A niche business

Midway through their pregnancies, expectant mothers who plan to deliver at Winter Park (Fla.) Memorial Hospital will meet with a “birth designer” to choreograph their ideal birth experience.

No detail is left overlooked at the Dr. P. Phillips Baby Place, from the types of pillows on the new mom's hospital bed to the musical soundtrack that will help ease the long hours of labor to whether and when she's offered pain relief.

And after the baby arrives, the new mom can relax on her high-thread-count sheets, order an in-room massage or freshen up with the high-end bath products provided.

“We try to create a much more personalized experience for patients,” says Ken Bradley, administrator at Winter Park, which also offers orthopedics, sleep medicine and ears, nose and throat specialties.

Orlando-based Florida Hospital, which owns Winter Park Memorial, is part of a growing number of systems that are creating a personalized, upscale experience for patients and investing in smaller hospitals that offer a limited number of specialty service lines.

Boutique and specialty hospitals have been proliferating for more than a decade, but they are no longer solely the domain of physicians and other independent operators. Instead, they are also partnering with larger, more traditional health systems.

“I think we've seen a fairly significant transition in ownership,” says Bill Cherry, a principal at Pinnacle Healthcare Consulting. “I certainly see that as a trend that can continue.”

Healthcare reform has accelerated the shift, both because of changes to the Stark anti-kickback law that further restricts physician ownership of hospitals as well as the increased focus on population health management, which encourages more integrated healthcare delivery.

Systems have long used a hub-and-spoke model, where community hospitals feed more complex patients into the flagship tertiary-care center. But some are turning that model on its head, with the “spokes” being high-margin, high-tech services that can be packaged with hotel-like amenities in less-urban settings.

While the specialty approach might seem counterintuitive during a time when hospitals are being encouraged to take more control of the entire continuum of care, executives say their goals actually align with healthcare reform to deliver value-based services and motivate patients to take more control of their health.

At Coordinated Health, a hospital network in eastern Pennsylvania, President and CEO Dr. Emil DiIorio sees two kinds of care: “empirical medicine,” which requires complex, multidisciplinary teamwork, and “precision medicine,” where the care might be high-tech but still routine. “These need to be split up,” he says, further arguing that payment models should differ between each group, with the former better served with a fee-for-service model and the latter with a bundled payment.

Most of Coordinated Health's service lines—orthopedics, musculoskeletal health, cardiology and women's health—fall into the latter category. “There's no reason why those conditions can't have a single price,” he says.

DiIorio, who studied systems engineering before going to medical school and training as an orthopedist, notes that the titans of Silicon Valley purposely limit their scope to a few areas. “They don't try to be everything to everyone—it's impossible,” he says. “It's not about cherry-picking; it's about putting in the right business model.”

While specialty hospitals are designed to create a certain atmosphere—perhaps best described as an ultra high-tech hotel—Cherry notes that they can be more cost-effective than their sprawling tertiary-care counterparts.

“The infrastructure is set up for one set of services only,” he says, adding that these hospitals also don't have to deal with the inefficient use of resources that come, for instance, when a pneumonia patient is admitted to a cardiology floor because of a lack of beds.

Outcomes also tend to reflect the highly specialized expertise of the staff. “In specialty hospitals, physicians tend to be very much engaged in the operations of the system,” Cherry says. “In general, the specialty hospitals have been successful and effective over the past decade in improving operations and improving the level of quality.”

A 2006 study in the Journal of Health Economics that looked at cardiac specialty hospitals found that these types of facilities lowered the cost of the care without compromising quality. But the authors also found that specialty hospitals tend to attract healthier patients and perform more intensive procedures.

In an age when patient satisfaction matters, specialty hospitals have an edge on the customer experience.

“The demand has been strong,” Bradley says of the Baby Place. “We've had a growing market share in a market that has otherwise declined.”

Bradley adds that the hospital has taken the services it normally provides and customizes them, and offers a few additional upgrades—such as a gourmet candlelight dinner for the new parents or a trip home in a Mercedes limousine—for an extra out-of-pocket fee.

