Southlake hospital adapts to new federal insurance regulations

The long-reaching effects of federal health care reforms has affected every level of the U.S. health care system, but the Texas Health Harris Methodist Hospital in Southlake plans to use what some see as a major roadblock to its advantage.

As part of the Affordable Health Care Act, physician-owned hospitals may not add to the number of inpatient beds, procedure rooms or operating rooms. They also cannot obtain a Medicare provider number if they did not hold one before the reform went into effect in 2010.

"A hospital could be owned by a businessman, it could be owned by a health system, but if they're owned by a physician the restrictions are that you are unable to add inpatient beds, procedure rooms or operating rooms," THHMH President Traci Bernard said. "I wouldn't say it's a moratorium: it's just a restriction on the ability to do that."

According to Bernard, the physican-owned hospital had its Medicaid qualification prior to the reform taking effect, so it can still accept Medicare/Medicaid patients. About 43 percent of the patients that come through the THHMH doors use Medicare or Medicaid.

THHMH expansion plans were also put to a halt in 2010 when the reforms took effect.

"We actually had plans to add two more operating rooms and go up to 30 beds, which would have been an additional 14 inpatient beds in 2010," Bernard said.

Because of the regulations, Bernard and the hospital have had to institute some novel changes in the way it operates. Most notably the hospital works with physicians to perform afternoon surgeries, which is something that normally does not happen in the industry.

Another way the hospital maximizes what it can offer is through scheduling and patient flow.

"We try to manage the flow into beds through the seven-day week," Bernard said. "Most hospitals would just do on Monday as many inpatient cases as they wanted. We have to try and make sure that the surgical cases are managed so that as patients are discharged and another patient is admitted."

Inpatient vs. outpatient

As surgical technology and techniques advance, many procedures that would have required multiday stays for recovery now require less than 23 hours in recovery. That number is important for the hospital because if a patient stays for less than 23 hours, it is considered an outpatient procedure.

"There is not a restriction on building outpatient beds or expanding outpatient services," Bernard said. "So instead of licensing beds as inpatient, we have the opportunity to hold the patient in an observation bed."

"If that evolution continues I think we are going to see more and more of what we see as an inpatient surgical procedure become more of a defined outpatient procedure."

The lack of restrictions on outpatient beds gives the hospital the opportunity to expand those services. However, the hospital has not yet committed to switching to that model of care.

"We're watching health care evolution and are trying to stay ahead of that curve," Bernard said. "It's not necessarily something that you can plan: it's just the way health care is moving out of the traditional model where surgical patients stay in the hospital."