Construction, Health Care, and Human Resources

Hospital excesses

December 29, 2017
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I recently had occasion to be visiting a local hospital over a weekend and noticed something disturbing to an old “cost container” like myself. The hospital was mostly empty!

Empty hospital beds — like those I noticed at Spectrum Health Blodgett Hospital — represent excess costs in a few ways. Hospital building construction and renovation costs many times more than other kinds of building construction. If needed, this is justifiable. But if there are empty beds and therapy spaces, that is wasteful. From Monday through Thursday, most hospitals have a higher inpatient and outpatient census. But come the weekend, the census and activity drop remarkably. The expensive facilities represent costs, and guess who gets to pay for those costs?

Although staffing of the empty beds drops significantly, it is not a proportionate drop — meaning there are more staff than needed for the number of patients being served. Hospitals claim they often simply close empty floors, but that fails to account for utility costs for the spaces, and hospital utility bills are quite high. How about the food service – does the kitchen size shrink? The lab? How about the X-ray department? The list goes on and on.

During weekdays, the facilities generally are more than adequate to allow physicians and therapists to do their jobs during daylight hours. The idea of waiting to use an operating room or a patient bed usually doesn’t need to be considered. After all, excess facilities allow staff to be home in the evening to dine with their families and live a normal life. I’ve even encountered office staff telling patients that a delay for admission is needed due to hospital crowding when actually the delay is due to the doctor needing to go on vacation.

What does the extra capacity cost?

In the past, many hospital behaviors and attitudes were based on the need to keep independent doctors happy. After all, isn’t the doctor the hospital’s real customer? The doctor makes the decision as to which hospital to use, and if there is enough surplus capacity (beds, operating rooms, etc.), the hospital will look attractive. Patients rarely enter into the decision process.

Today, however, many doctors are employees of the hospital. They do not exercise judgment as to which hospital to use, since they are indentured. Who cares if they are happy? There is no longer a need to have excess capacity to mollify them. The situation could be like the manufacturing industry in which many workers are expected to be available for second- or third-shift work. In fact, why shouldn’t the hospitals be able to function on a 24/7 basis? Think of the savings patients might realize.

Also, bear in mind that patient illnesses and accidents aren’t scheduled for just 8 a.m. to 4 p.m., Monday through Thursday. So why are the facilities meant to serve them set us this way?

Always bear in mind, the costs for any excesses are born by the people — through direct payments, insurance premiums, taxes, charitable gifts and pass-through of excess charges due to some people not being able to pay (cost shifting). Who is looking out for the people?

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