What is a micro-hospital, and could it be the future of health care in the Lehigh Valley?
When it opens next year, Lehigh Valley Health Network’s newest hospital will have many of the most widely used amenities patients come to expect when seeking emergency care — but on a much smaller scale.
Lehigh Valley Hospital–Macungie will be the first so-called micro-hospital in the Lehigh Valley, and is part of a growing, national trend of smaller hospitals being built to provide for basic health care needs in underserved communities, especially rural ones.
While Lower Macungie isn’t considered a rural or underserved area, Brian Nester, LVHN’s president and CEO, said the new facility in the township will serve as a bridge between LVHN’s ExpressCAREs and its larger hospitals. He and other LVHN officials said they expect shorter emergency department wait times, faster inpatient admissions, a reduced length of stay for patients and reduced cost to patients as a result.
For LVHN, the concept behind the Lower Macungie hospital and a similar one proposed in Whitehall Township — but on hold after being rejected by township officials — is just one way to better serve patients in the Lehigh Valley.
Chad Meyerhoefer, a Lehigh University professor of economics, said some health networks have been able to find success with micro-hospitals in relatively densely populated suburban areas by filling a niche that isn’t already met by other models.
He said one major advantage for patients is that the hospitals can provide care for more serious conditions than an urgent care without the wait times generally associated with the emergency room at a traditional hospital.
But the model has yet to be widely accepted.
“I haven’t seen explosive growth in these facilities,” Meyerhoefer said. “Obviously they’re not inexpensive to build and there are some economies of scale in treating patients in acute care settings. There isn’t going to be as many market areas where this makes sense as there might be for urgent care in general. It’s not a revolutionary, new type of service delivery model that we can expect to see everywhere, but in certain places, it does seem to be sustainable and work pretty well.”
What is a micro-hospital?
Though LVHN has stopped short of calling LVH–Macungie a micro-hospital — instead referring to it as a “neighborhood hospital” — it meets the state’s requirements for a micro-hospital.
The Pennsylvania Department of Health issued its earliest guidance related to micro-hospitals in 2019 and updated it in March.
The state requires at least 10 acute care beds, 10 emergency department treatment rooms and imaging services. The 22,194-square-foot LVH–Macungie will have 11 emergency department beds and 10 inpatient beds, along with a laboratory, imaging center and pharmacy.
It will be staffed 24 hours a day, seven days a week and be equipped to stabilize and transfer patients that need more advanced care as well as accommodate multi-day inpatient stays.
To comply with the state’s other guidelines for a micro-hospital, LVH-Macungie and any other LVHN-operated micro-hospitals to come also will need:
at least one room for isolation from airborne infections.
at least one physician and one registered nurse as well as other staff on-site at all times to meet the needs of patients and provide observation.
at least one physician and one registered nurse with qualified emergency care experience in the emergency department at all times along with any other necessary staff.
LVH-Macungie’s ER will have an individual examination and treatment room for obstetrics and gynecology needs as well as another room for psychiatric and behavioral health needs. Those rooms will be equipped to provide care on an emergency outpatient basis or stabilize for transfer to Cedar Crest but will not be equipped to care for OB-GYN needs and psychiatric or behavioral health needs on an inpatient basis.
LVHN does not have projections at this time on how much money patients could save, but Meyerhoefer said because micro-hospitals don’t need to have all the services, features and staff a traditional acute care hospital would, the result is lower overhead. Meyerhoefer said data he has seen shows the cost of care at micro-hospitals is generally between the cost of urgent cares and more traditional hospitals with emergency rooms.
Brian Downs, spokesperson for LVHN, said LVHN’s neighborhood hospitals should also help alleviate some of the patient load at Cedar Crest and other LVHN acute care hospitals while providing acute care services closer to these communities. LVH–Cedar Crest has the highest level adult and pediatric trauma certification in the region and many patients who need the highest level of emergency medical and trauma care are taken to Cedar Crest even if they are coming from a few counties away.
Meyerhoefer said having a hospital that can funnel in patients who don’t need the highest levels of emergency care but can still stabilize patients in more serious cases and prepare for transfer has proven advantageous for health care providers elsewhere.
The case for, and against, micro-hospitals
He said micro-hospitals started popping up in certain markets about a decade ago, and rose to greater prominence nationally between 2017 and 2019.
