3 Ways to Prepare for Coming Shifts in Care Delivery Sites

Health care executives may want to devote even more strategic planning time to moving services outside hospital walls.

That’s because seismic shifts are expected in the outpatient landscape over the next decade, notes a recent forecast from the market analytics firm Sg2, a Vizient company.

The forecast projects patient volume changes by 2029 in the following areas:

• Non-inpatient surgeries:
  • Hospital outpatient departments +19%.
  • Ambulatory surgery centers (ASCs) +25%.
• Home-based care +15%.
• Office-based diagnostics, laboratory testing and imaging +19%.
• Virtual visits will rise from near zero to 29% of all evaluation and management.

Hospital inpatient discharge volumes, meanwhile, are projected to be flat or drop by 1% due to the accelerated surgical outpatient shift and the gradual scaling of risk-based payment models, remote monitoring and hospital at home, which drive care delivery innovation in both the home and ambulatory settings. In addition, forecasted declines in birth rates will drive inpatient declines for maternity and neonatal care.

Restructuring Systems of Care

Policy changes, virtual and digital innovations and the shift to lower-cost settings will all contribute to a restructuring of the current system of care, says Madeleine McDowell, M.D., principal and Sg2 medical director.

The outpatient surgery shift will accelerate as the Centers for Medicare & Medicaid Services eliminates all procedures on the inpatient-only list (more than 1,700 codes) and expands the number of ASC-covered procedures by 278 by the end of 2023, Sg2 states.

Likewise, some of the site-of-care shifts that occurred during the pandemic due to clinical necessity will forever change the way care is delivered. Virtual care visits, for example, will grow significantly while in-person visits with physicians are projected to decline 19% by 2029. The net forecasted impact on physicians’ offices and clinics will be an 18% growth in volume before the decade is out, according to the forecast.

3 Takeaways on the Evolving Care Site Landscape

1. Plan for sicker emergency patients and inpatients.

Emergency department (ED) volumes are expected to decline by 5% by 2029, as low-acuity visits shift to urgent care clinics, physicians’ offices and other locations. This means that sicker patients will be using the ED, often for treatment of chronic diseases. Likewise, behavioral health and substance use-related visits to the ED also are expected to grow by nearly 25% during this time. Inpatient stays are expected to increase by 9% driven by a rise in chronic diseases, an older population that requires more care and innovations increasing the number of treatable conditions.

2. Evaluate your digital infrastructure.

The investments hospitals and health systems made in digital infrastructure for telehealth and remote patient monitoring certainly helped meet demand during the height of the pandemic, but now is the time to evaluate technology gaps so you can scale for future needs.

3. Redesign carefully.

Future inpatient volumes will have upstream and downstream implications in areas like rehab and advanced imaging. And with the high expense associated with inpatient beds and space, health care organizations will need to plan wisely. For more on post-pandemic facility planning, view this recent AHA Transformation Talks video.