Case Study: Clinical Reconfiguration


Cone Health needed to evaluate its clinical service lines and related distribution of bed capacity among its three Greensboro hospital campuses in conjunction with the relocation of women’s services. Ultimately, Cone was seeking a Clinical Reconfiguration and Master Bed Plan that supported efficient distribution of services among the campuses and incorporated clinical service strategy goals.


Cone Health partnered with Ascendient to assist with service reconfiguration and bed planning. Working through individual service lines teams, Ascendient engaged physicians and hospital leadership to evaluate technological and clinical changes affecting care delivery, assess market position, project service line patient volumes and, ultimately, service line bed need by level of care. As part of the dynamic process, other operational issues emerged that provided Cone with the opportunity to improve efficiencies, avoid costs, and improve patient satisfaction.

Data Disconnect

Early on, Ascendient and Cone uncovered a disconnect between bed need calculated using traditional planning formulas and the everyday reality that existed on Cone’s clinical nursing units. To explore the apparent discrepancy, Ascendient created a detailed patient census algorithm tool showing exactly where patients were each hour, each day, for an entire year. Critically important, this patient census included outpatients and observation patients housed on nursing units, in addition to inpatients. This disconnect led to the realization that traditional bed planning formulas and occupancy rates were ineffective given today’s shorter average lengths of stay. Using the patient census tool, Ascendient calculated a modified average daily census (ADC) that would raise target occupancy rates to allow Cone to maintain maximum efficiency and still accommodate patient demand most days of the year.


Projecting Emerging Population Health Needs

With a continued look into the future, Ascendient leveraged its proprietary, future- focused HealthytownTM statistical model to help Cone Health’s leadership better envision projected changes in inpatient service demand that would emerge under a different payment model. The analysis showed that bed demand would shift considerably in the coming years, with inpatient volume declining in certain specialty areas, as illustrated in Figure 1. These projections were evaluated by the service line leaders along with more traditional projections that did not factor into this shift in care delivery.

Cone’s service line leaders recognized that while long-term capacity needs may be reduced, neither the payment system nor the necessary delivery infrastructure was yet in place to support a complete transition to Healthytown in the immediate future. For example, hospitalists and other medicine specialties acknowledged that the primary care infrastructure is not sufficiently robust at present to accommodate the level of access required to drive down inpatient admissions.

Incorporating the Healthytown model provided a clear benefit by assuring that Cone’s leaders recognized the long-term demand for its service lines and could avoid overbuilding bed capacity. However, Cone also needed to address today’s demands while positioning the organization appropriately for the future. To balance these opposing points in time, Ascendient helped Cone develop a short-term Clinical Reconfiguration and Master Bed Plan, with an eye toward moving the organization to the long-term Plan through triennial updates. The short-term Plan essentially bridges today’s facility needs and constraints with tomorrow’s need for a greater focus on population health and diminished inpatient care.


As a result of the Clinical Reconfiguration and Master Bed Plan, Cone Health was able to avoid investing in new inpatient capacity for patient demand that is projected to decline over time, while realigning its clinical services across campuses. Ascendient and Cone Health’s novel, in-depth, integrated approach and discovery process facilitated more than just improved bed planning. The engagement illustrates the importance of revisiting and adjusting long-held assumptions and variables when planning to account for and prepare adequately for the coming changes in reimbursement and healthcare delivery that will dramatically impact hospitals, physicians, and other key stakeholders by next decade.

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