Accountable care initiatives are changing the way healthcare is delivered and consequently reducing hospital inpatient utilization among all ages and most service lines, according to a new study from Health Affairs.
Study authors wanted to explore whether healthcare's new disruptive business models — such as pay-for-value reimbursement and employer health benefit redesigns to value-based plans — have made a difference in care provision from 2010 to 2012. The study covered a seven-county area with 71 hospitals in Illinois and the greater Chicago area, covering 8.5 million residents.
Researchers used comprehensive inpatient and outpatient data for this area, finding that the 71 discharged roughly 1.02 million inpatients in 2010. In 2012, that figure dropped to 970,000 discharges.
This finding isn't a new trend, as inpatient utilization in the United States has declined in the past decade, according to the study. What is relevant, however, is the finding that inpatient utilization rates per 1,000 people dropped across all age groups from 2010 to 2012. The average decline was 5 percent, but it fluctuates between groups — ages 0-14 saw a 0.9 percent decrease while patients ages 65-74 saw a 9 percent drop. Patients 75 and over also saw an 8 percent drop.
The study authors noted that something "structural in nature" appears to be at work for patients who are 65 years and older, as their inpatient utilization rates significantly dropped. Even deferring care for rising copayments and deductibles required in their Medicare managed care plan is unlikely to account for such a large drop in inpatient rates, according to the study.
Another interesting finding was that inpatient use rates per 1,000 people declined for almost every hospital service line. The median drop between 2010 and 2012 across 33 services was also 5 percent, but some service lines were hit harder than others.
Gynecology (-16 percent), interventional cardiology (-14 percent), cardiology (-11 percent), urology (-11 percent) and vascular surgery (-10 percent) all saw declines in the double digits. Rehabilitation (0 percent), neurosurgery (3 percent) and nephrology (3 percent) were the only service lines to with stable or increased inpatient use rates.
Age groups covered by Medicare showed the highest use-rate drops for inpatient use rates in surgical areas, such as cardiac surgery, spine and back surgery, orthopedics and urology. The study authors said this again suggests that structural changes are in play, likely including increased use of outpatient settings for care delivery. But they also noted that most of the volume decline for surgeries must be attributed to factors other than a shift to observation status and movement of short-stay surgical cases to ambulatory settings.
The study results, although specific to the greater Chicago areas, do have some national implications. Findings indicate inpatient-centric healthcare is declining in the region, and the depth of the inpatient utilization drop suggests structural factors are at work in changing healthcare provision in the region. The findings are not solely linked to the recession, according to the authors. "The Chicago regional study indicates that there is indeed early evidence that the transformation agenda is taking hold," the study authors concluded.
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