The Hybrid Hospital: Balancing On-Site and Remote Hospitalization

Abstract

Hybrid hospitals offer on-site and remote hospitalization through telemedicine. These new healthcare models require novel operational policies to balance costs, efficiency, and patient well-being. Our study addresses two first-order questions: (i) how to direct patient admission and call-in based on individual characteristics and proximity and (ii) how to determine the optimal allocation of medical resources between these two hospitalization options and among different patient types. We develop a model that uses Brownian Motion to capture the patient's health evolution during remote/on-site hospitalization and during travel. Under cost-minimizing call-in policies, we find that remote hospitalization can be cost-effective for moderately distant patients, as the optimal call-in threshold is non-monotonic in the patient's travel time. Subject to scarce resources, the optimal solution structure becomes equivalent to a simultaneous, identically sized increase of remote and on-site costs under abundant resources. When limited resources must be divided among multiple patient types, the optimal thresholds shift in non-obvious ways as resource availability changes. Finally, we develop a practical and efficient policy that allows for swapping an on-site patient with a remote patient when the latter is called-in and sufficient resources are not available to treat both on-site. Contrary to the widely held view that telemedicine can mitigate rural and non-rural healthcare disparities, our research suggests that on-site care may actually be more cost-effective than remote hospitalization for patients in distant locations, due to (potentially overlooked) risks during patient travel. This finding may be of particular concern in light of the growing number of ``hospital deserts'' amid recent rural hospital closures, as these communities may in fact not be well-served through at-home care.