Hospital Execs Expect Greater Shift to Outpatient Care

Hospital and health system executives are expecting large increases in outpatient volume this year, according to a recent analysis from the Guidehouse Center for Health Insights.

The Center for Health Insights analyzed a survey of 182 hospital and health system CEOs, CFOs, COOs, and other executives conducted by the Healthcare Financial Management Association (HFMA). The analysis showed that 95 percent of executives project higher outpatient volumes in 2023, with 40 percent anticipating increases of 10 percent or more.

While outpatient care volumes rise, 41 percent of hospital and health system leaders also expect lower inpatient volumes. About 17 percent of the leaders project decreases of 10 percent or more on the inpatient side.

Hospitals and health systems have been seeing a shift from inpatient to outpatient care since the start of the pandemic. Patients have avoided hospital emergency departments to stop the spread of the highly contagious virus, while many facilities canceled or postponed elective surgeries.

Now, hospital and health system leaders polled by HFMA for the analysis also say emergency department visits will increase, with a third projecting a rise of at least 10 percent. A quarter of executives also expect a 10 percent to more increase in elective procedures.

“Most health systems are still experiencing volumes below pre-COVID levels, resulting in sizable market challenges,” Richard Bajner, Guidehouse partner and payer/provider leader, said in a statement.

“These shifts should inform strategic growth efforts that are focused on person-centered care, such as excellence in ambulatory services, to create sustainable business models that attract and retain patients while driving financial resiliency in an era of volatility.”

Hospital leaders, however, are struggling with workforce issues. An overwhelming majority of respondents (96 percent) report that the state of their workforce is having a negative impact on their growth strategy. Of those respondents, 62 percent say it is a significant impact.

A hospital’s workforce can impact innovation, researchers say. Clinician burnout, staff resignations, executive retirements, and equity issues are some of the top challenges hospitals and health systems are facing with their workforce.

Leveraging contracted labor is also straining hospital and health system budgets. Hospitals spent more than $4.5 million on contracted labor last year.

According to the analysis, over 40 percent of leaders plan to reduce the number of contractors and traveling clinicians by 10 percent or more. About 18 percent of those respondents say they are planning decreases of 20 percent or more.

However, there is still a major demand for contracted labor, especially in light of projected outpatient care increases. A third of executives expect to hire more traveling clinicians and contractors this year.

Most hospital and health system executives (90 percent) also plan to hire more advanced practitioners in 2023. Additionally, about 80 percent anticipate adding more behavioral health providers to their workforce.

Notably, the survey also finds that nearly three-quarters of executives are seeking revenue cycle, coding, and IT experts in 2023.

“With growth in labor and supply costs, many leaders are turning to purposeful artificial intelligence, automation, and digital care strategies to improve engagement and efficiency,” Thomas Zenty III, national advisor at Guidehouse, said in the statement.

“Successful organizations are reevaluating their digital connectivity capabilities to ensure patients and caregivers know how to access and use patient portals, EHRs, and other technologies, as well as to streamline corporate and non-clinical services.”

About 18 percent of hospital and health system leaders say revenue cycle automation is likely to be the area with the greatest budget increase over the next year. The only other area to exceed revenue cycle automation is digital engagement and virtual care, with 20 percent of respondents citing it as the area projected to have the greatest budget increase.