The Decline of the Inpatient: 5 Observations

Hospital inpatient admissions are undoubtedly trending downward, and the transition to an outpatient and wellness model of healthcare will further deteriorate those volumes, according to a study from financial consulting firm Kaufman Hall.

Researchers with Kaufman Hall studied inpatient and outpatient data from 2010 to 2012 at the 71 hospitals in the seven-county area surrounding Chicago. The region has 8.5 million people, which represents about two-thirds of all Illinois residents.

Here are five key observations from the firm's study.

1. Inpatient admissions declined across all age groups. Overall inpatient utilization at Chicago-area hospitals dropped by about 4.6 percent from 2010 to 2012 (from approximately 1.02 million discharges to 970,000 discharges). The authors said one of the more surprising results was that inpatient admissions declined across all age groups. For those aged 45-64, inpatient rates fell 5 percent, while rates for Medicare-eligible adults (65 and older) declined more than 8 percent.

2. Almost all service lines experienced lower utilization rates. Kaufman Hall analysts found the median inpatient rate drop across 33 service lines was 5 percent, and volume declines touched almost every service line studied. Inpatient rates fell the most in cardiology, gastroenterology, general medicine, OB/GYN and psychiatry.

3. Services lines with effective outpatient care alternatives dropped the most. The study looked at "ambulatory case-sensitive admissions," which are patient admissions in which solid outpatient care can potentially prevent hospitalization. Utilization rates for ACSAs dropped more than for other cases within the same service lines, according to the report. For example, ACSAs in interventional cardiology decreased 23.5 percent compared with an inpatient decline of 12.7 percent for all other interventional cardiology cases.

4. Accountable care and risk-based models are contributing to the decline. Accountable care organizations, risk-based payment contracts and performance-based physician incentives are prominent in the Chicago region. Researchers found patients treated under these models had lower lengths of stay and fewer avoidable admissions.

5. Inpatient admissions will continue to significantly lessen. If Chicago-area hospitals were able to eliminate inpatient admissions for 139,000 ACSA patients and 96,000 patients with one-day stays recorded in 2012, the market would experience a 24 percent reduction of inpatient discharges. "In other words, the region could lose up to another 1,900 inpatients per day," according to the report. "This provides an early signal that the greater Chicago region — and by analogy many other regions in the nation — are likely not to need as many hospital beds or hospitals going forward."

More Articles on Hospital Admissions:
3 Observations Surrounding Healthcare Finance in 2014
The State of Healthcare Finance: 9 Major Survey Findings From Hospital CFOs
15 Statistics on Inpatient Hospitalization Costs

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