Director of Marketing
Since the 2008 recession, we have observed a steady decline in the popularity of inpatient care, and we know it will continue to impact the future of healthcare.
The stats
- The number of inpatient hospital facilities decreased by 6 percent, and the total number of inpatient hospital beds dropped 47 percent from December 1990 to December 2014, according to the CMS.
- Between 2005 and 2014, the inflation-adjusted mean cost-per-inpatient-stay increased by 12.7 percent, from $9,500 to $10,900.
- There were an average of 2,174 outpatient visits per 1,000 people in 2014, up from an average of 2,000 visits in 2007.
The drivers
- Patients want cheaper and more convenient care
As patients assume more of their own healthcare costs, ambulatory settings are increasingly attractive to them. Patients often find these settings to be more convenient, more efficient and less costly than inpatient treatment options are.
- Pressure on hospitals to reduce readmissions
The Hospital Readmission Reduction Program (HRRP) was established in 2012 as part of the Affordable Care Act to help patients avoid unnecessary and avoidable hospital readmissions. This program financially penalizes hospitals if their readmission rates for certain illnesses are higher than expected.
- New technology and treatment methods
As modern treatment methods are developed, inpatient care becomes increasingly obsolete. An increasing number of procedures can be performed at lower costs on an outpatient basis because of technological advances. Other new technology has made virtual visits and telehealth more efficient and convenient than traditional medical care is, too.
- Emphasis on prevention, proactive care and population health
Pay for performance and risk-based contracting provide incentives for health systems to invest in population health initiatives as well as preventative care.
How are hospitals responding?
- Better use of staff
Many organizations are accustomed to the fee-for-service environment, relying on a relatively straightforward staffing structure: they deliver support to physicians, who conduct the majority of patient–provider interactions. But the future of healthcare is likely more decentralized and more focused on population health. Nurses, physician assistants, care managers, social workers, behavioral health experts and specialists will likely all be deeply involved in coordinating services and achieving goals for an individual patient.
In addition, physicians will partner with patients in healthcare more than ever before. This will create an environment where physicians interact with patients as part of a connected care network. “Flexing” — or giving fewer hours to some workers — will become more common where necessary. Nurses will provide more care for patients and communities such as in nurse-managed health centers.
- Digital solutions
Mobile health applications, often referred to as “mHealth” apps, enable nurses and patients to engage with healthcare on the go. More than 165,000 mHealth apps already exist. Applications allow nurses to stay connected to patients post-discharge via text, email and/or voice, and they have the potential to drastically reduce readmissions. Other applications can help manage chronic diseases such as diabetes, cardiovascular disease and epilepsy. Some mHealth products might be so effective that doctors begin to provide them by prescription.
- Extending outside the hospital
Hospitals are increasingly turning to mergers, acquisitions, collaborations and partnerships with ambulatory care providers to take a consistent, integrated approach to managing populations as they adjust to consumerism. This enables hospitals to decongest emergency departments and reduce the costs of care while increasing patient volumes by leveraging these ambulatory care centers as referral nodes.
As we move into a more consumer-centric future, more non-acute care will take place within the community, including at retail clinics, at home and through technology-enabled care such as telehealth and tech-enabled preventative care.
- Chronic disease management strategies
Patients with one or more chronic conditions can seek care from the nearest retail clinic. Uninsured patients can access inexpensive care, and insurers can incentivize patients to seek care in these facilities as opposed to in primary care clinics.
- Population health initiatives
Providers must work to understand their patient population and prevalent risk factors. Providers can then identify their highest-risk individuals and target appropriate proactive interventions as necessary. Depending on the population, targeting smoking cessation, diabetes, obesity or vaccination rates as population health initiatives could lessen the cost of care and lead to reduced readmission rates.
