A new Fitch Ratings report indicates the United States is likely experiencing ďsystemic shiftsĒ in healthcare as a result of the impending Affordable Care Act (ACA) implementation in January 2014.
Acute care admissions dropped nationwide in 2013. Fitch analysts reported a 3.8 percent drop in same-hospital admission rates for the first quarter of 2013. In my area, leaders are reporting anywhere between 10 to 20 percent reduced inpatient admissions over the course of a single fiscal year.
Is that a good thing? Well, it depends on how you look at it. Fitch ratings does give some probable explanations for the reduction in admissions, including a weak economy, increased patient responsibility for medical expenses, and/or hospitals focusing on efforts to keep people well and out of the hospital in anticipation of the drastic change from fee-for-service to value-based care reimbursement.
Itís great that we may actually be working hard to keep people well and avoid hospitalization. However, if more people are without insurance or cannot afford to pay higher medical fees, that can deter people from seeking care -- even necessary care.
Currently, our healthcare system is reimbursed based on volumes. That means that admissions actually make hospitals money. In January 2014, when the ACA is ďfullyĒ implemented, our healthcare system will be reimbursed based on value of care and quality metrics. It is truly a paradigm shift, creating lots of disruption to healthcare as we know it.
However painful and imperfect it is, disruption is necessary because we cannot continue to sustain healthcare as it currently is in the US today. Still, the reimbursement model hasnít changed yet, so when people arenít in hospital beds, hospitals arenít getting paid. And when hospitals donít have cash flow, that leads to big changes, including layoffs, job role attrition, and even hospital or clinic closures.
I recently endured the effects of declining acute care admissions. Trust me, it was painful. However, I realize the specific measures had to happen in order for my healthcare system to remain viable for the millions of people we serve in our area. Itís hard to accurately project numbers and volumes during this transition time before ACA implementation.
Has your healthcare system experienced declining inpatient admissions? Have you felt the monetary effects of this change? How so?