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

What are the trends? 2006-2011 Change in Inpatient Use Rates per 1,000 Source: Analysis by Kaufman, Hall & Associates http://healthaffairs.org/blog/2013/03/08/decline-in-utilization-rates-signals-a-change-in-the-inpatient-business-model/

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

Cumulative change in total all-payer inpatient admissions and outpatient visits, 2000-2013 http://www.medpac.gov/documents/data-book/june-2015-databook-health-care-spending-and-the-medicare-program.pdf?sfvrsn=0

Cumulative change in Medicare outpatient services and inpatient discharges per FFS beneficiary, 2006-2013 http://www.medpac.gov/documents/data-book/june-2015-databook-health-care-spending-and-the-medicare-program.pdf?sfvrsn=0

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 http://www.medpac.gov/documents/data-book/june-2015-databook-health-care-spending-and-the-medicare-program.pdf?sfvrsn=0

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)

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

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

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

National Average Employee Contributions and Out-of-Pocket Costs http://www.forbes.com/sites/brucejapsen/2014/11/13/worker-out-of-pocket-health-costs-have-doubled-in-five-years/ 74.58% change from 2008 to 2015 (proj)

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.

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