Inpatient and Outpatient Activity Declines in 2014

Both policy makers and providers expected a movement of patients from inpatient to outpatient settings due to payment redesign and other cost-cutting initiatives in the years since the Affordable Care Act was signed into law. However, both inpatient and outpatient utilization fell among pre-Medicare-age enrollees in employer-sponsored plans in 2014, according to a new report from the Health Care Cost Institute. (2014 Health Care and Cost Utilization Report, Health Care Cost Institute [HCCI], October 2015)


Inpatient admissions as well as some areas of outpatient services have been declining for the last three years. However, in 2014, nearly every outpatient service declined. “This trend of declining services really seems to be solidifying now.” (“No Patient Switch from Inpatient to Outpatient Settings in 2014: Report,” HFMA Weekly, November 6, 2015)


Utilization figures for pre-Medicare-age enrollees in employer-sponsored plans in 2014 include:


  • Acute inpatient admissions declined 2.7 percent in 2014, the latest decline in a five-year slide from 59 per 1,000 adults in 2010 to 53 per 1,000 adults in 2014.
  • Among all age and gender groups, only girls 0 to 18 had a slight increase in inpatient admissions during that four-year span.
  • Outpatient visits declined by 0.9 percent from 324 per 1,000 in 2012 to 317 in 2014.
  • The drop in outpatient visits was almost entirely driven by a decrease in outpatient surgical visits.
  • The only increase in outpatient visits was to emergency departments.
  • Among inpatient utilization, medical admissions declined from 22 per 1,000 individuals in 2010 to 19 in 2014.
  • Surgical admissions declined from 18 admissions per 1,000 individuals to 13.
  • Labor and delivery, mental health, and substance use admissions were steady. The only increase was 2.7 percent in newborn admissions.
  • Among outpatient visits, the 2014 decline also was influenced by a small decrease in the number of observation visits.


Declining service use has an important impact on overall healthcare spending, according to the author of the HCCI report.


Even though per capita healthcare spending increased 3.4 percent among those with employer-sponsored insurance in 2014, those spending increases were driven by prices that rose enough to compensate for the decline in utilization. (“No Patient Switch from Inpatient to Outpatient Settings in 2014: Report,” HFMA Weekly, November 6, 2015)


Hospitals and their boards have made strategic decisions over the last four to five years to maintain revenues affected by value-based purchasing and other initiatives by moving volume from inpatient to outpatient settings. But the report shows both inpatient and outpatient utilization continuing to trend downward. This is particularly troubling because patients with employer-sponsored plans are among the highest paying for hospitals. (“No Patient Switch from Inpatient to Outpatient Settings in 2014: Report,” HFMA Weekly, November 6, 2015)


To read the full report from HCCI, please click here.




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