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，然后馬上就能回家，一點都不麻煩。現(xiàn)在的手術(shù)越來越微創(chuàng)，康復(fù)時間大大縮短，一種新型的“無床”醫(yī)院便應(yīng)運而生。除了沒有過夜的地方，其他配設(shè)備與傳統(tǒng)醫(yī)院無異：手術(shù)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(tǒng)的首席執(zhí)行官Akaram醫(yī)生說，“這種醫(yī)院的出現(xiàn)降低了成本與感染的風(fēng)險，治療后人們在家休養(yǎng)有助于他們恢復(fù)。”不久前，在Cleveland的附近就開設(shè)了造價4800萬美元的“無床”醫(yī)院，他預(yù)計第一年的就診人數(shù)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.

隨著這種門診服務(wù)日益成為趨勢，美國的醫(yī)療體系從根本上發(fā)生了改變。都市健康的部分資金來自納稅人，醫(yī)療補助計劃中的很大一部分人都享受著它的服務(wù)。數(shù)據(jù)顯示，在過去的4年，它就診總?cè)藬?shù)上升了40%，從85萬上升到12萬。

Outpatient visits, experts say, subsidize more expensive inpatient treatment.But 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(jié)約下來的資金能補貼需要花大錢醫(yī)治的住院病人。但是也有人擔(dān)心隨著“無床”的普及，會成為醫(yī)院的斂財工具，病人得不到應(yīng)有的醫(yī)療服務(wù)，同時還會占用住院病人的醫(yī)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(yī)療服務(wù)質(zhì)量與支付改革中心”的首席執(zhí)行官Harold說，那些經(jīng)過治療仍然需要后續(xù)住院病人，他們應(yīng)該要去哪里得到資金以及醫(yī)療的支持和幫助？這個問題尚待解決。開設(shè)“無床醫(yī)院”的初衷是為了減輕聯(lián)邦政府和個人的醫(yī)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.

因為各種五花八門的檢查，在醫(yī)院的花費很高。而且門診和住院所享受的服務(wù)也是截然不同的。“無床”醫(yī)院的出現(xiàn)與所提倡的簡化治療的過程的理念是一致的。數(shù)年前，斯隆凱特靈癌癥中心的醫(yī)生們?yōu)榱双@得更多手術(shù)空間而做了一次頭腦風(fēng)暴，這也是將常規(guī)手術(shù)標(biāo)準(zhǔn)化的一次嘗試，這些手術(shù)包括，乳房切除手術(shù)，術(shù)后不需要再醫(yī)院過夜。終于在曼哈頓東北角建成了杰西羅伯森外科中心，一棟16層小樓，供門診病人手術(shù)，有28張臨時休息床，大部分病人都能在術(shù)后規(guī)定的時間內(nèi)離開醫(yī)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(jù)醫(yī)療保障體系和其他改革措施的規(guī)定，補償與療效直接掛鉤，只有在患者得到了多快好省的醫(yī)療服務(wù)之后，才能獲得經(jīng)濟上的補償。城市健康集團通過建造和收購“無床”醫(yī)院來與Cleveland 診所和其他綜合醫(yī)院競爭。 新建的醫(yī)院都帶停機坪，為了更好的應(yīng)對急性病癥患者。“許多人都會選擇離家近 “無床”醫(yī)院，為了它全套專業(yè)的醫(yī)療服務(wù)。

"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(yī)療服務(wù)對于一個患者來說多么的重要，要盡量減少他們在醫(yī)療機構(gòu)輾轉(zhuǎn)的次數(shù)，你只要能提供更便捷的服務(wù)，那么你就能贏得這部分患者的青睞。”

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，然后馬上就能回家，一點都不麻煩。現(xiàn)在的手術(shù)越來越微創(chuàng)，康復(fù)時間大大縮短，一種新型的“無床”醫(yī)院便應(yīng)運而生。除了沒有過夜的地方，其他配設(shè)備與傳統(tǒng)醫(yī)院無異：手術(shù)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(tǒng)的首席執(zhí)行官Akaram醫(yī)生說，“這種醫(yī)院的出現(xiàn)降低了成本與感染的風(fēng)險，治療后人們在家休養(yǎng)有助于他們恢復(fù)。”不久前，在Cleveland的附近就開設(shè)了造價4800萬美元的“無床”醫(yī)院，他預(yù)計第一年的就診人數(shù)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.

隨著這種門診服務(wù)日益成為趨勢，美國的醫(yī)療體系從根本上發(fā)生了改變。都市健康的部分資金來自納稅人，醫(yī)療補助計劃中的很大一部分人都享受著它的服務(wù)。數(shù)據(jù)顯示，在過去的4年，它就診總?cè)藬?shù)上升了40%，從85萬上升到12萬。

Outpatient visits, experts say, subsidize more expensive inpatient treatment.But 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(jié)約下來的資金能補貼需要花大錢醫(yī)治的住院病人。但是也有人擔(dān)心隨著“無床”的普及，會成為醫(yī)院的斂財工具，病人得不到應(yīng)有的醫(yī)療服務(wù)，同時還會占用住院病人的醫(yī)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(yī)療服務(wù)質(zhì)量與支付改革中心”的首席執(zhí)行官Harold說，那些經(jīng)過治療仍然需要后續(xù)住院病人，他們應(yīng)該要去哪里得到資金以及醫(yī)療的支持和幫助？這個問題尚待解決。開設(shè)“無床醫(yī)院”的初衷是為了減輕聯(lián)邦政府和個人的醫(yī)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.

因為各種五花八門的檢查，在醫(yī)院的花費很高。而且門診和住院所享受的服務(wù)也是截然不同的。“無床”醫(yī)院的出現(xiàn)與所提倡的簡化治療的過程的理念是一致的。數(shù)年前，斯隆凱特靈癌癥中心的醫(yī)生們?yōu)榱双@得更多手術(shù)空間而做了一次頭腦風(fēng)暴，這也是將常規(guī)手術(shù)標(biāo)準(zhǔn)化的一次嘗試，這些手術(shù)包括，乳房切除手術(shù)，術(shù)后不需要再醫(yī)院過夜。終于在曼哈頓東北角建成了杰西羅伯森外科中心，一棟16層小樓，供門診病人手術(shù)，有28張臨時休息床，大部分病人都能在術(shù)后規(guī)定的時間內(nèi)離開醫(yī)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(jù)醫(yī)療保障體系和其他改革措施的規(guī)定，補償與療效直接掛鉤，只有在患者得到了多快好省的醫(yī)療服務(wù)之后，才能獲得經(jīng)濟上的補償。城市健康集團通過建造和收購“無床”醫(yī)院來與Cleveland 診所和其他綜合醫(yī)院競爭。 新建的醫(yī)院都帶停機坪，為了更好的應(yīng)對急性病癥患者。“許多人都會選擇離家近 “無床”醫(yī)院，為了它全套專業(yè)的醫(yī)療服務(wù)。

"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(yī)療服務(wù)對于一個患者來說多么的重要，要盡量減少他們在醫(yī)療機構(gòu)輾轉(zhuǎn)的次數(shù)，你只要能提供更便捷的服務(wù)，那么你就能贏得這部分患者的青睞。”