Creating HOPD

[po_boy]

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Apologies if there have been dedicated threads on this topic.

It seems that if one were to create a HOPD from the ground up that most recommend:

- 5-6 exam rooms
- one procedure room next to the exam rooms
- procedure room dimensions at least 15x15
- 2x MAs

Would anyone agree or disagree with the above?
What changes would you make?
Anything else important missing?

Thanks!

 

[BobBarker]

If they are going to want to do sedation, you need a little area for IV placement and a recovery area. Sedation slows everything down though and that will only hurt your throughput.

You could offer but discourage sedation by only doing once a month at the hospital.

 

[BobBarker]

Public bathroom adjacent to waiting. UDS bathroom and employee bathroom inside the office.

 

[BobBarker]

Break room.

 

[geauxg8rs]

If you can why not have two procedure rooms? You aren’t paying and can have you not be slowed by the hospital inefficiencies

 

[drusso]

Apologies if there have been dedicated threads on this topic.

It seems that if one were to create a HOPD from the ground up that most recommend:

- 5-6 exam rooms
- one procedure room next to the exam rooms
- procedure room dimensions at least 15x15
- 2x MAs

Would anyone agree or disagree with the above?
What changes would you make?
Anything else important missing?

Thanks!

Do you think HOPD's will still be a thing in 5 years?

 

[po_boy]

Do you think HOPD's will still be a thing in 5 years?

Why wouldn’t they be? What’s going to replace them ?

 

[BobBarker]

That doesn’t matter. I don’t think this is his first job. Make hay today. Most pain docs here retire around 60.

 

[nvrsumr]

Do you think HOPD's will still be a thing in 5 years?

I’m meeting with a system next week to discuss -strategic alignment

A 7% bump this year for a fraction of a fraction of my patients isn’t changing the future of continued consolidation in healthcare in my city

 

[DOctorJay]

Are there hospitals out there willing to create procedure rooms like this if they don’t get HOPD facility fees? My understanding is that these procedure rooms can no longer be built (unless you’re in very close proximity of an actual hospital).

 

[drusso]

Why wouldn’t they be? What’s going to replace them ?

HOPD expansion feels less like “the future” and more like the final expansion of legacy hospital real estate. High-deductible plans are now standard. First-dollar coverage is basically a museum exhibit. Patients are paying real money again and, unsurprisingly, are starting to ask why the same injection costs 2–3× more because it sits under a hospital tax ID.

Hospitals respond the only way they know how: add layers, add fees, add process. Throughput slows, overhead balloons, and everything becomes optimized for billing gravity rather than patient flow or experience. It works great when the patient is insulated from cost. That insulation is gone.

The dirty secret is that most “new” HOPDs are already being designed like office-based clinics anyway, just with enough compliance furniture bolted on to justify a facility fee. That alone should tell you where this is headed. Once SOS payment games get squeezed, there isn’t much left to defend the model for routine outpatient care.

The obvious fixes aren’t revolutionary. Pay the same for the same service regardless of the sign on the door. Make prices visible before care happens. Reward efficiency and outcomes instead of ownership status. Hospitals will still exist. They just won’t be able to subsidize everything with SOS arbitrage.

 

[BobBarker]

750 yards from parking lot to parking lot and you can keep adding on from new physician building to new physician building.

 

[SSdoc33]

Do you think HOPD's will still be a thing in 5 years?

HOPD expansion feels less like “the future” and more like the final expansion of legacy hospital real estate. High-deductible plans are now standard. First-dollar coverage is basically a museum exhibit. Patients are paying real money again and, unsurprisingly, are starting to ask why the same injection costs 2–3× more because it sits under a hospital tax ID.

Hospitals respond the only way they know how: add layers, add fees, add process. Throughput slows, overhead balloons, and everything becomes optimized for billing gravity rather than patient flow or experience. It works great when the patient is insulated from cost. That insulation is gone.

The dirty secret is that most “new” HOPDs are already being designed like office-based clinics anyway, just with enough compliance furniture bolted on to justify a facility fee. That alone should tell you where this is headed. Once SOS payment games get squeezed, there isn’t much left to defend the model for routine outpatient care.

