According to a new working paper by the National Bureau of Economic Research (NBER), as the nation’s hospitals battle for paying customers, they are engaged in a fierce “amenities race.”. What is troubling about the report is that it reveals that many patients seem to care more about rooms with views and pleasant service than just how many patients survive their hospital stays. (Thanks to Stephen Dubner for calling attention to this report in his Freakonomics column in the New York Times; hat-tip to reader Brad F. for sending me the column.)
In “Hospitals as Hotels” Dana Goldman and John A. Romley, (both of RAND) offer a stunning example of just how expensive the competition has become: in 2004, a Beverly-Hills-based physician group acquired Century City Hospital in west Los Angeles. The group invested nearly $100 million in improvements to medical care and patient amenities, with "five-star personalized service" including a concierge and nightly turn down; bedside internet portals and.at-screen televisions with movies on demand; and gourmet organic cuisine prepared and served by the staff of chef Wolfgang Puck.” The hospital filed for bankruptcy in August, 2008.
The physicians who managed Century City may have gone overboard, ,but they’re not alone. Nearby, Goldman and Romley report, “the Ronald Reagan Medical Center opened in June, 2008, at a cost of $830 million. UCLA built this hospital to meet new mandates for seismic safety. Even so, an aggressive marketing campaign emphasizes its ‘hospitality.’ Where UCLA.s previous hospital lacked private rooms, the new facility boastsL "large, sunny, private patient rooms that feature magnificent views” as well as “daybeds for family members, wireless Internet access for patients and guests, multiple outdoor play areas for children, and a host of other unexpected amenities including massage therapy and ‘hotel- style’ room service for meals.”
Elsewhere, I have written about how a stay at UCLA Medical Center costs Medicare far more than if a very similar patient were treated at the Mayo Clinic. This might help explain why. (Though in truth, the fact that patients at UCLA see more specialists and undergo more tests and procedures is probably a more important factor.)
The Dartmouth Research that I have written about in the past shows that when it comes to medical tests and treatments, the supplier (i.e. the doctor or hospital) drives demand. The health care provider tells the patient what he needs. But, when it comes to amenities, the NBER report suggest that hospitals are, in fact, responding to customer demand.
When reserachers surveyed 8.721 Medicare fee-for-service pneumonia patients discharged from general acute-care hospitals in greater Los Angeles in 2002, they found that patients placed a high value on hotel-like services. In fact, they rated amenities as more important than clinical quality of care by a statistically significant 10 percent.
As a proxy for quality of care, patients were given information about mortality rates: pneumonia mortalities averaged 12.5% at the hospitals studied. One would think that piece of information might make patients more interested in questions about the quality .of care than what the hospital was serving for dinner.. But no, researchers found that a one-standard-deviation increase in a hospital.amenities increases its demand among the patients studied by a startling 38.4% . By contrast, a standardized increase in clinical quality (as measured by lower pneumonia mortality) increases a hospital’s demand by only 12.7%.”
The researchers were flummoxed: “This evidence that amenities are valued more highly than clinical quality is surprising insofar as mortality would seem to be of paramount concern to most patients.” Well, yes, one would think so.
They try to explain their subjects’ seeming irrationality: “Our analysis may understate the value of [information about]clinical quality.. . , patients may recognize that quality information is subject to sampling variability and discount apparent differences.. Finally, there is evidence that people systematically overstate low-probability mortality risks while understating high-probability risks .Pneumonia mortality averaged 12.5% at the hospitals studied. Patients may underestimate the average level of pneumonia mortality and, moreover, may "under-react" to differences across hospitals.”
In other words, patients just don’t believe that they are going to die of pneumonia if they are in a hospital. In other words, they over-estimate the value of acute medical care, and underestimate the risks. This squares with much of what we know about how consumers choose medical care: they tend to trust the doctors and hospitals they know—even when they shouldn’t. This is because they would prefer to trust their health care providers. (No one wants to think about the number of errors that occur in their local hospital—it’s just too frightening.)
Researchers also found that heart-attack patients value amenities; indeed, they value creature comforts even more than pneumonia patients. Nevertheless, they also place a higher value on clinical value (measured by whether the hospital has the latest technology and equipment.) This is somewhat reassuring —though the latest equipment does not always mean the best care..
