Admissions will shift significantly from the inpatient to the outpatient setting in 2013 as providers transition to new care delivery models, says a Premier healthcare alliance survey. It also indicates that hospitals will make their biggest capital investments this year in information technology.
In its spring 2013 Economic Outlook, Premier reports that 65% of the 530 survey respondents—mainly hospital C-suite executives and materials and practice area managers—are projecting a decrease in inpatient volume in 2013 compared to 2012.
Accordingly, 69 percent of respondents are projecting an increase in 2013 outpatient volume compared to 2012.
"As these survey results suggest, more care is being shifted to outpatient care sites that are less intensive and expensive, but with lower reimbursement rates," says Premier COO Mike Alkire. "In other words, health systems are adjusting to reimbursement cuts and lower inpatient volumes, while they have a foot in both camps managing the financial transition away from fee-for-service to accountable, pay-for-performance models."
Another trend identified in the survey is the increasing investment hospitals are making in their IT infrastructures. Nearly 43% of respondents say their organization will make its biggest capital investment in healthcare information technology and telecommunications in 2013, up 21% from two years ago.
"Many health systems have invested in EHRs that are critical to patient care, but they're only one of dozens of needed IT assets. They weren't created to support and track the seamless transitions of care from one setting to another or facilitate intra-team communications—functions [that are] central to accountable, patient-centric care," Alkire says.
With the shift to value-based reimbursements, healthcare providers are investing in the IT necessary to improve population health management, Alkire says.
"Providers are increasingly looking at IT that facilitates predictive capabilities and the intelligence to support action to better care for the populations they serve. A comprehensive population health suite of technologies helps providers manage patient care more efficiently, with a better understanding of total cost and outcomes… This allows providers to better support emerging care delivery and risk management models such as ACOs that are reimbursed based on quality and cost overall."
Despite the growing investments in HIT, however, 32% of survey respondents report that they are still unable to share data across the continuum of care.
A third of respondents cite healthcare legislation and mandates as the biggest driver of healthcare costs. Alkire says providers are responding to the challenge of trying to keep costs down by looking for strategies to get to a "price point of zero."
"This means not purchasing a supply that isn't needed or admitting a patient that does not need hospital care," he says. "We continue to see a movement to standardize appropriate medical treatments, fueled by more detailed and plentiful clinical, operational, and supply data that can pinpoint providers that are outliers."
Other key survey findings include:
- Almost 22% of respondents are in an accountable care organization, with 55% planning to be by the end of 2014.
- Nearly 27% currently do not have plans to pursue the ACO model, and may choose other forms of clinical integration, such as bundled payment, care management fees, or pay-for-performance.
- Reimbursement cuts were cited by 48% of respondents as having the greatest impact on their health systems, up 5% from last year and 10% from six months ago.
- 40% of respondents are projecting their capital spending to increase over the next 12 months as compared to last year, down slightly from 43% a year ago.
- Almost 37% are projecting a capital spending decrease based on the same criteria, up from 35% in spring 2012.