Dive Brief:
- Hospitals continue to shift care to outpatient settings, according to a new analysis of data from the first half of the year by Strata Decision Technology.
- As a result, hospitals are seeing sicker patients in their inpatient wards as they send lower-acuity patients to outpatient departments.
- Patients in some service lines, like gynecology, had procedures done less in hospitals as minimally invasive surgery options in outpatient settings grew. However, other service lines like breast health saw more, sicker patients in the hospital, likely due to an increase in breast cancer testing and diagnoses, according to the data.
Dive Insight:
The latest data, pulled from more than 2,000 hospitals and 149,000 providers, puts some near-term numbers behind hospitals’ aggressive push toward outpatient care.
Health systems have invested heavily in outpatient care to capitalize on growing patient sentiment and, hopefully, save some money. New technological innovations, like minimally invasive surgery, have made procedures cheaper to perform in outpatient settings and patients say they increasingly prefer getting procedures in more accessible facilities with lower out-of-pocket costs.
Vizient, an organization that provides data analytics, supply chain management and consulting services to health systems, recently predicted outpatient volumes would grow by a whopping 20% over the next decade, while inpatient discharges would rise by just 7%.
As they pivot more to outpatient care, health systems are also starting to see their margins grow, with overall operating margins inching into the positive after starting the year in the red. The Strata analysis found hospitals ended June with the highest operating margin of 0.7% despite inflated drug and supply costs.
Payers have also sought to cash in on growing outpatient demand to cut costs. Outpatient procedures can cost up to 50% less than the same service performed in an inpatient setting, research shows.
The CMS has led this charge, starting to phase out Medicare’s inpatient-only list, a registry of procedures the agency deems as only safe and reimbursable in the inpatient setting. Over 280 procedures were eliminated from the list this year, with expectations to fully eliminate the list by 2028.
The agency has also sought to broaden site-neutral payments in which Medicare pays the same rate to hospital outpatient departments as independent physician offices. Currently, Medicare reimburses hospitals more for the same care provided in inpatient settings, compared to outpatient facilities.
Payers are fed up paying more to hospitals, and some have tried to equalize payments toward outpatient settings against the wishes of hospitals. Elevance Health announced new billing policies earlier this month that will pay lower rates for services and tests delivered at off-campus departments.
