The Decline of Inpatient Care

We recently wrote about this trend as one of the largest in the healthcare industry for 2018, but this decline has been observed since the 2008 recession. We wanted to understand the drivers of this trend and how it impacts the future of healthcare.

The Stats

  • The number of inpatient hospital facilities decreased by 6 percent and total inpatient hospital beds have 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 was an average of 2,174 outpatient visits per 1,000 people in 2014, up from an average of 2,000 visits in 2007.
Infographic source: Frost & Sullivan

The Drivers

1. Patients want cheaper and more convenient care

As patients assume more of the cost of care, ambulatory settings are increasingly attractive. Patients find these settings more convenient, more efficient and less costly than inpatient treatment.

2. 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, established in 2012 as part of the Affordable Care Act, penalizes hospitals financially if readmission rates for certain illnesses are higher than expected.

3.  New technology and treatment methods

As modern treatment methods are developed, the need for inpatient care is reduced. Hospital inpatient care has been falling as an increasing number of procedures can be performed at lower costs on an outpatient basis because of technological advances.

New technology has made virtual visits and telehealth more efficient and convenient than traditional medical care.

4. Emphasis on prevention, proactive care and population health

Pay for performance and risk-based contracting provide incentives for systems to invest in population health initiatives as well as preventative care.

How are hospitals responding?

Source: Advisory Board
  1. Better use of staff

Many organizations are accustomed to the fee-for-service environment, relying on a relatively straight-forward staffing structure centered on delivering support to physicians, who conduct the majority of patient-provider interactions.  The future is likely more decentralized, and more focused on population health, with nurses, PAs, care managers, social workers, behavioral health experts, and specialists all deeply involved in coordinating services and achieving goals for an individual patient.

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, 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 – NMHCs.

2. Digital solutions

mHealth. Mobile health applications enable nurses and patients to check on health care process on the go. More than 165,000 mobile health apps already exist. Applications will allow nurses to stay connected to patients post discharge via text, email and/or voice, and have the potential to reduce readmissions drastically. Other applications can help manage chronic diseases such as diabetes, cardiovascular disease, and epilepsy. Some m-health products may prove so effective that doctors begin to provide them by prescription.

3. Extending outside the hospital

Hospitals are increasingly turning to mergers, acquisitions, collaborations and partnerships with ambulatory care providers to have a consistent, integrated approach to managing populations while adjusting to consumerism. This enables hospitals to decongest emergency departments and reduce costs of care while increasing patient volumes by leveraging these ambulatory care centers as referral nodes.

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.

4. 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 incent patients to seek care in these facilities as opposed to primary care clinics.

5. Population health initiatives

Providers must work to understand their patient population and what prevalent risk factors are present. 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 increasing vaccination rates as population health initiatives could lessen the cost of care and lead to reduced readmissions.

Top 5 Healthcare Trends That Aren’t Going Anywhere

  • Patient Experience is Paramount

Patients are increasingly demanding the same consumer-centric experience they are receiving in retail settings when they are receiving medical care. It all starts with understanding your population and patient personalization. How do they like to receive care? How do they like to communicate with providers? Who is their preferred doctor? Next, you can build out technology and other solutions to customize the care you provide.

Most providers offer patient portals for viewing lab results and upcoming appointments. Many patients find these portals frustrating to access and not user friendly. Many patients also want online appointment scheduling and cancellation. They want waiting lists in the case of an earlier canceled appointment. They want to contact providers through electronic means/real time/video/email. They want convenient extended hours.

Improving communication and delivering a more retail-focused experience will go a long way towards developing patient loyalty.

  • Lower Cost Healthcare is a Necessity

Lowering the cost of healthcare is imperative, not only for providers facing budget pressure, but for consumers who are shouldering more and more of the cost of care and for payers who are looking to minimize reimbursements for unnecessary procedures.

The goal for providers is how to deliver the best results while keeping costs down. In fact, 41% name financial constraints as the force that will cause the greatest disruption in healthcare this year. Increased budget pressure should increase innovation in delivery of quality care.

Consumers are increasingly struggling with rising drug prices and more cost responsibility due to high deductible plans. It’s likely we will see pricing models including paying prescriptions over time, rather than all at once. We can also expect to see increased governmental regulation to curb rising prices. In addition to this, the FDA has created new initiatives designed to unleash more competition that can moderate drug price trends. These include encouraging new market entrants to rapidly start developing generics in classes where there is no competition, streamlining the generic drug approval process, promoting biosimilars and taking steps to prevent branded drug makers from exploiting programs

During 2018, we predict an increase in consumer-focused medical plans. What consumers want in a plan is convenience and value. To achieve that goal, we will likely see bundled finance offerings with plans, loyalty programs similar to frequent flyer miles, professionals (similar to a financial planner) who manage one’s health spending.

Payers will continue to become more involved in the provider side as a way of controlling costs. They will continue to create policies, design plans, and narrow provider networks.

  • Changing Governmental Regulations

45% of providers name government regulations as the force that will cause the greatest disruption in healthcare this year. Tax reform, healthcare reform, and governmental requirements will all significantly impact how the industry provides and pays for care.

With the probable reduction of the corporate tax rate, we will see change in the way companies invest, structure, and hold profits.

Efforts continue to loosen Affordable Care Act consumer protections and mandates, cut Medicaid spending, and expand access to lower-premium health insurance.