LVHN is not the only health network in the state that sees value in micro-hospitals. Maggi Barton, spokesperson for the Pennsylvania Department of Health, said the state has no formal system for tracking micro-hospitals, but about seven across the state operate consistent with the guidelines.
Allegheny Health Network operates four “neighborhood hospitals” in Allegheny and Westmoreland counties. Penn Highlands Healthcare is building an 85,000-foot micro-hospital in Centre County just outside of State College that is expected to be completed in late 2023.
However, not all health networks have embraced the concept. Officials with St. Luke’s University Health Network said where other health networks see opportunity, they see pitfalls and drawbacks.
Robert Martin, St. Luke’s senior vice president and chief strategy officer, said there are many reasons why the micro-hospital model doesn’t make sense to the network from an operational and business standpoint.
One is that the network does not believe these facilities would help alleviate strain on emergency rooms at larger hospitals. The problem St. Luke’s faces isn’t a lack of beds in hospital emergency departments, it’s a shortage of health care professionals to care for the patients occupying ER and inpatient beds, he said.
He added proximity to emergency health care is not a problem in our region. In the area covering Lehigh, Northampton, Monroe, Carbon and Schuylkill counties, 82% of people can reach a St. Luke’s or LVHN-operated hospital after 20 minutes or less of driving. And within this five-county area, only about 3% of the population lives more than 30 minutes away from either network’s hospitals.
Martin said for just Lehigh and Northampton counties, proximity is even better; 94% are within 20 minutes of a hospital and only 1% is more than 30 minutes away.
He said St. Luke’s views ongoing efforts like using telemedicine to allow patients to get care in their own homes as a better use of resources.
Dr. Aldo Carmona, St. Luke’s senior vice president of clinical integration and chair of the department of anesthesia and critical care, said he doesn’t see micro-hospitals as a way of effectively improving health equity in underserved areas of the Lehigh Valley.
“If you’re talking about access to care in a community, for example, that has to walk to get their care, has to take a bus to get their care, that is in the inner city. Those are people that may actually have an access problem,” Carmona said. “I don’t believe that putting these in sort of suburban locations increases access to a population that may really need it.”
Carmona also said he believes transferring patients from one facility to another increases delays in care, and for patients with emergency or acute care needs it’s best if the first facility they arrive at can provide everything they need. He added there are times when patients need an escalation of care, andit isn’t ideal to have to transfer them when their condition is deteriorating due to something like sepsis.
“If you have an infection, there’s a certain percentage of those folks who will do worse with that infection, and so what happens then? Well, if they need an escalation of care, they’re also going to be transferred out to a step-down unit or a critical care unit,” Carmona said. “It’s very difficult to predict who’s going to end up with sepsis. It’s our No. 1 mortality in all hospital systems.”
Martin and Carmona both said micro-hospitals could create confusion for some patients.
“When we require people to think about ‘Oh, I have chest pain. Now is it chest pain where I should go to my primary care doctor or an urgent care center or micro-hospital or full-service hospital?’ People aren’t doctors, they don’t know that. We’re trying not to create so many decisions for them that they run the risk of making the wrong decision,” Martin said.
But LVHN is betting that LVH-Macungie and other micro-hospitals like it will cut down on confusion patients experience when seeking care by offering a smaller facility with none of the maze-like hallways that can be found in larger hospitals.
David Burmeister, LVHN’s chief medical officer, said the network is planning to provide extensive education to the emergency services providers it works with so they know which hospital destination is the best for each individual patient. He also said a patient’s condition would be stabilized before they are transferred.
“The neighborhood hospital emergency departments will be equipped to handle any emergency that presents. They will be able to stabilize and provide initial treatment to any patient regardless of their disease, illness or injury,“ Burmeister said. “However, once that stabilization occurs they may be transferred for definitive care.”
He said patients that meet the criteria for a trauma center, burn center or comprehensive stroke center should be initially transported to Cedar Crest.
Burmeister said LVHN has already considered potential staffing challenges. Recruitment is already occurring for LVH-Macungie despite the expected opening date being about one year away and he said LVHN is working with entities outside the network to ensure it will have the staff to open.
Meyerhoefer added that some medical professionals may end up preferring micro-hospitals.
“The difficulties we have with staffing pertains to burnout and high-stress environments and because these are smaller facilities, they could be lower-stress environments, the level of complexity isn’t as much, which means nursing staff doesn’t need to focus on as many different types of treatments,” he said. “As far as commuting goes, they’re in locations where people who would work in a hospital tend to live.”