Providers Expect Significant Inpatient to Outpatient Admission Shift in 2013

April 29, 2013 - Hospitals and health systems nationwide are projecting a significant shift in 2013 admissions from inpatient to outpatient settings as they transition toward new care delivery models, according to the Premier healthcare alliance’s spring 2013 Economic Outlook.

Only 35 percent of 530 survey respondents--primarily hospital C-suite, and materials and practice area managers--are projecting an increase in inpatient volume in 2013 compared to 2012, a 30 percent decrease from predictions a year ago. Respondents projecting a decrease in inpatient volume in 2013 compared to 2012 rose 28 percent over the same period.

Accordingly, 69 percent of respondents are projecting an increase in 2013 outpatient volume compared to 2012.

This trend is likely being driven by healthcare legislation and mandates, cited by a third of respondents as the biggest driver of healthcare costs.

“With reimbursement cuts and changes in care delivery threatening today’s status quo, healthcare providers face a significant change imperative as they transition toward more accountable, value-based care models,” said  Premier Chief Operating Officer Mike Alkire. “Ensuring patients are cared for in the most efficient manner--without compromising quality--is key to success. This means more care is being shifted to less intensive and expensive outpatient care sites, with lower reimbursement rates.”

HIT expenditures

When asked where the largest capital investment is expected to be made over the next year, almost 43 percent of respondents cited healthcare information technology/telecommunications, up 21 percent from two years ago.

Still, 32 percent reported being unable to share data across the continuum of care, which is essential for effective care coordination.

“We need to know everything we can about a patient’s care--what has gone on before and what’s coming up,” said Eric Bieber, MD, chief medical officer, University Hospitals (Cleveland). “Otherwise, we have variation and redundancies that may degrade care quality and efficiency. The closer we can get to real-time information and get it in the hands of providers, the more likely the right things will be done and opportunities won’t be missed.”

Additional results from the spring 2013 Economic Outlook survey

ACO - Yes or no?

  • Almost 22 percent of respondents are in an accountable care organization (ACO), with 55 percent planning to be by the end of 2014.
  • Nearly 27 percent currently do not have plans to pursue the ACO model, and may choose other forms of clinical integration such as bundled payment, care management fees or pay-for-performance.

Weight of waste

  • When asked about the biggest drivers of healthcare costs, overutilization of products and services (29 percent, up 22 percent from a year ago) and lack of clinical care coordination (22 percent, up 21 percent from a year ago) were often cited.

Reimbursement cuts

  • Reimbursement cuts were cited by 48 percent of respondents as having the greatest impact on their health systems, up 5 percent from last year and 10 percent from six months ago.

Capital spending projections

  • 40 percent of respondents are projecting their capital spending to increase over the next 12 months as compared to last year, down slightly from 43 percent a year ago.
  • Almost 37 percent are projecting a capital spending decrease based on the same criteria, up from 35 percent in spring 2012.

About the Economic Outlook

Premier’s Economic Outlook highlights emerging economic and industry trends impacting alliance members and the overall industry. The publication leverages subject matter expertise to build consensus from diverse points of view while highlighting best practices and strategies needed to drive performance improvement.

The spring 2013 edition includes insights from Premier member experts, including:

  • Eric Bieber, MD, chief medical officer, University Hospitals (Cleveland);
  • Michelle Darnell, vice president of systems improvement, St. Mary’s Good Samaritan Inc. (Mt. Vernon/Centralia, Ill.);
  • Tim Kirby, executive vice president of system alignment and integration, Methodist Health System (Dallas);
  • Mark Laney, MD, president and CEO, Heartland Health (St Joseph, Mo.);
  • Keith Suedmeyer, director of social services, St. Mary’s Good Samaritan Inc. (Mt. Vernon/Centralia, Ill.); and
  • Ferdinand Velasco, MD, and chief medical information officer, Texas Health Resources (Arlington, Texas).

Source: Premier healthcare alliance