The findings explain why so many hospitals invest so much in the amenities race—even when they don’t offer palliative care. What are the implications for public policy? “Under Medicare’s current prospective payment system,” the researchers point out, “ reimbursement for medical services and amenities are bundled.” In other words, hospitals are reimbursed for what it cost them to treat the patient, lumping gourmet food and pain-killers together. “Such reimbursement is neutral with respect to the potential trade-off between the supply of clinical quality and amenities, and the incentive to supply each turns on their private benefits and costs to hospitals. As the Centers for Medicare and Medicaid Services increasingly pursue ‘value-based purchasing"[ the social benefits and costs of amenities and clinical quality, and the provision of each in market equilibrium, become all the more important.”
Interesting post, Maggie. I think a some “amenity upgrades” do improve patient care, though. For example, when I started doing pediatric critical care in the early 1980s the norm for a PICU was a huge room with glaring overhead lights and all the children arrayed in their beds around the walls. It was cheaper, I’m sure, but it was far from ideal. There was no privacy at all. You could be doing CPR on a patient while the family surrounding the bed of the neighboring child (often only a few feet away) tried to nap in 1950s-era straight-backed chairs. The situation was also an infectious disease nightmare; old-timers may recall the strips of tape we put on the floor to “isolate” patients with communicable diseases from each other. What we have now — private rooms with sleeping arrangements for family members, things for siblings to do when visiting, unlimited visiting hours, the WiFi access — really is much better for the children.
Regarding Mayo Rochester, I was there during their massive building expansion of the past several decades. In 1974 the typical Mayo accommodations were like those of most other institutions — mostly semi-private rooms with a few small wards, pretty horrible food on the patient trays, long, poorly-lit, echoing hallways and stairwells. By the time I left there I’d say the patient experience was well above average compared to what I’ve seen elsewhere. So in spite of the lower cost to Medicare, the typical Mayo patient has nice facilities. And they do have some very, very nice suites of rooms tucked away for folks like the King of Jordan and such that probably never see a Medicare patient.
An H.L. Mencken quote about the general public and Americans in general applies very well here.
“No one in this world, so far as I know … has ever lost money by underestimating the intelligence of the great masses of the plain people.”
I remember my first time in a civilian hospital was in 1976 in NYC. I was told it was a semi-private room but it was actually a corner room with four beds and not two. It wasn’t a pleasant experience. On several other occasions, the semi-private room was OK. However, for my last night after my CABG, my roommate had been discharged because he was one day ahead of me in the post surgery recovery process. His bed remained empty for my last day leaving me with, in effect, a private room. It was much quieter and easier to rest and sleep. I think private rooms could be safer due to lower infection risk, fewer visitors coming and going, less chance of medication errors, etc., along with superior peace and quiet as well as privacy. I think plenty of people would be willing to pay extra for a private room within reason.
Regarding the amenities, including the nice food, Internet access, flat screen TV’s and even waterfalls, I wonder how much these really add to the cost of building and operating the hospital. It sounds like this issue could be comparable to high CEO pay. That is, it makes a nice soundbite, but it’s probably not all that big a contributor to higher costs at the end of the day. Some data on cost differences attributable solely to amenities would be helpful.
Very interesting. None of us shouldn’t worry too much about amenities with life threatening situations. BUT many hospitalized patients are not in life threatening situations.
Also I know something about this phenom because….
-in the 1970s I became involved with the Philadelphia County Medical Society about the irony of Nobel Prize winning doctors in hospitals with the NO parking!(talk about user unfriendly)
-I became heavily involved with incorporating arts with Medicine especially since 1985 including hospitals.
My take is that there is a growing blurring line between health care facilities and the hospitality industry(hotels, etc) This is most manifest with the overnight spas which are becoming increaingly “medicalized” More Docs on spa staffs.
Have you noticed that many former exercise only facilities now do rehab work on injured customers?
At lot of this blurring is driven by aging US demographics.
So I think hospitals will look very different in the the coming decades?
And I for one think that is a welcome change from these broken and dangerous institutions we call hospitals today.
Allocation of $ remains problematic of course.
Dr. Rick Lippin
Southampton,Pa
There’s nothing wrong with amenities – pleasant surroundings probably aid the healing process. Of bigger concern to me is what these data say about our ability to be rational consumers under the so-called consumer directed health care that is pushed by conservatives. Again, cost, quality, and access are nowhere to be found in the things we value as health care consumers.
