Chapter 3: Utilization and Volume

26 Chartbook 2000 Community hospital acute care admissions declined 15 percent between 1980 and 1994 and then began slowly trending upward. After declining sharply in the 1980s and more modestly in the early 1990s, admissions per thousand have been flat. Average length of stay has dropped more than a day and a half (or 20 percent) between 1980 and 1998, but the pace of decline has slowed over the last three years. Length of stay by state varies from a high of 11.2 days in Montana to a low of 4.5 days in Oregon and New Mexico. Although inpatient days and days per thousand continue to decline, the rate of decrease has slowed as well (Charts ). Meanwhile outpatient visits have more than doubled since 1980, and outpatient utilization rates continue to increase at a rapid clip. Outpatient surgeries now represent nearly 60 percent of all surgeries (Charts ). Chapter 3: Utilization and Volume

27 Chartbook Chart 3.1: Inpatient Admissions in Community Hospitals Source: The Lewin Group analysis of American Hospital Association Annual Survey data, for community hospitals Chart 3.2: Inpatient Admissions per 1,000 Persons Source: The Lewin Group analysis of American Hospital Association Annual Survey data, for community hospitals and US Census Bureau data Millions

Utilization and Volume 28 Chartbook 2000 Source: The Lewin Group analysis of American Hospital Association Annual Survey data, for community hospitals Chart 3.3: Average Length of Stay in Community Hospitals Days Chart 3.4: Average Length of Stay in Community Hospitals by State to 6.9 Days 7.0 to 8.9 Days 4.0 to 4.9 Days > 9 Days Source: The Lewin Group analysis of American Hospital Association Annual Survey data, 1998 for community hospitals RI 5.63 Days DE 6.04 Days DC6.97 Days

Utilization and Volume 29 Chartbook 2000 Chart 3.5: Total Inpatient Days in Community Hospitals Source: The Lewin Group analysis of American Hospital Association Annual Survey data, for community hospitals Millions Chart 3.6: Inpatient Days per 1,000 Persons Source: The Lewin Group analysis of American Hospital Association Annual Survey data, for community hospitals and US Census Bureau data

Utilization and Volume 30 Chartbook 2000 Chart 3.7: Total Hospital Outpatient Visits in Community Hospitals Source: The Lewin Group analysis of American Hospital Association Annual Survey data, for community hospitals Millions Chart 3.8: Hospital Outpatient Visits per 1,000 Persons Source: The Lewin Group analysis of American Hospital Association Annual Survey data, for community hospitals and US Census Bureau data Per Thousand

Utilization and Volume 31 Chartbook % 20% 40% 60% 80% 100% Source: The Lewin Group analysis of American Hospital Association Annual Survey data, for community hospitals Chart 3.9: Percentage Share of Inpatient vs. Outpatient Surgeries Outpatient Surgeries Inpatient Surgeries