“The shift in patient volumes from admissions to observations is partially attributable to the implementation of the two-midnight census rule by CMS in October 2013,” Cleveland Clinic management wrote in the system's unaudited quarterly financial statements.
Analysts and financial officers have repeatedly pointed to the two-midnight rule as one of the drivers behind the trend in declining admissions. But the focus on reducing admissions and shifting care away from hospitals and into outpatient settings has also played a role as Medicare has aligned its financial incentives with these goals.
And the proliferation of high-deductible health plans with expensive copayments and coinsurance has also reduced patient demand for certain inpatient procedures.
At MedStar Health, a 10-hospital system based in Columbia, Md., quarterly admissions fell 4.6% from their third-quarter 2013 level. But they were also 2.1% under budget for the period.
Yet not all systems fared so poorly on the admissions front. San Francisco-based Dignity Health actually saw its inpatient volumes climb 3.1% to 151,335. And Froedtert Health in Milwaukee reported a 6.5% increase in admissions, thanks to higher volumes and higher acuity.
But overall, hospital admissions for the 13 large hospital systems surveyed by Modern Healthcare fell 1.4% in the third quarter of 2014 compared to the similar period a year ago.
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