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 post-acute-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.