49% of providers cited increased regulatory and reimbursement requirements as the issue most likely to impact their orgs future. Providers worry the unknowns will affect bottom line, morale, and workflow.

For the foreseeable future, the healthcare industry will continue to see inconsistency in government policies and funding. This is especially dangerous for hospitals in underserved communities that rely almost exclusively on Medicaid and Medicare funding. Unless they are supported in some way, many of these providers will sink deeper into debt.

  • The Shift to Non-Inpatient Care

47% of hospital revenue is currently from outpatient care, and this is expected to continue to rise, as inpatient care is more expensive and hospitals are looking for ways to cut costs. This can benefit patients, as they are looking for quicker and more convenient care. Ambulatory surgery centers are increasingly used for low risk patients who require a surgery. Care is moving from the hospital into the community giving consumers the quick and convenient access they desire.

Telemedicine and virtual care is currently offered by 75% of institutions. This growth is driven by patients’ desire for more convenient care. Reimbursement is currently the main barrier to expanding these offerings.

  • Consolidations, Partnerships and Mergers, Oh My!

There is a new form of competition emerging: providers and payers are organizing themselves into vertically-integrated, high-value care and financing networks. Insurers, physician groups, health systems, and even retail organizations are each seeking to compete as high value care and financing networks.

Providers and payers have increasingly worked collaboratively. Payer-provider partnerships vary in type, size, location and model. There are 50/50 joint ventures with co-branding, and less intensive partnerships like pay for performance, accountable care organizations, patient-centered medical homes and bundled payments.

Employers are getting into the game, too. Amazon, Berkshire Hathaway and JPMorgan Chase partnering to cut costs and improve service to their employees could be a game changer, as they target tech solutions to simplify the healthcare system.

We expect to see the industry become increasingly hybridized with more and more partnerships, consolidations and mergers.

You Have Abundant Data, But Are You Maximizing It?










Since the widespread adoption of Electronic Health Records (EHRs), hospitals are collecting more data than ever before Effectively analyzed and applied, this data can be used to increase efficiency of care, boost revenue, cut costs and improve health.

However, as more information becomes available, some hospitals are having difficulty parsing what data is useful. As providers begin to understand the available data, curate it and ensure the people working with it can understand what is being measured, this undertaking will lead to improvements in several key areas.

1. Population Health 

Data can be analyzed to examine the health and wellness of patient populations. With insights into socio-economics, genetics and patient history, providers can more thoroughly understand their patients and create better treatment plans. Data and analytics will allow providers better insight into population health epidemics such as heart disease, obesity, diabetes, and more recently, opioid overuse.

A number of potentially dangerous chronic conditions have emerged as major risk factors for the U.S. population, which has experienced an increasingly and extremely high obesity rate in recent years. Analytics will help to test and confirm health models for populations so providers can identify at-risk patients.

2. Improved Quality of Care and Patient Outcomes

Providers already know through their daily experience what is taking place. With a shift toward predictive analytics, healthcare providers can plan for what is most likely to happen in the future. This information helps predict which patient are potentially at-risk and create treatment plans to proactively address diseases.

With widespread EHR adoption and the progress in genome sequencing, physicians now have enough information to identify consistent patterns in symptoms and create accurate patient profiles.

As a result, there has been a boost in precision medicine. As David Shaywitz, chief medical officer at DNAnexus, a cloud-based data analysis and management platform for DNA sequence data, wrote in his article for Forbes: The core premise … of precision medicine … is that the integration of genetic information, Electronic Medical Record data and rich dynamic phenotypic information will enable sophisticated patient segmentation, revealing biologically distinct subgroups and pointing the way to precisely targeted treatments.

This will lead to the end of “one-size-fits-all” treatments in favor of personalized, more effective treatment. Instead of treating a patient for cancer, we will be able to define their specific symptoms of the disease, their individual condition and medical history — and even their genetic makeup — in order to tailor treatment and increase the chance of a positive outcome.

3. Reduced Costs

One of the many ways that predictive analytics help cut costs is by reducing the rate of hospital readmissions.

“The idea of predictive analytics comes in looking for relationships that are consistent with readmission that we would not have predicted or we did not understand before,” Mark Wolff, chief health analytics strategist for SAS Institute and an analytics software developer, says in a post on the Hewlett Packard Enterprise Enterprise.nxt blog. “Once we identify those relationships, we can set up protocols on how to deal with this type of patient and manage things to prevent readmission.”

UNC Healthcare, working to reduce readmissions, combined EHR information with geographic and socioeconomic data to better identify current patients at a high risk for readmission. UNC is working on ways to embed that intelligence into workflows to keep track of those high-risk patients to decrease the likelihood that health problems will occur. The predictive models they developed were more than 30 percent accurate at identifying at-risk patients.

 4. Improved Patient Safety

According to the white paper How to Use Data to Improve Patient Safety, adverse events in healthcare are the third-leading cause of death in the U.S. — proving that while the industry may have done work and performed research to improve patient safety, it’s made little to no progress. In fact, patients today are experiencing 10 times the rate of preventable harm as they were in the 1990s. Without a data-driven, all-cause approach to patient safety, history will continue to repeat itself.

With initiatives around data-driven patient safety, health systems will have the tools they need to achieve better outcomes. Analytics will leverage integrated data and predictive analysis with machine learning to address organizational weakness and increase patient safety.