医院越来越洋气，早上换个膝盖，晚上去蹦迪

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.

来吧，换个膝盖，然后马上就能回家，一点都不麻烦。现在的手术越来越微创，康复时间大大缩短，一种新型的“无床”医院便应运而生。除了没有过夜的地方，其他配设备与传统医院无异：手术室、输液室、甚至还有急救室和停机坪。

"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."

来自都市健康系统的首席执行官Akaram医生说，“这种医院的出现降低了成本与感染的风险，治疗后人们在家休养有助于他们恢复。”不久前，在Cleveland的附近就开设了造价4800万美元的“无床”医院，他预计第一年的就诊人数在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.

随着这种门诊服务日益成为趋势，美国的医疗体系从根本上发生了改变。都市健康的部分资金来自纳税人，医疗补助计划中的很大一部分人都享受着它的服务。数据显示，在过去的4年，它就诊总人数上升了40%，从85万上升到12万。

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.

专家说，门诊病人节约下来的资金能补贴需要花大钱医治的住院病人。但是也有人担心随着“无床”的普及，会成为医院的敛财工具，病人得不到应有的医疗服务，同时还会占用住院病人的医疗资源。

"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.

“医疗服务质量与支付改革中心”的首席执行官Harold说，那些经过治疗仍然需要后续住院病人，他们应该要去哪里得到资金以及医疗的支持和帮助？这个问题尚待解决。开设“无床医院”的初衷是为了减轻联邦政府和个人的医疗支出。

"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.

因为各种五花八门的检查，在医院的花费很高。而且门诊和住院所享受的服务也是截然不同的。“无床”医院的出现与所提倡的简化治疗的过程的理念是一致的。数年前，斯隆凯特灵癌症中心的医生们为了获得更多手术空间而做了一次头脑风暴，这也是将常规手术标准化的一次尝试，这些手术包括，乳房切除手术，术后不需要再医院过夜。终于在曼哈顿东北角建成了杰西罗伯森外科中心，一栋16层小楼，供门诊病人手术，有28张临时休息床，大部分病人都能在术后规定的时间内离开医院。

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.

根据医疗保障体系和其他改革措施的规定，补偿与疗效直接挂钩，只有在患者得到了多快好省的医疗服务之后，才能获得经济上的补偿。城市健康集团通过建造和收购“无床”医院来与Cleveland 诊所和其他综合医院竞争。 新建的医院都带停机坪，为了更好的应对急性病症患者。“许多人都会选择离家近 “无床”医院，为了它全套专业的医疗服务。

"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说：“我们都知道便捷的医疗服务对于一个患者来说多么的重要，要尽量减少他们在医疗机构辗转的次数，你只要能提供更便捷的服务，那么你就能赢得这部分患者的青睐。”