醫院越來越洋氣，早上換個膝蓋，晚上去蹦迪
Get in, get a new knee, go home. As treatments get less invasive and recovery times shrink, a new kind of hospital is cropping up — the "bedless hospital." They have all the capabilities of traditional hospitals: operating rooms, infusion suites, and even emergency rooms and helipads. What they don't have is overnight space.
來吧，換個膝蓋，然後馬上就能回家，一點都不麻煩。現在的手術越來越微創，康復時間大大縮短，一種新型的“無牀”醫院便應運而生。除了沒有過夜的地方，其他配設備與傳統醫院無異：手術室、輸液室、甚至還有急救室和停機坪。
"It reduces cost, and it reduces the risk of infection," said Dr. Akram Boutros, CEO of MetroHealth System, which just opened a $48 million bedless hospital near Cleveland that he expects will serve about 3,000 people in the first year. "People go home to a less-risky environment, where they tend to get better faster."
來自都市健康系統的首席執行官Akaram醫生說，“這種醫院的出現降低了成本與感染的風險，治療後人們在家休養有助於他們恢復。”不久前，在Cleveland的附近就開設了造價4800萬美元的“無牀”醫院，他預計第一年的就診人數在3000人。
The growth in outpatient healthcare is a fundamental shift in U.S. medicine. MetroHealth, which gets part of its funding from taxpayers and serves a large Medicaid population, has expanded outpatient visits from 850,000 to 1.2 million in the last four years, a 40 percent increase.
隨着這種門診服務日益成爲趨勢，美國的醫療體系從根本上發生了改變。都市健康的部分資金來自納稅人，醫療補助計劃中的很大一部分人都享受着它的服務。數據顯示，在過去的4年，它就診總人數上升了40%，從85萬上升到12萬。
Outpatient visits, experts say, subsidize more expensive inpatient some observers worry that the development of bedless hospitals is part of a financial shell game hospitals must play to make the dollars match up with the care they offer. And they wonder if such facilities are diverting resources away from a large population of patients who still require more complex treatment.
專家說，門診病人節約下來的資金能補貼需要花大錢醫治的住院病人。但是也有人擔心隨着“無牀”的普及，會成爲醫院的斂財工具，病人得不到應有的醫療服務，同時還會佔用住院病人的醫療資源。
"The untold story is what's happening to all of those patients who do still need to be in the hospital," said Harold Miller, chief executive of the Center for Health Care Quality and Payment Reform. "And are the places where they are going getting paid enough to support good care?" What's driving the development of bedless hospitals, said several hospital executives, are changes in reimbursement, both from the federal government and private insurers.
“醫療服務質量與支付改革中心”的首席執行官Harold說，那些經過治療仍然需要後續住院病人，他們應該要去哪裏得到資金以及醫療的支持和幫助？這個問題尚待解決。開設“無牀醫院”的初衷是爲了減輕聯邦政府和個人的醫療支出。
"Hospitals tend to be the highest-cost setting because of the intensity of services there," she said. "You see a dramatic difference in the payment for inpatient and outpatient services." The rise of bedless hospitals has also tracked the development of streamlined treatments. Several years ago, doctors at Memorial Sloan Kettering Cancer Center started brainstorming plans for more surgical space — an exercise that led to efforts to create standardize protocols for routine surgeries, such as mastectomies, that could be done without prolonged hospital stays. The end result was the Josie Robertson Surgery Center, a 16-story building on Manhattan's Upper East Side where doctors perform outpatient cancer surgeries. It has 28 short-stay beds, but most patients leave within hours of their procedures.
因爲各種五花八門的檢查，在醫院的花費很高。而且門診和住院所享受的服務也是截然不同的。“無牀”醫院的出現與所提倡的簡化治療的過程的理念是一致的。數年前，斯隆凱特靈癌症中心的醫生們爲了獲得更多手術空間而做了一次頭腦風暴，這也是將常規手術標準化的一次嘗試，這些手術包括，乳房切除手術，術後不需要再醫院過夜。終於在曼哈頓東北角建成了傑西羅伯森外科中心，一棟16層小樓，供門診病人手術，有28張臨時休息牀，大部分病人都能在術後規定的時間內離開醫院。
But under the Affordable Care Act and other reforms, reimbursement is linked more directly with the effectiveness of treatment, meaning providers are rewarded financially if they can deliver better care at a lower cost. For MetroHealth, building and buying bedless hospitals is part of a strategy to compete with Cleveland Clinic and University Hospitals. While a helipad at its new building offers the capability to treat patients facing medical emergencies, most people will come for the convenience of having all medical services — primary care and specialty services — in one location near their homes.
根據醫療保障體系和其他改革措施的規定，補償與療效直接掛鉤，只有在患者得到了多快好省的醫療服務之後，才能獲得經濟上的補償。城市健康集團通過建造和收購“無牀”醫院來與Cleveland 診所和其他綜合醫院競爭。 新建的醫院都帶停機坪，爲了更好的應對急性病症患者。“許多人都會選擇離家近 “無牀”醫院，爲了它全套專業的醫療服務。
"We know that convenience matters for patients," Boutros said. "They would like to do the least amount of travel between themselves and the health care organization. The closer you are, the more likely you are to have a closer relationship with them."
Boutros說：“我們都知道便捷的醫療服務對於一個患者來說多麼的重要，要儘量減少他們在醫療機構輾轉的次數，你只要能提供更便捷的服務，那麼你就能贏得這部分患者的青睞。”
