Contrary to Fitch’s expectation, the implementation of the Patient Protection and Affordable Care Act was not cited as the primary factor influencing capital spending. Instead, 95 percent of hospitals said potential and actual decreases in Medicare and Medicaid reimbursements are moderately or greatly influencing their capital spending plans. The top five capital expenditure factors were:
• Potential and actual decreases in Medicare and Medicaid reimbursement rates.
• The shift of services from the inpatient setting to the outpatient setting.
• The impending implementation of the PPACA.
• The current state of the economy.
• Increasing patient co-pays and deductibles.
Although many health IT initiatives, such as electronic health records and meaningful use of other IT systems, are at the forefront of hospitals’ capital expenditure plans, hospitals indicated that physician alignment and outpatient capacity plans were also important to future capital spending.
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