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Providers see shift to outpatient care

Reimbursement cuts have biggest impact

Health systems foresee a major shift this year from inpatient admissions to treatment in outpatient settings as they overhaul care delivery models to meet healthcare reform changes, according to the Premier healthcare alliance.

In its spring 2013 Economic Outlook, 69 percent of the 530 hospital executives and practice area managers who responded to the survey projected an increase in 2013 outpatient volume compared to last year, Premier said in a news release Monday. Only 35 percent of the respondents anticipate an increase in inpatient volume in 2013 compared to last year, a 30 percent decrease from predictions in 2012.

Those who project lower inpatient volume this year rose 28 percent since the same period in 2012. A third of hospital executives and managers cited healthcare legislation and mandates as the biggest driver not only of the patient shift but also 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 Mike Alkire, Premier chief operating officer, in the press release. “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.”

About half of respondents, or 48 percent, cited reimbursement cuts as having the greatest impact on their health systems, up 5 percent from last year and 10 percent from six months ago.

Overall, the capital investment outlook changed only slightly from last year’s report. Forty percent of respondents projected 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 forecast a decrease in capital spending decrease, up from 35 percent in spring 2012.

However, the largest capital investment over the next year is going toward health IT and telecommunications, according to almost 43 percent of respondents, up 21 percent from two years ago.

Still, 32 percent said that they were 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, in the press release. “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. But nearly 27 percent currently do not plan to pursue the ACO model and may choose other forms of clinical integration, such as bundled payment, care management fees or pay-for-performance, the report said.

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