Limited resources, reimbursement shortfalls threaten hospitals' role in community

Increased demand, funding and resource shortages, and migration of services to other settings threaten hospitals' capacity to provide 24-hour care, according to a new report from the American Hospital Association (AHA).

Patients continue to rely specifically on hospitals' 24-hour services, the report found, with emergency department (ED) visits up nearly 19 percent over the past decade, including 133 million visits in 2013.

While increased coverage under the Affordable Care Act (ACA) was intended to reduce ED use, it has actually increased since the implementation of the law, FierceHealthcare previously reported. Furthermore, the Congressional Budget Office projects the uninsured population will continue to top 30 million by 2024 despite access to insurance under the ACA. Hospital EDs often serve as safety nets to Medicaid recipients and the uninsured population, as well as community care resources during disasters such as 2012's Hurricane Sandy.

The report found other obstacles to hospital functions. For example:

  • The number of hospitals providing emergency care is down even as ED visits increase
  • Providers face a projected staff shortage of nearly 90,000 by 2020
  • Hospitals' role as safety nets is not specifically funded, but rather part of the overarching, patient revenue-supported cost structure
  • Government reimbursements fall short of the cost of Medicare and Medicaid beneficiaries' care, with a shortfall of more than $51 billion in 2013

Hospitals also face declining revenues as other providers, such as ambulatory surgical centers and physician practices, offer outpatient surgical and diagnostic procedures. "The challenges facing hospitals in maintaining the standby role are symptoms of broader issues facing the healthcare system in the context of growing need and constrained resources," the report states. "How the system addresses these issues, the success of these efforts, and the lessons learned will have a profound effect on the healthcare system as a whole."

To learn more:
- read the report (.pdf)