Hos­pi­tal dis­charges down in 2014

Ranked by to­tal acute-care dis­charges per 1,000 peo­ple, based on fis­cal 2014 data

Modern Healthcare - - CLASSIFIED MARKETPLACE - By Michael San­dler

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.


Sources: Amer­i­can Hos­pi­tal Di­rec­tory; U.S. Cen­sus Bureau

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