Inpatient admissions at many hospital systems across the country continued to decline during the third quarter of 2014, with volumes at least partly attributed to healthcare reform.
The Cleveland Clinic Health System reported that admissions for the 11-hospital network fell 3.25% to 38,880 for the quarter ended Sept. 30, 2014, down from 40,186 in the year-ago period. Meanwhile, outpatient observations increased 14.15% during the same three months.
“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 also has played a role as Medicare has aligned its financial incentives with these goals.
The proliferation of high-deductible health plans with expensive copayments and coinsurance also has 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 2.12% under budget for the period.
Not all systems saw admissions fall. San Francisco-based Dignity Health saw its inpatient volumes climb 3.05% to 151,335. And Froedtert Health in Milwaukee reported a 6.49% 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 1.43% in the third quarter of 2014 compared to the similar period a year ago.