It offers similar perks to its orthopedics patients, many of whom do not have commercial insurance but are on Medicare, Bradley says. “Insurance and out-of-pocket have nothing to do with each other.”

Orthopedic patients who come in for a procedure such as a knee replacement can consult with the hospital's concierge staff at no charge, paying only for the outside services they use. “We get an amazing number of people who say … what's going to happen to my pets or what's going to happen to this or that?” Bradley says.

As systems move more care away from urban centers and into the suburbs, they've also started to think about which services would be most attractive to those residents.

“We try to look at community needs and try to build centers of excellence around them,” says Dr. Julie Tome, vice president of medical operations and clinical integration at ProMedica Health System, Toledo, Ohio.

ProMedica's 591-bed Toledo Hospital and the adjacent Toledo Children's Hospital are its tertiary-care base. But the Hickman Cancer Center, its oncology hub, is at the suburban Flower Hospital in suburban Sylvania.

“We did that by design,” says Kevin Webb, president of the system's acute-care division. “We spent a lot of capital on the Flower campus. It's got a pastoral setting. It's a nice setting for people going through a terrible disease.”

Likewise, the system's Wildwood Orthopaedic and Spine Hospital, while still in Toledo, is closer to the suburbs than Center City. The hospital is also home to the Wildwood Athletic Club, a 40,000-square-foot fitness center that's open to anyone who wants to join. “One of the appeals of a boutique hospital is an aura of expertise,” Webb says.

While that draws patients, it also attracts physicians, who lead a number of ProMedica's specialty divisions. It also allows systems to invest more strategically in technology. A treatment such as radiation therapy, for instance, can be expensive to provide at multiple sites, Webb notes.

“I think systems are being forced to do that more and more because of the costs of duplication,” he says about the interest in specialty hospitals. “More systems are doing that just to rationalize costs.”

But even as service offerings have become more specialized, ProMedica is increasingly focused on population health management, Tome says.

“A lot of work on population health is done not in bricks and mortar, but in virtual (settings),” she says, noting that Wildwood was the system's first all-digital hospital, using electronic health records and other IT, when it opened in 2011. “A lot of this work is done by webinars, electronically and by conference calling. We also use a lot of telemedicine.”

While many of the service lines boutique hospitals offer are high-volume, high-margin specialties, women's health has also been a standout. DiIorio of Coordinated Health notes that women make the vast majority of decisions on healthcare spending, which means that investing in women's health can pay big dividends.

Nebraska Methodist Health System, Omaha, started thinking about service-line planning when it began to run out of room at its 460-bed acute-care campus. Physicians identified the women's services department—which was taking up three floors—as one of the easiest to relocate. Methodist Women's Hospital, Omaha, opened in 2010. Although the new facility is only 10 miles away from the flagship campus, it's closer to the suburban ZIP codes that represent most of the babies it delivers.

Thanks to recommendations from local women community leaders as well as physicians, Methodist Women's is designed to invoke a weekend getaway more than a hospital stay. Each room has a refrigerator, a safe, a hair-dryer, a vanity and a suitcase rack. Bathrooms have alcoves for toiletries and peri bottles. Medical equipment is hidden behind cupboards.

In addition, six rooms for high-risk pregnancies are designed to provide all the comforts of a studio apartment, since stays for women at risk of preterm birth can often stretch into months.

Even though women's health is the hospital's primary service line, the facility also offers many other services that are in demand in the surrounding communities outside of the urban core, including an emergency room, imaging services for men and women, and general surgery procedures. An adjacent office building not only offers adolescent gynecology and midwifery care, but also behavioral health and skin renewal services.

“Our goal patient-wise is to be a one-stop shop,” says Sue Korth, Methodist Women's vice president and chief operating officer. “We built the hospital for our future growth.”

Methodist Women's also works closely with Nebraska Methodist Hospital to facilitate patient transfers. Women's Hospital, for instance, prides itself on being able to transport cardiac catheterization patients to the tertiary-care campus within the crucial 60-minute time frame.

“We were hoping the emergency department would be a feeder to the hospital and not cannibalize them,” Korth says. “We collaborate very well.”

Follow Beth Kutscher on Twitter: @MHbkutscher