What I find disgraceful is patients being turned away from medical care because they don’t have the money to pay for it, yet right behind those doors they are refused entry to are glass waterfalls, imported marble, ornate landscaping, etc etc etc. How can we tell a citizen they have to do without medical treatment because we had to buy a glass waterfall? In my view, that’s exactly what we’re saying. And I say we, we’re all in this together, ultimately.
Press Ganey and similar patient satisfaction tools score rely overly heavily on hotel services. And so, with our lovely for-profit predatory model, many hoteliers and corporate sales/marketing services got into the act. The Ritz produced a scripted customer service improvement tool for hospitals. I know because I worked for a lousy hospital that cultivated its rich local customer base using this phony “we love you” tool.
It mandated that all employees – including professional staff such as nurses, therapists and ED and hospitalist docs, use the Ritz script at all times. It was horrid, and needless to say, the Press Ganey scores didn’t improve, nor did the patient or staff experience.
Design of inpatient facilities is critical for infection control, promotion of rest and sleep, and for mental health. It has been demonstrated that normal light/dark cycles with natural light and green views (not city views or brick walls) are essential for healing for everyone.
A real and damaging problem – induced cognitive decline and actual psychosis can result when these are not consistently available.
But hospital design for patient care units was supposed to facilitate those aspects of a healing environment with ergonomic, patient and staff safety and nursing efficiency so that nurses were not spending more time managing finding and brining needed supplies to patients, but instead had good visibility and the ability to reach patients quickly with a minimum of back tracking and traveling on errands.
This has been subverted with dismal results.
As to the hotel amenities per se, part of this also has to do with privately owned boutique hospitals getting into the market and with hospitals fleeing poorer locations (poorer patients, more Medicaid and self pay) for wealthier suburbs with lower indices of acuity and higher reimbursement rates for desirable services and treatments.
No one questions hospital improvements designed to maximize patient safety, facilitate healing, and improve healthcare delivery. The amenities race is on a completely different level. One of the nicest hospitals I have ever been in, which has state of the art surgery suites and specially ventilated isolation rooms, in case of bio-terrorism or natural epidemic, plus all of the advanced technology available, etc., is now going to add $100,000,000 in new amenities. It lacks for nothing and already has an incredible indoor fountain. Meanwhile it is cutting staff like crazy–both patient care and administrative. It’s both inefficient and inequitable to spend scarce healthcare dollars this way.
Travel around the US, in almost every small-medium size city, the largest employer is the hospital industry. As jobs and health insurance are lost, these heavily mortgaged hospitals, which have upgraded their facilities to keep up with the “Jones”, will increasingly cut staff and services as they struggle to stay solvent. Without major health reform, I fear that massive hospital closings are in our future.
David Weissman posted that he fears massive hospital closures are in our future
As insensitive as this may sound- I agree. But for hospitals, in many cases, it is “change or die”. They are stuck in failing models of what a hospital should be.
So hospitals need to morphe into new entities -not close
Dr. Rick Lippin
Southampton,Pa
In my limited experience with hospitals I think that heart-attack patients are probably younger and more active (likely to talk a hosptial up or down with their friends afterwards) than pneumonia patients.
My FIL had a pacemaker and several other procedures when he was in his 70s and at that point he was active and mobile enough that he would have bailed on a hospital he didn’t like. In fact, he got an infection at one facility and maneuvered to go to another the next time around.
MIL made it into her 80s before hitting the hosptial circuit. By that time she’d gotten demented and went to the hosptial that her nursing home had a relationship with. She was insured, that’s where they sent her – end of story on “choice.”
So I think they add amenities because the people it draws in are 1) younger and will be coming back again over the years 2) likely to give the place good word-of-mouth.
It’s too bad because the ward with the pneumonia old-age patients was pretty grim and more help there (think of a 2 week stay where nobody ever gave you a bath or washed your hair) would have been decent.
Maggie – I think the study’s authors are overstating the availability of information to patients. They point out that patients didn’t have access to the very measure they used, and they simply assume that patients might somehow infer comparable information instead. That’s a pretty strong assumption. Moreover, they don’t say anything about whether patients might use amenities as a proxy for quality – which I think is likely.
