In Part I of the blog series we wrote regarding the first four causes of the negative growth in hospital admissions being experienced in most parts of the US . Most would agree that these causes, although affecting the growth of hospitals admissions negatively, are really leading to better clinical outcomes, which in many cases are more affordable and accessible.
The additional eight causes that should be added to this important list include:
1. Improvement in Long-Term Care
Ø More full continuum retirement communities are opening with a greater variety of payment plans
Ø Increase use of LTACs, Long-Term Acute Care
Ø More care being rendered in nursing homes, retirement communities, and even at home, related to the management of chronic diseases, pain management, and intravenous therapies
Ø Nursing homes are improving their care because of increased governmental scrutiny and involvement on family members
2. The Economy
Ø Declining incomes are causing some to delay or permanently postpone elective procedures
Ø Higher co-pays are also causing delays in medical care and elective procedures
Ø Hospital closures
3. New Entrants into the market, including physician owned facilities
Ø New Entrants
a. Retail Clinics
b. Free-standing Emergency Rooms
c. Free-standing Urgent Care Centers
d. Convenient Clinics
Ø Physician-Owned Facilities
a. Outpatient Surgery Centers
b. Diagnostic Center
4. Governmental Interventions
Ø Public reporting of ranking and ratings listing “unsafe hospitals”
Ø OIG Reports of Overuse and Outlier Billing
Ø Declining Reimbursements
5. Medical Liability Costs
Ø Some physicians are doing less high risk elective procedures
Ø Increase in early retirement of some physicians
6. Pharmacy Costs Increasing
Ø Increased use of generics
Ø Increase use of self-medications
7. Personnel Shortages
Ø Temporary or permanent closure of beds
8. Aging and Changes in Demographics
Ø The aging populations appear to be healthier than once predicted
Ø Most elderly prefer to die at home
Ø More complete end-of-life planning which is reducing expensive care in the last six months of life which often only extends the quantity of life but not the quality
Reflecting on these 12 causes of declining in-patient volumes articulated in these two bogs, it would appear that, many of the causes for the negative growth are really positive, leading to better clinical outcomes, which may also lead to more accessibility of both sick and well-care in settings that are most preferred by the clients. Clearly, this information would dictate caution in hospital bed expansions, and undoubtedly some new ways to look at the strategic directions for what are predominately hospital-centric health care delivery systems in the US. Change in the healthcare industry is occurring at an unprecedented rapid pace and, as these 12 causes demonstrate, often are leading to better healthcare. Yet, some are still resisting these changes to preserve the once thriving hospitals that were generating the bulk of the net revenue. This desire to maintain the past may, in fact, lead to a future which is unsustainable. This possible reality was best brought forth in a recent presentation when the speaker predicted that “someday in the future we may be paid more for an empty bed than a full one”.