Incubators for New Ideas
Micro-hospitals can serve as little incubators, allowing healthcare providers to try different technology and workflows without affecting the entire system. One example being that most providers use telehealth doctors to support the micro-hospital staffing needs, but one of our clients is testing out using the same doctors within the micro-hospital setting as seen at the larger campus setting.
The Future of Micro-hospitals
• Telemedicine + Home Based Care Impact
The historic challenge with telemedicine is the inability to bill for facility use of the services, but with Medicare recently approving reimbursements for Hospital at Home care with a long-term goal of moving people out of the hospital setting and into their home, it may lead the way to being able to bill for telemedicine services. There could be benefits of incorporating telemedicine care, as it requires less space and less onsite ancillary services. By providing this choice within the micro-hospital setting, doctors can opt-in to take on caseloads when volumes are lower. Micro-hospitals are also complementary to telemedicine and Hospital at Home. As a patient comes out of the ED, they can be admitted for observation or head home and do telehealth care with the micro-hospital acting as a logical community-based way for check-ins versus going to the main campus.
• Offset System Volume and Infrastructure Investments – One healthcare organization we are working with is planning to build a new tower at their main academic medical campus. A strategic community-based micro-hospital prevents the need for costly and potentially disruptive on-campus construction while simultaneously reducing the strain on the main campus. Also, an unknown and widely catastrophic event, like the COVID-19 pandemic, can be better addressed by a micro-hospital setting that can quickly react and function as surge capacity as needs change.
• Technology Integration – There is no doubt that the future of the micro-hospital setting will be more technology based and the experience will be more virtual. As these sites are smaller and see less patient throughput than a typical hospital, testing technology advances in these settings just makes sense. A remote registration experience is just one example — today you walk into an ED and the first person you see is the registration person; in the future, this position will be handled by an automated system that scans your driver's license and then directs you to the next step, or an automated secure door system with advanced wayfinding in place to support self-rooming.
• Community Relationships – Micro-hospitals can provide demographic solutions for remote area support, but to operate facilities in non-urban settings and remote areas, staffing becomes vital to success. As these facilities are introduced, there will be increased importance on establishing relationships within the community and bolstering local amenities to make it an attractive proposition for medical practitioners as a place to not only work, but also live and be part of the community.
• Serving the Underserved – Although the US has a robust healthcare network, given the large expanse of land, there are still large swaths of geographic regions, both in urban and remote settings, that are underserved by healthcare. The question becomes, how do we reach the underserved? A micro-hospital setting offers the opportunity to lower the cost of care and physical distance to reach a disadvantaged population, bringing new patients into the system, and filling gaps in between service areas to enhance ROI, while in turn improving the health and wellness of the community.
• Modular Design + Construction – When it comes to the future of micro-hospital design, there are modular construction opportunities. For years, the Navy has been supporting disasters by flying in metal shipping containers with a generator and solar power, and within a couple of days turning them into field hospitals that can go up in a flash. With the formulaic model that we have developed for micro-hospitals, there is the opportunity to create highly specialized modular components or prefabricated building elements that could quickly and easily come together to create a stand-alone setting, saving time and construction costs.
The evolution and future growth of the micro-hospital system is ripe with opportunities, and as construction costs and healthcare costs continue to rise, the model has become a cost advantage for systems. As healthcare disruptors and advancements continue to come forward, the micro-hospital model is fertile ground to test and implement newly developed technologies to advance productivity within an already highly efficient model.
This article originally published in Medical Construction & Design Sept/Oct 2021 Issue.
About the authors
Renee Kubesh, AIA, EDAC
Senior Project Manager : Associate, EUA
Renee believes that architecture makes a difference in people’s lives and is excited to be a part of that dynamic in healthcare. Over her 30-year career, she has led the creation of spaces that are able to flex to future needs. Her healthcare environments help staff work to their best potential, welcoming family and visitors in a relaxing atmosphere and helping patients take control of their treatment and wellness. She values an Evidence Based design approach of understanding and respecting what has worked in the past, while also making the design/construction process engaging and fun for everyone involved.
James Hutchinson, MBA, RN, CEN
President, Covider Health
James Hutchinson is the CEO and co-founder of Covider Health. With over 25 years of experience in healthcare and a decade in micro-hospital leadership, James has had the opportunity to support some of the first micro-hospitals in the nation and see these facilities mature. Since that time, he and his team have opened and operated dozens of micro-hospitals throughout the nation. A certified emergency nurse, James received an executive MBA from SMU Cox and is passionate about continuing education.
Olivia Fritts, PhD, MS
Chief Administrative Officer, Covider Health
With over a decade of experience managing large scale projects, Olivia’s primary focus at Covider Health is supporting micro-hospital implementation strategies. Prior to joining the Covider team, Olivia worked in a variety of settings in healthcare and academia. These experiences have allowed Olivia to bring empirically supported strategies to the company roadmap.
Renee Kubesh, AIA, CDT, EDAC, James Hutchinson, MBA, RN, CEN and Olivia Fritts PhD, MS