The only conclusion I’d be comfortable turning into policy is that patients need much better access to clinical quality information. Until then, it’s not really helpful to describe them as irrational.
Maggie,
The problem as I see it is how the insurance industry obscures the true cost of these costly amenities and actually adds to the problem. If a patient has health insurance, he can pick from a list of hospitals that may vary in the level of patient perks and attractiveness of facilities and will not suffer any increase in his or her cost as a result of choosing the more expensive hospital since most insurance works on the basis of deductibles. Once the is met, then insurance picks up the rest of the tab regardless of the condition of the facilities or added amenties. I would liken it to buying hotel insurance that would allow you to stay in any hotel within its network and included hotels ranging from a Motel 6 to the Ritz Carlton. Which would you choose if the cost was the same between the one or the other? Hospitals with good reputations (earned or not) an loads of money in their coffers, can leverage increased payments from private insurers that they can then use to provide fancy facilities and flat screen TVs in patients rooms. Witness the recent revelation that Partners Healthsystem in Boston was getting much larger payments that its competition without any real proof that they offered superior care. These perks serve to further differentiate them from their undercompensated competition which can’t begin to afford their own medical Taj Mahals. Seems like a short sighted strategy on the part of the insurance industry, since this is resulting in more expensive hospitals with all the fancy gadgets that money can buy along side second tier hospitals that are either closing if they are not located in the right zip code with a ready supply of insured patients, or are being merged into the hospital systems that are financially doing well. This consolidation is only serving to increase the leverage of these well endowed hospital conglomrates with the likely result of driving prices higher. Insurers need to have patients pay more for these more expensive hospitals out of their own pockets if they want to stop them from continuing this race to out do each other with fancy ammenities.
Thanks for all of your commments.
This is an interesting subject.
I’ll be back with more responses later . .But here are a couple of thoughts:
Chris– I definitely agree that children in pediatric ICU units need private rooms, privacy and comfort for their families.
But do we need the same facilities for the families of a healthy 65-year-old having a knee implant? I can certainly see having a daybed available so that a relative can stay overnight with a patient.
This makes the patient safer. But all of the other extras? And should we all (Medicare) be paying for these amentities?
When I had my children, I was in a semi-private roomo with another mother. This was fine. If something had gone wrong during the delivery, I would have wanted to be in a private room. This is what private rooms should be for–people who truly need privacy.
It is fine to have a few VIP suites for folks like the King of Jordan, who pay cash, and help support care for patients who cannot pay.
Barry– The lavish lobbies, atriums, outdoor briges from one wing to another, and lavish extras that that Susan B. and others talk about do add greatly to construction costs.
We don’t need isolation rooms in hospitals in case of bio-terrorism. How many people would be saved?
(This reminds me of the bomb shelters of the 1960s–a huge amount of money wasted. First, we now realize that the Soviet Union was not interested in launching a nuclear war. It had enough problems within its own sphere. Secondly, if there had been a nuclear war, these bomb shelters would not have saved people.
But someone made a lot of money selling fear.
If bio-terrorism is truly a danger, rooms in the White House, Congress, the Pentagon that might protect our leaders might make sense.
But isolation rooms in some hospital so the hospital can hype the rooms on TV and a few people can feel that they are staying in best, “safest hospital” in America–when in fact infection rates may be much higher than in other hospitals?
MG–I have to agree: many Americans are not shrewd consumers.
Everyone–We need to redistribute health care dollars. And we need to take a look at much more spartan hospitals in countries like Germany.
As long as we cannot afford to treat all sick children, we really have to re-think our priorities–especially in a recession.
Putting the unemployed on Medicaid–which is SUBPAR MEDICAL CARE (-PROVIDERS ARE PAID 1/3 LESS THAN THEY WOULD BE IF CARING FO MEDICARE PATIENTS)-while continuing to spend on amenities does not speak well for this country.
Lisa-IF I recall, not long ago yout had a job that involved billing hospitals for expansion a and some over-the top new consturtion. Can you give Barry a better idea about costs?
Duncan–where in the report do you see the reserachers saying that patients did not have the info about mortalities rates, etc.? (Please quote and cite page– I don’t find this.)
I’ll be back . . . I hope you’ll continue your conversatoin.
what could better epitomize the split between the wonks and the civilians — the former criticizing the latter for preferring hospitals where they feel more comfortable? foolish patients. to my eyes, they’re rational, gravitating toward the places that seem better given the resources that are available to them.
