Hospital execs project shift to outpatient care, more HIT spending

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Only about a third of hospital and practice executives think inpatient admissions will increase this year, a new survey shows, down 30 percent from a year ago. But more than two-thirds think outpatient volume will increase, according to the spring 2013 Economic Outlook survey from Charlotte, N.C.-based Premiere, a healthcare purchasing alliance.

The reform-driven shift to new care-delivery models will push patients into "less intensive and expensive outpatient care sites, with lower reimbursement rates," Premier Chief Operating Officer Mike Alkire said in an announcement describing the findings.

About 43 percent of respondents said improvements to health information technology and telecommunications will represent their largest capital investment over the next year--up 21 percent from two years ago. Roughly one-third said they are unable to share data across the continuum of care, according to the announcement.

"We need to know everything we can about a patient's care--what has gone on before and what's coming up," Eric Bieber, M.D., chief medical officer at University Hospitals in Cleveland, said.

"Otherwise, we have variation and redundancies that may degrade care quality and efficiency. The closer we can get to real-time information and get it in the hands of providers, the more likely the right things will be done and opportunities won't be missed."

About a third of respondents called healthcare legislation and mandates the biggest driver of healthcare costs, according to the announcement.

"With reimbursement cuts and changes in care delivery threatening today's status quo, healthcare providers face a significant change imperative as they transition toward more accountable, value-based care models," Alkire said. "Ensuring patients are cared for in the most efficient manner--without compromising quality--is key to success."

The survey also found that about 22 percent of respondents are in an accountable care organization; 55 percent expect to be in one by the end of next year.

Nearly half cited reimbursement cuts as the greatest single impact on their organizations, up 10 percent from six months ago.

The shift to outpatient services already has begun, with hospitals opening new outpatient facilities including urgent-care and other walk-in centers in response to the Patient Protection and Affordable Care Act.

"We can anticipate lower (Medicare) payments, and we can anticipate a shift in incentives to less inpatient work and more outpatient work. Our inpatient volume here and elsewhere is falling and outpatient volume is rising," Bruce Crowther, chief executive of Illinois' Northwest Community Healthcare, said last year.

Meanwhile, the American Hospital Association recently urged the Centers for Medicare & Medicaid Services to relax physician supervision requirements for 13 outpatient services, arguing that other nonphysician providers can carry out those services.

To learn more:
- read the Premier announcement

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