Survey: Shift from inpatient to outpatient admissions expected

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.

Just over one-third (35 percent) of 530 survey respondents—primarily hospital C-suite, and materials and practice area managers—projected 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.

More than two-thirds (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 COO 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.”

When asked where the largest capital investment is expected to be made over the next year, almost 43 percent of respondents cited healthcare IT/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 in 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.”

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.

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 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.

Access the complete results here.