Pandemic accelerates trend toward more outpatient health care, report finds – Winston-Salem Journal


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Wake Forest Baptist Medical Center reported Feb. 25 that it had a 24.3% increase year over year in outpatient operating-room cases to 41,301 during the quarter that ended Dec. 31. It also had a 0.2% decrease in inpatient admissions to 60,133.
The shift toward emphasizing outpatient and in-home medical care is likely to stick even as the COVID-19 pandemic is waning locally and nationally, according to a national bond-rating agency.
Moody’s Investors Service said in a report released Friday that healthcare systems and hospitals’ revenue growth and margins will “continue to be strained” by the shift in care delivery to lower-cost outpatient or in-home settings.
“The pandemic has fueled a shift in healthcare delivery, with more patients unable or unwilling to seek care in hospital settings,” Moody’s analyst Diana Lee said.
“Even as the pandemic ebbs, its effect on how consumers access healthcare will persist, with fewer emergency-room visits.”
“Changes in reimbursement models, new drugs, devices and growing investment in outpatient services, including ambulatory surgery centers (ASC), will drive down inpatient care, the traditional measure of market share and presence,” Lee said.
Another factor includes increasing acceptance and use of telehealth, resulting in fewer non-COVID emergency-room visits. Some providers are expanding home-care services to include in-home acute-care admissions.
“An aging population, higher acuity cases and strong population growth in some markets will lessen this shift,” Lee said.
Wake Forest Baptist Medical Center reported Feb. 25 that it had a 24.3% increase year over year in outpatient operating-room cases to 41,301 during the quarter that ended Dec. 31. It also had a 13.6% jump in emergency-department visits to 197,101 and a 0.2% decrease in inpatient admissions to 60,133.
Cone Health reported March 1 in its first quarter 2022 report having outpatient visits increase 12.2% to 249,952, while emergency-department visits were up 10.9% to 81,074. The system reported conducting 11,870 telehealth visits, down 24.5%.
Lee said the federal Centers for Medicare and Medicaid Services’ decision to remove certain orthopedic and cardiac procedures from its inpatient-only list will shift more treatment to hospital-based outpatient departments or ambulatory surgical centers.
“Hospitals will also continue to transition to risk-taking models of reimbursement, keeping patients out of more expensive, acute-care hospital settings,” Lee said.
“Not-for-profit hospitals will increase partnerships with leading industry players in telehealth and urgent care, as well as with ASCs. Since most ASCs are owned or jointly owned by physicians, hospitals will often share revenue and income.”
Advancements in medication and medical devices also are playing a role in lower inpatient care.
Lee cited as an example that in cardiology, new drugs and at-home heart monitors “will reduce the risk of hospitalizations for heart failure, a key reason that patients over 65 are admitted.”
“In orthopedics, new technologies that help reduce surgical time or create patient-specific implants will aid the shift to outpatient procedures.”
A counterpoint to the trend, Lee said, is the projection of increases in highly complex cases requiring greater levels of specialty care
“Hospitals with a strong focus on quaternary and tertiary care will be better off than hospitals offering less complex, or secondary care,” Lee said.
“An aging population will also help offset the shift to less hospital-based care.”
A group of 12 healthcare systems that include Novant Health Inc. and UNC Health debuted in October the Advanced Care at Home Coalition in response to recent healthcare trends.
The coalition is serving to “bring together like-minded stakeholders to advocate in Congress and to the Biden administration for policies that foster and support advanced care at home services.”
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Wake Forest Baptist Medical Center reported Feb. 25 that it had a 24.3% increase year over year in outpatient operating-room cases to 41,301 during the quarter that ended Dec. 31. It also had a 0.2% decrease in inpatient admissions to 60,133.
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