From page 6:
We measure the clinical quality of hospitals with their mortality rates for
patients with community-acquired pneumonia.
From page 7:
These rates proxy for patient information about the clinical quality of
hospitals. Pneumonia mortality rates were first publicly reported only after the patients studied made their hospital choices [emphasis mine]. Even so, patients may be reasonably well informed about clinical quality from their physicians, friends
and families.
However, I did miss a sentence in the report, where the authors do find correlation between amenities and quality (page 7):
Hospitals with low pneumonia mortality tended to have slightly better amenities in this sample ( [rho] = +0.086).
So amenities are in fact a bad predictor of pneumonia mortality. But again, the choice patients have isn’t between bad information and good; it’s between bad information and none.
Assuming national planning and coverage, why not just institute a well-defined and absolute rule that things so classified as non-essential (for quality care) must be paid for privately or through privately contracted policies!
Ng, Duncan, Jim and Everyone–
I’m still at this conference in D.C, so tonight, I’m just responding to the most recent comments.
(Sleep-deprived, I don’t have the energy to respond to all of your comments, but I will come back.)
In any case, thanks to you all for responding—and I hope you will continue to talk to each other.
NG-
You wrote: “Assuming national planning and coverage, why not just institute a well-defined and absolute rule that things so classified as non-essential (for quality care) must be paid for privately or through privately contracted policies!”
As you say– why not?
What you suggest is what most European countries do–and patients are generally much more satisfied than they are in the U.S.
In Europe, if you want something extra (something that is not medically necessary, but that you might like), you pay for it. But the government pays for all medical treatments that have some poof that they are effective. And patients are, on average, much happier than patients in the U.S.
European governments also negotiate for discounts with drug-makers and regulate, in various ways, how much hospitals and doctors can charge.
Duncan–
You are right– the report (which is not terribly well-written ) is very vague on what patients did and didn’t know about quality and even amenities when answering the survey.
(I asked you to look at the report, because I was hoping that you had spotted something that I hadn’t seen.)
But as you say, the patients do seem to be responding to info about amenities even if they don’t have info about quality.
I would only add that, at this point in time, it is very hard to get good info on health care quality. Info on amenities is easier to get, via word of mouth, or just driving by/ or visiting someone in the hospital.
But other research does suggest that, even when patients get some pretty clear info about cardiac mortalities at hospitals in N. Y., this didn’t have the influence on their choice of hospitals that one might expect.
Most patients would rather go to a hospital very close to home, even if mortalities are much higher.
Jim–
You write: “what could better epitomize the split between the wonks and the civilians — the former criticizing the latter for preferring hospitals where they feel more comfortable? foolish patients. to my eyes, they’re rational, gravitating toward the places that seem better given the resources that are available to them.”
Jim
I agree insofar as the info we have on quality is pretty soft, it makes sense for patients to go
to hospitals that feel “comfortable.’
But I have to say that in some cases, the difference in quality—between very low quality hospitals where many patients die due to hospital errors, hospital acquired infections, lack of staffing, etc.) and higher quality hospitals is pretty clear. Yet, patients still tend to go to the hospital that is closest to home.
I understand this: patients want friends and family to be able to visit them.
But unless I were dying (in which case I would want the faces of my loved ones there) I would rather talk to my husband and kids on the phone, and feel relatively secure that the people around me had probably gotten the right diagnosis early on in my stay, would probably avoid gruesome hospital-acquired infections and medication mix-ups—as well as all of the other errors that
can so easily happen in hospitals.
I really don’t care if I can order movies on demand, whether the TV is thin-screen high definition, or old-fashioned, or whether the art in the hallways is very valuable.
I would just want to get out of the hospital as soon as possible–without having to be readmitted.
In other words, I would want to be in a hospital where stays are shorter, and re-admissions
We may have gotten to the point in this country where we started to believe everything had to be a luxury (hospitals as hotels), but with the deepening recession and massive layoffs, I think people will forego unnecessary care (elective surgeries, etc.) and even let health conditions worsen because without a job they don’t have health insurance. Luxury rooms seem like a bad investment. Hospitals are going to be seeing fewer paying patients and more people ending up in the emergency rooms without health coverage.
