PORTLAND, Ore. — Hospitals, like hotels, need to fill beds to stay in business.
A “no vacancy” sign, however, is not ideal.
If occupancy is too high, that could put the hospital at risk for overcrowding and necessitate diverting of patients who cannot wait several hours for a bed. If it's too low, that could make the operation financially unviable.
Yet there is no set range for the ideal occupancy because so much depends on what kinds of beds are full or available and the overall size of the health center.
“If a hospital is too empty, that’s stressful; if it’s too full, that’s stressful. Getting it exactly right hardly ever happens,” said Dr. Matthias Merkel, medical director of critical care and chief medical capacity officer at OHSU Hospital. “I’m sure there’s a sweet spot, but it varies in what area you’re looking at, either by service line or by level of care. All of these are complex intertwines.”
Business Journal Data Editor Brandon Sawyer ranked Oregon and Southwest Washington hospitals from highest to lowest occupancy in 2018, based on data from the Oregon Association of Hospitals and Health Systems. OHSU Hospital had an occupancy rate of 84.5 percent, while several other hospitals were in the 60 percent-70 percent range, and many others fell below that level.
Merkel said he doesn’t worry about the overall occupancy at OHSU so much as managing throughput and length of stay. He said a parking lot provides a good analogy.
“If it’s 50 percent full, it’s easy to find a spot,” he said. “The higher the parked number of cars, the harder it is. Go to the Portland Airport and there are visual cues to guide you to the deck with spaces, even though it’s very full.”
OHSU created a Mission Control Center in 2017 to manage bed flow in real time, not only at the main hospital on Marquam Hill but also at its partner hospitals: Hillsboro Medical Center and Adventist Medical Center. OHSU has been accepting more transfers after implementing the system, which is powered by GE Healthcare.
“The important thing is what is the right place for the patient and how can you deliver the right care and what are your options?” Merkel said. “Average occupancy isn’t the most helpful metric, which is why we changed from that to looking minute by minute.”
That might mean that, rather than transferring to a regular acute care bed, the patient remains longer in the ICU, where they can be cared for safely, and is discharged home directly from there.
“We’re doing less hand off,” Merkel said. “Health care as a whole is changing the narrative — how can I bring the care team to the patient independent of the location? It creates more flexibility in the system and the infrastructure around that.”
PeaceHealth Sacred Heart Medical Center at RiverBend in Springfield, had the highest occupancy rate in 2018, at 96.7 percent.
Officials at the hospital declined to comment for this story, but released a statement saying that the hospital has maintained high average occupancy “because it is a large regional medical center, offering many advanced medical services to patients from a broad geographical area.”
Sacred Heart at RiverBend is the only certified Comprehensive Stroke Center between Sacramento, Calif., and Portland and is a growing hub for pediatric specialty services, including pediatric surgery and pediatric cardiology, according to the statement. In addition, the hospital opened a 20-room guest house recently to provide a home away from home to families being cared for in Springfield and the sister hospital in Eugene.
PeaceHealth also operates a transfer center that’s similar to OHSU’s Mission Control called Access PeaceHealth to triage and coordinate requests for higher level of care within PeaceHealth and outside PeaceHealth, similar to an air traffic control center at an airport.
Oregon’s lowest-occupancy hospitals tend to be small, critical access facilities in rural areas with fewer than 50 beds. The issue may not be lack of demand but that those hospitals simply aren’t equipped to treat the most serious cases, since those services aren’t used every day. The patients needing the highest level care are, thus, transferred to larger hospitals that can provide the highest-acuity care.
In the future, more of those patients may be treated at their local hospitals, as telemedicine becomes more widely used, Merkel said. Stroke care is provided remotely throughout the state by OHSU and Providence Health & Services.
“How are we helping local communities to provide better care by assisting specialists with modern technology to provide care closer to home?” he said. “What is the right thing for the patient? We know being closer to family and home has a benefit.”
The Portland Business Journal is a KGW News partner.