Subpage Banner Image

Are the Causes for Negative In-Patient Growth Really Positive?

Are the Causes for Negative In-Patient Growth Really Positive?

In most parts of the United States the number of hospital admissions have been decreasing between 3% and 8% in the last several years. The mean length of stay, although more variable from institution to institution, has stabilized or decreased. Gross revenue increases are being consistently reported due to more uninsured becoming insured, better contracts from some payers, clinical outcomes, and, unfortunately, due to price increases. However, simultaneously, the bottom line is often decreasing due to expense growth which is out-stripping the revenue growth. This is often due to declining reimbursements from third-party payers including the government, and in some cases, increasing bad debt.

After reviewing these statistics, it appears to the Royer-Maddox-Herron Advisors that there are 12 major causes for the negative numbers being experienced in hospital admissions, most of which we believe, are really positive. This blog, Part I in a Series, will identify 4 of the factors, which Pat II will articulate the remaining 8.

The first four include:

1. Clinical Improvements

Ø Preventive measures are now used broadly enough that they are showing a positive impact

a. Flu vaccine

b. Pneumonia vaccine

c. Hepatitis vaccine

d. Decrease in smoking

Ø Decrease in teenage pregnancies

Ø Decrease in size of families

a. Declines in maternity cases

b. Less pediatric patients

Ø Diabetic management Programs

a. Better medications for better control of blood sugars

Ø Weight Reduction Programs

a. Growing number of Bariatric Programs

Ø Increased number of Wellness Center and Membership

Ø Better and safer anticoagulation protocols and medicines

Ø Enhanced asthma management

a. Best practice is a goal of zero admissions

>More comprehensive wound care on an outpatient basis

>More effective outpatient managements of infections

2. Clinical Process Improvements

Ø Increase in the use of nurse practitioners as care managers in

Outpatient settings

Ø In-hospital case managers

a. Improvement in discharge instructions

b. Earlier discharges

c. Decrease in readmissions

Ø Increased focus on quality and patient safety and the Value Equation

Ø Decrease in c0-morbidities

a. Nosocomial Infections

b. Decrease in decubiti and pressure ulcers

3. Impact of New Technology

Ø Increase in use of non-invasive procedures

a. Permit more procedures to be done in ambulatory clinics and physician offices

Ø Improved diagnostics

a. Often result in earlier diagnosis of diseases which increase possibility of treating in ambulatory settings

Ø Improvement in anesthesia agents

a. Permit safer administration and recovery in outpatient settings

4. Increasing Use of Alternate Treatment Modalities

Ø Self-medication with over-the-counter drugs

Ø Increased use of Alternative and Complimentary Medicine

Ø Increased use of hospice and palliative care programs

Ø Better end-of-life planning which is increasingly done in the home or retirement community

Ø Increase use of pain management outpatient programs

Many of these causes are providing higher quality and safer clinical outcomes, which are often more affordable to the patients. Are not these positive steps in the right direction for healthcare delivery? The final 8 cause will be included in Part II of this series.