Regarding private rooms:
There are four main rationales for them:
Patient Safety
Patient Privacy
Infection Control
Sleep and Rest Protection
~and~
Patient Preference (elective – no health reason)
Research and evidence demonstrates that fewer medication and patient identification errors occur when private rooms are in use. You’d be amazed at how often patients respond to being called the wrong name – this can be due to hearing impairments, effects of medications, cognitive deficits, increased stress, staff misidentification, and a whole host of other problems.
Patients no longer convalesce in hospitals, so please forget all that you experienced if you were hospitalized prior to the mid 1980s. Patients are now hospitalized for intensive batteries of diagnostic testing, complex treatments and high risk procedures.
Patient privacy is a HIPAA mandate, and it is very difficult to maintain it using wards and semi-private rooms. Moreover, it is also common for patients of rival factions, gangs, local competitive groups (think churches, businesses, schools and the like) to be hospitalized at the same time. Trust me when I tell you that to discover that two members of rival gangs or two clergy from unfriendly churches are rooming together is not a good thing for many, many people. Private rooms with sleep chairs or pull out sleep sofas promotes family and loved ones to be able to learn how to care and support the patient while still in the hospital. It also saves them untold fees in motels and hotels (equally important for those from rural settings who have to travel great distances and those with critical problems and end of life concerns). This is so much better than the filled to overflowing waiting rooms in which family camp out and bring their own tensions, stresses, infections and problems into a very public fishbowl setting.
Infection control: There are two types of private rooms – those with normal airflow and those with negative pressure air flow.l The latter are necessities for airborne communicable disease containment, such as TB, anthrax, influenza, etc. They are not amenities – they are critical and there are way too few of them.
Infections such as MRSA, VRE and other high risk organisms when diagnosed or suspected, are required to have the patient isolated. As these become community originating, it is becoming increasingly important to have more private rooms available. The only other option is to close a bed and make a semi into a private or to house patients with the same organisms together. (And that often doesn’t work due to gender and multiple organism incompatibilities).
Finally, the sleep and rest protection factor can’t be over-emphasized. As care has become more intensive treatment and diagnostic oriented, patients are exposed to round the clock bright lights, staff conversations, staff visits and interventions, noxious noises (intercoms, alarms, overhead pages, code alarms, even fire alarms have to be tested on nights and evenings every month – woe be to you if you hit the testing day), smells (vomitus, stool, infectious exudates, sputum, cleaning agents, medications, body odors, staff colognes, aromatic foods, etc), sights – overhead room lights, exam lights, hallway and nursing station lights (never turned off), upsetting things to touch: cold stethoscopes, unfamiliar equipment, uncomfortable mattresses, wheelchairs, scratchy linen, hospital gowns, tape on skin, bandages, casts, splints, restraints – all sorts of things which are unfamiliar or distressing.
So anything which provides some degree of psychological comfort, which reduces extraneous noise, allows for lighting to follow natural daylight and darkness at night, and which allows for maximal family support and comfort is not an amenity. It very well may be the difference between a recovery with better outcomes and shorter lengths of stay.
Regarding private rooms:
There are four main rationales for them:
Patient Safety
Patient Privacy
Infection Control
Sleep and Rest Protection
~and~
Patient Preference (elective – no health reason)
Research and evidence demonstrates that fewer medication and patient identification errors occur when private rooms are in use. You’d be amazed at how often patients respond to being called the wrong name – this can be due to hearing impairments, effects of medications, cognitive deficits, increased stress, staff misidentification, and a whole host of other problems.
Patients no longer convalesce in hospitals, so please forget all that you experienced if you were hospitalized prior to the mid 1980s. Patients are now hospitalized for intensive batteries of diagnostic testing, complex treatments and high risk procedures.
Patient privacy is a HIPAA mandate, and it is very difficult to maintain it using wards and semi-private rooms. Moreover, it is also common for patients of rival factions, gangs, local competitive groups (think churches, businesses, schools and the like) to be hospitalized at the same time. Trust me when I tell you that to discover that two members of rival gangs or two clergy from unfriendly churches are rooming together is not a good thing for many, many people. Private rooms with sleep chairs or pull out sleep sofas promotes family and loved ones to be able to learn how to care and support the patient while still in the hospital. It also saves them untold fees in motels and hotels (equally important for those from rural settings who have to travel great distances and those with critical problems and end of life concerns). This is so much better than the filled to overflowing waiting rooms in which family camp out and bring their own tensions, stresses, infections and problems into a very public fishbowl setting.
