This is the Healthcare Delivery Providers, part of the Healthcare Marketplace Specialization. This is Module 2.3.2, Single Service Line Hospitals. The learning outcomes for this lecture are, we will discuss hospitals that have either one or very few specialized service lines. And also review their opportunities and challenges. In patient psychiatry facilities. So I do want you to note that there are some hospitals that only provide a single type of service line, or very few service lines. And I want to cover a few of those with you in this particular lecture. So, we'll talk a little bit about pediatric hospitals, so these are hospitals that focus on children and taking care of very complicated children's needs. Another type of hospital is the in-patient psychiatry facility or the psychiatry hospitals that we talk will about. Tertiary hospitals are those hospitals that provide very high end services. So again, primary care is again, to primary services, secondary is the community based hospitals doing a little bit more, and then tertiary hospitals are those that do much more and act as referral centers. And then finally, we will cover some emerging single specialty hospitals focused on sub-specialty areas like heart and bones. So let's start first with children's hospitals. Obviously by, as the name indicates, these serve pediatric patients. And focus on children with extreme medical complexity, and also vulnerable kids. So a lot of other hospitals do have childbirth happen there. They serve normal babies who have no medical problems. But then, if a baby or a pediatric patient becomes sick, they are typically transferred to a specialized pediatric or children's hospital. Given the reimbursement structure and the governmental payers that cover families and children, Medicaid, which is, remember, the state operated and managed program where both federal and state monies are combined. That's the major payer, Medicaid. And as we have seen in Medicare, similarly here about 40% of the funds paid for about 6% of the children who are extremely medically complex. So, a small number drives a very high amount of the cost. And then, some of the services that children's hospitals provide are extremely specialized. So for example, transplants, bone marrow transplants, or heart transplants, very complicated heart surgeries, also complicated cancer care. Again, children's hospitals focus on small children, and all of the other hospitals in the region mere refer the pediatric patients to these highly specialized hospitals. Let's talk about in-patient psychiatry facilities, IPF, or the psychiatry hospitals. There's about 1,500 of those, 400 are freestanding, so they are in a building on their own, and 1,100 reside within other hospitals. So it might be a unit or it might be a smaller section of a larger hospital campus. Now, about a third of the time, one particular diagnosis, and this is a psychiatry diagnosis called psychosis, accounts for most of these patients and most of these admissions. There has been noted a growth in the for profit inpatient psychiatry hospitals and that is under review. So data is available through the MetPath that we've looked at before regarding the margins, the growth, and other metrics for inpatient psychiatry facilities. Now, given the extreme review of mental and behavioral health in the United States and also across the world. These hospitals are a critical nature of the backbone and safety net for patients who are struggling with these very important medical conditions. Let's do a short quiz. Now, let's briefly cover what is a tertiary care hospital. So, this is a hospital that is typically large and has many highly specialized services. So, it likely would have very specialized equipment, very specialized staff, and also the make up of the hospital would be highly specialized and complex. Typically, this particular hospital will have a referral networks. So, we'll have a feeder system from smaller hospitals that do not provide these level of specialty services. And those hospitals might have referral networks to the smaller critical access hospitals. So again, patient presents here, too complicated, might go to the next level. Still too complicated, might go to this tertiary care hospital. Some of the examples of services are transplants, very complicated trauma cases, high risk pregnancy, child birth and new born care. Again, we've discussed that in children's hospitals as well. And then they typically will have highly specialized radiology, for example, PET scans and other very costly and very specialized radiological services. Finally, let's talk about the single specialty hospitals. Typically, these are hospitals that are trying to leverage economies of scale and scope. So, they will develop competencies in one particular service line. So most of the patients in that hospital will be of the same type with the same or very similar conditions. So for example, one might be heart. And as you can imagine in Harlan's case, if he knew and had a choice between a heart hospital that only took care of heart cases, or could go to a general hospital that does heart in one area, but does other services. That may be one consideration for Harlan and his family. Again, it all depends upon the quality metrics, the quality metrics of these two hospitals, and that's exactly the point of what is being looked at. Are these single specialty hospitals in fact more efficient. So, do they reduce overall cost, and do they increase quality? So again, we're back to this concept of that triple aim. So do they meet all three of those triple aims, and because of the single specialization, are they able to do that or not? That is being reviewed and is undergoing some debate now. In summary, single service line hospitals like psychiatry or children's try to leverage economies of scale and scope. Some of them like children's and psychiatry services are extremely well recognized. Although some of the new ones that are emerging are being analyzed right now for value creation along the triple aim paradigm.
