Insights from a Chief Medical Officer – Challenges with the Outpatient Transition

Provider Challenges as More Procedures Shift Outpatient 

The CMO identified several challenges and opportunities for MedTech and digital health companies in the evolving outpatient environment. These include:

GPO Compliance in Outpatient Setting

The hospital’s GPO has strict guardrails around vendors’ access to providers and contracts for devices and software. The CMO says that vendors have to work through the GPO to get their products approved and contracted, and that the hospital has a new product committee that reviews the products based on their contribution margin and patient outcome. The hospital has to comply with the minimum percentage requirements for certain product categories that are contracted at the regional or national level, which is complicated by the shift of purchasing to outpatient settings.

Education and Training

The hospital’s providers need education and training on the new products, especially if they are complex or innovative. The CMO says that vendors must provide education and training for the providers, as well as data analytics on the providers’ skill sets, time in the OR, length of stay and quality metrics. This presents a challenge as more procedures shift outpatient.

Hospital Quality Metrics

The hospital’s patient population is becoming sicker and more complex, as the healthier patients are shifted to the ASC or FSD. The CMO says that this poses a challenge for the hospital’s quality metrics, as the patients who stay in the hospital have longer lengths of stay, increased risk of readmission, wound infection, re-exploration, etc. The CMO also says that this requires more advanced and specialized products and software that can cater to the needs of these patients. 

Billing and Coding

The hospital’s interest is in digital health solutions that can help them with billing and coding, length of stay and patient engagement. The CMO says that the hospital is looking for digital health solutions that can help them with the appropriate documentation, coding, DRG capture, and revenue generation, as well as predictive modeling for length of stay and patient discharge. The CMO also says that the hospital is looking for digital health solutions that can help them with patient education, communication and satisfaction, especially for the outpatient procedures.

Opportunities for MedTech and Digital Health Companies

Outpatient procedures are expected to continue to grow in the next few years, as hospital reimbursement and product innovation continue to improve care in outpatient settings. This presents both challenges and opportunities for MedTech and digital health companies that want to support the hospitals in this continued transition. MedTech and digital health companies must continue to evolve their go-to-market models to support providers in what is a very fragmented non-acute market by doing the following:

1. Companies should size the non-acute market relative to acute care  
2. They should calibrate their non-acute roles and balance of resources across care settings to ensure providers have the support they need
3. They should utilize advanced marketing tactics that help drive awareness of their products in a more efficient manner
4. Finally, it is critical for them to connect the acute and non-acute settings

Providers must operate in a way that accommodates the transition of patient volumes to outpatient. MedTech and Digital Health companies should be aware of the care continuum providers face and avoid disjointed approaches to supporting providers that cross the continuum.