Infection control: There are two types of private rooms – those with normal airflow and those with negative pressure air flow.l The latter are necessities for airborne communicable disease containment, such as TB, anthrax, influenza, etc. They are not amenities – they are critical and there are way too few of them.
Infections such as MRSA, VRE and other high risk organisms when diagnosed or suspected, are required to have the patient isolated. As these become community originating, it is becoming increasingly important to have more private rooms available. The only other option is to close a bed and make a semi into a private or to house patients with the same organisms together. (And that often doesn’t work due to gender and multiple organism incompatibilities).
Finally, the sleep and rest protection factor can’t be over-emphasized. As care has become more intensive treatment and diagnostic oriented, patients are exposed to round the clock bright lights, staff conversations, staff visits and interventions, noxious noises (intercoms, alarms, overhead pages, code alarms, even fire alarms have to be tested on nights and evenings every month – woe be to you if you hit the testing day), smells (vomitus, stool, infectious exudates, sputum, cleaning agents, medications, body odors, staff colognes, aromatic foods, etc), sights – overhead room lights, exam lights, hallway and nursing station lights (never turned off), upsetting things to touch: cold stethoscopes, unfamiliar equipment, uncomfortable mattresses, wheelchairs, scratchy linen, hospital gowns, tape on skin, bandages, casts, splints, restraints – all sorts of things which are unfamiliar or distressing.
So anything which provides some degree of psychological comfort, which reduces extraneous noise, allows for lighting to follow natural daylight and darkness at night, and which allows for maximal family support and comfort is not an amenity. It very well may be the difference between a recovery with better outcomes and shorter lengths of stay.
Yes, I work as an accountant in the construction industry. I used to work for a subcontractor who specialized in high-end, upscale interior components. Their biggest customer was healthcare. I don’t have comparative costs analyisis, but I have worked in construction for many years, and have a pretty good idea what generic, useful components cost vs the upscale, highly specialized, highly customized features cost. I know that a pedestrian bridge was built in one hospital area at a cost of at least 8 million dollars, this bridge was a very small component of the overall project. The hospital ran out of money and couldn’t pay for the bridge (at the time I left that position.)
Anyway, 8 million dollars for a small pedestrian bridge seems pretty excessive to me.
There was another healthcare project involving this specialized upscale interior component, changes were made to the original specs which sent the costs over 1 million. I said, to a co-worker “You know, ultimately you and I are paying for this foolishness!” The co-worker said “This isn’t even in a patient area, this is a faculty room.”
If you’ve ever done any remodeling work at your house, it’s much the same, costs multiply substantially when you start moving into customized fabrication, high-end materials….it’s all form over function I guess is my point.
Lynn, Annie and Lisa
Lynn– You’re absolutely right. Doctors tell me that even ER traffic is down.
Hospitals will be hurting, like everyoe else.
They need to save their dollars for the essentials that will help them care for patients who may not have insurance.
And yes, our culture has
become obsessed with luxusry.
But that too will change. I caught ten minutes of a program on television this morning, explaining how extravagance, bling, etc. is disappearing in Manhattan. Many people can’t afford it (they’re selling their very expensive jewelry); others realize that, in hard times, flaunting it is in poor taste.
The Nineties–and the first years of this century–were very much like the 1920s– a time when the gap between the rich and everyone else grew.
But then came the pendulum swing, as it always does.
Annie–
I’m not against private rooms. My point is simply that we cannot afford everything that one might possible want in a hospital.
And if you visit Europe and see hospitals there. . . They are much simpler; the empahsis is on basics.
But the rate of erors is lower and outcomes are better.. .
Lisa– Yes, most people don’t realize how much custommized construction costs. Someone on the
hospital board thinks “wouldn’t it be nice if . . . .” And there goes $8 million .
What you suggest is what most European countries do–and patients are generally much more satisfied than they are in the U.S.
In Europe, if you want something extra (something that is not medically necessary, but that you might like), you pay for it. But the government pays for all medical treatments that have some poof that they are effective. And patients are, on average, much happier than patients in the U.S.