Texas Health Harris Methodist

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."