Hospital births have been dropping since 2008. In 2013, they dropped more than 0.1% to just under 3.75 million from 3.754 million in 2012.
Outpatient visits, however, increased 1.2% to more than 787 million in 2013.
More hospitals, meanwhile, are establishing medical home programs in which care teams coordinate patient care using a comprehensive, whole-person orientation. In 2013, 20.4% of hospitals had a medical home program compared with 14.5% in 2011.
“Although the patient-centered medical home model is all about keeping patients out of the hospital and away from emergency departments, hospitals are an integral part of this movement,” Kevin Kenward, research director for the AHA's Health Research & Educational Trust, wrote in the report's introduction. “Among their business strategies are converting their own hospital-owned practices into medical homes, acquiring practices already certified as medical homes and requiring practices being considered for purchase to convert.”
Participation in accountable care organizations also was on the rise. Eighteen percent of hospitals were participating in an ACO in 2013, tripling the share from two years earlier. By 2013, Kenward wrote, ACOs were in operation all across the county except for Mississippi, West Virginia and the District of Columbia.
Also on the increase were the total numbers of hospital employees, expenses and uncompensated care.
Uncompensated care increased 1% to $46 billion in 2013 from $45.9 billion in 2012, the AHA reported, but this trend may have already been reversed. The Obama administration issued a projection last September that uncompensated care would decline in 2014—particularly in states that had expanded Medicaid coverage to include residents with incomes up to 138% of the federal poverty level.
Total hospital expenses increased almost 3.6% to $859.4 billion in 2013 from $829.7 billion in 2012. The number of full-time personnel increased 1.6% to more than 5.34 million in 2013. (Hospital hiring in 2015 is expected to be modest as most new healthcare employees are expected to be working in outpatient settings.)
Investor-owned community hospitals slightly bucked some of the prevailing trends by maintaining the same bed count and average daily census in 2013 as in 2012. They also had slightly fewer outpatient visits. Outpatient visits declined 1.2% at investor-owned hospitals to 53.2 million in 2013.
Nongovernment not-for-profits had the most expenses per inpatient day: $2,289. They also had the largest increase in this category, going up 3.4%. Government-owned community hospitals saw per-inpatient-day expenses increase almost 2.6% to $1,878. Investor-owned hospitals saw these expenses go up slightly more than 2.5% to $1,791.
Kenward noted that “the era of fee-for-service medicine is coming to an end” and that hospitals and other providers were experiencing “seismic transformation” in the way they do business and in how they deliver care.
That observation comes as HHS adopts aggressive targets to subject more of its fee-for-service spending to incentive-based programs that promote quality and efficiency.
“Government and private payers are demanding models that require providers to share the financial risk and deliver both improved outcomes and lower costs,” he concluded. “While the design of these models varies, a shared objective is the movement away from fee-for-service payment toward financial incentives that reward high-quality, high-value care.”
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