Hospital discharges down in 2014
Ranked by total acute-care discharges per 1,000 people, based on fiscal 2014 data
Healthcare delivery system changes continue to push patients away from inpatient care.
That’s suggested by a Modern Healthcare review of American Hospital Directory data, which found that the number of patient discharges fell 8.4% from 2013 to 2014.
There were 28.6 million total U.S. discharges in fiscal 2014. Alaska saw the biggest decline, with its hospitals discharging 52.4% fewer patients in 2014 than in 2013.
On the mainland, Washington state experienced the biggest decline, with a 32% discharge drop.
Steve Valentine, president of the Camden Group, a healthcare management consulting firm based in El Segundo, Calif., said big year-over-year changes such as those in Alaska and Washington are hard to explain.
There could be a change in the way the states reported discharges, he said. Alaska has small hospitals, and even a small change in discharge volume would significantly affect the percentages, he said.
Valentine noted that states with a higher percentage of non-Hispanic whites saw a greater number of hospital discharges.
That may be because whites are more likely to have health insurance through their workplace.
The health of a state’s population also plays a role. States with higher rates of diabetes, smoking, obesity and heart disease experienced greater hospital usage, Valentine said. “If we’re going to do population health (management) like we should, we must change people’s lifestyles and behaviors. They have a long-term impact.”
The shift from volume-based to value-based payment is also affecting discharge numbers, Valentine said. Because hospitals now face penalties for Medicare readmissions, they are doing better with follow-up care in patients’ homes and that is reducing repeat hospital visits.
Fewer admissions could lead to hospital closings around the U.S., he cautioned. Lower patient volumes will put a strain on some hospitals, and that will lead to calls for repurposing underutilized facilities. Hospitals could be repurposed into skilled-nursing facilities or postacute-care centers, where care needs are greater, Valentine said.
When hospitals close, consumers and policymakers worry about the availability of nearby emergency services. “But it’s expensive to keep all those resources available,” he said.