1. FINANCIAL IMPLICATIONS: PUSH FROM INPATIENT TO OUTPATIENT CARE
Presented by: Dean J. Verret, CPA, MBA
November 16, 2015

3. What are the trends? 2006-2011 Change in Inpatient Use Rates per 1,000
Source: Analysis by Kaufman, Hall & Associates

4. Rate of inpatient stays per 1,000 population by U. S
Rate of inpatient stays per 1,000 population by U.S. Census division, 2012
Source: Agency for Healthcare Research and Quality (AHRQ), Center for Delivery, Organization and Markets, Healthcare Cost and Utilization Project (HCUP), National Inpatient Sample (NIS), 2012

5. Cumulative change in total all-payer inpatient admissions and outpatient visits, 2000-2013

6. Cumulative change in Medicare outpatient services and inpatient discharges per FFS beneficiary,

7. Cumulative change in Medicare inpatient discharges per FFS beneficiary by length of stay, 2006-2013
3-day
2-day
4-day
5-day
1-day

8. Several factors driving the shift
Healthcare delivery reforms
Population Health & Accountable Care Organizations
Payment shift from volume to value
Value-Based Purchasing – penalties and “bonus” opportunities (funded by 1.75% reduction in base operating DRG payments in FY 2016)
Readmission Reduction Program (3% penalty)
Bundled payment initiatives – prompting coordination of the full episode of care
Inpatient to Observation (medical necessity & 2 midnight rule)
RAC (Recovery Audit Contractors)

9. Several factors driving the shift
U.S. healthcare system's success stories, such as treating heart patients effectively without hospitalization.

10. Several factors driving the shift
Payers are reducing volume at some facilities and increasing it at others by creating narrow provider networks, which direct patients to hospitals and medical groups showing high marks on measures of quality and cost-effectiveness

11. Several factors driving the shift
For consumers, the continued rise of high-deductible insurance plans constrain medical use shifting services to the less costly outpatient arena

12. National Average Employee Contributions and Out-of-Pocket Costs
74.58% change from 2008 to 2015 (proj)

13. In conclusion
Healthcare reforms, advances in U.S. Healthcare, payer narrow networks, and healthcare consumer out-of-pocket responsibility are all factors contributing the push from inpatient to outpatient care.

14. FINANCIAL IMPLICATIONS: PUSH FROM INPATIENT TO OUTPATIENT CARE
Presented by: Dean J. Verret, CPA, MBA
November 16, 2015