The obvious fixes aren’t revolutionary. Pay the same for the same service regardless of the sign on the door. Make prices visible before care happens. Reward efficiency and outcomes instead of ownership status. Hospitals will still exist. They just won’t be able to subsidize everything with SOS arbitrage.

You cannot be impartial in this sphere.

And you aren’t seeing 50 percent Medicaid.

So you do your boutique practice.

Your analysis is erroneous and illegitimate

 

[drusso]

You cannot be impartial in this sphere.

And you aren’t seeing 50 percent Medicaid.

So you do your boutique practice.

Your analysis is erroneous and illegitimate

Facility fees rise
Deductibles wake patients up
Same shot, higher bill


Hospital badge gleams
Compliance furniture accrues
Flow quietly dies


Call it boutique care
When costs finally make sense
Efficiency wins


Subsidies disguised
Value language does the work
Accounting wins


Hospitals remain
But routine care drifts away
Bills tell the truth

 

[SSdoc33]

Facility fees rise
Deductibles wake patients up
Same shot, higher bill


Hospital badge gleams
Compliance furniture accrues
Flow quietly dies


Call it boutique care
When costs finally make sense
Efficiency wins


Subsidies disguised
Value language does the work
Accounting wins


Hospitals remain
But routine care drifts away
Bills tell the truth

An SOS haiku!

Well played.

You should sell your writing somehow. Seriously

 

[drusso]

An SOS haiku!

Well played.

You should sell your writing somehow. Seriously

I'm working on a book of poetry.

 

[Dr. Ice]

Not to worry, I’m sure treating the “functional spinal unit” will ultimately add up to all those facility fees….

 

[po_boy]

HOPD expansion feels less like “the future” and more like the final expansion of legacy hospital real estate. High-deductible plans are now standard. First-dollar coverage is basically a museum exhibit. Patients are paying real money again and, unsurprisingly, are starting to ask why the same injection costs 2–3× more because it sits under a hospital tax ID.

Hospitals respond the only way they know how: add layers, add fees, add process. Throughput slows, overhead balloons, and everything becomes optimized for billing gravity rather than patient flow or experience. It works great when the patient is insulated from cost. That insulation is gone.

The dirty secret is that most “new” HOPDs are already being designed like office-based clinics anyway, just with enough compliance furniture bolted on to justify a facility fee. That alone should tell you where this is headed. Once SOS payment games get squeezed, there isn’t much left to defend the model for routine outpatient care.

The obvious fixes aren’t revolutionary. Pay the same for the same service regardless of the sign on the door. Make prices visible before care happens. Reward efficiency and outcomes instead of ownership status. Hospitals will still exist. They just won’t be able to subsidize everything with SOS arbitrage.

Honestly, I don't have the knowledge or experience to fully grasp what you're saying. Feel free to dumb it down for a relatively young doc.


My understanding is that you either work in PP, HOPD, or PE. What's the alternative?

 

[drusso]

Honestly, I don't have the knowledge or experience to fully grasp what you're saying. Feel free to dumb it down for a relatively young doc.


My understanding is that you either work in PP, HOPD, or PE. What's the alternative?

I'm curious: Did your medical school have a lecture on Physician Enterprise or Business of Medicine?

 

[po_boy]

I'm curious: Did your medical school have a lecture on Physician Enterprise or Business of Medicine?

Absolutely not.

 

[drusso]

Not to worry, I’m sure treating the “functional spinal unit” will ultimately add up to all those facility fees….

Functional Spinal Unit Approach for Orthobiologic Injections for Low Back Pain - PubMed

Orthobiologic treatments offer a promising disease-modifying approach by addressing the entire FSU rather than isolated pain generators. Future research should focus on optimizing multitarget injection strategies, thereby standardizing treatment protocols.

pubmed.ncbi.nlm.nih.gov

 

[Dr. Ice]

Functional Spinal Unit Approach for Orthobiologic Injections for Low Back Pain - PubMed

Orthobiologic treatments offer a promising disease-modifying approach by addressing the entire FSU rather than isolated pain generators. Future research should focus on optimizing multitarget injection strategies, thereby standardizing treatment protocols.

pubmed.ncbi.nlm.nih.gov

View attachment 414094

Yes I know..I understand the rationale. Hopefully those doing it are charging for a single procedure rather than multiple.

Not to speak ill of the dead but I have a feeling FSU is going to turn many into baby Lutzs