By Wesley Wise
Now, more than ever, it is tempting to throw our hands in the air and conclude that the future of U.S. Healthcare is too unpredictable. With healthcare reform legislation constantly in debate, adjustments being made, and reimbursement structures shifting, it is certainly a cloudy picture. Add the demographic shifts happening on a more local level, such as the growth of the natural gas industry in Northern and Western Pennsylvania and the lure of younger workers and their families into the region to fill good paying jobs, predicting the impact of these factors on our industry is a huge challenge.
Along with these “unknown” factors, we have “known” elements that can help shed some light on the next five years. We, as a population, are getting older and our health is declining. Obesity continues to increase across the entire population, and the baby boomers tend not to be the best at following the doctors prescribed lifestyle adjustments. These trends provide some clues. With these clues in mind The Advisory Board Company, a global research, consulting, and technology firm, has made some predictions on service line national outpatient and inpatient volume trends for the next five years.
Outpatient volumes will continue to increase in vascular, cardiac, and neuroscience service lines. The vascular service line is predicted to increase 19% with the largest growth coming in peripheral procedures and vascular ultrasound studies as well as an increase in interventional radiology. Cardiac service is expecting to see a 12% increase attributed to growth in Cath Lab volumes including Coronary artery stents, angioplasty, and intra-cardiac catheter ablation procedures. The Neuroscience service line is predicted to see an increase approaching 8%. The major contributors reflect an aging population with Spinal Decompression and Spinal Fusion cases topping the list.
Inpatient volumes will shift from the Cardiac service line to Orthopedics and Neurosciences. Cardiac Service is predicted to see inpatient volumes decline by 9.1% in the next five years. The Advisory Board expects to see these cases shifting to an outpatient setting as treatments advance. The largest volume decreases are expected in heart failure, stent implants, and acute myocardial infarction cases. Most of the decline is attributed to an expectation that disease management will improve in the outpatient setting, reducing hospital stays. Countering these declines will be slight increases in defibrillator and pacemaker implants, valve procedures, and hypertension hospitalizations. Helping to backfill some of these patient beds will be a 6.1% increase in orthopedic volume. Joint replacement therapy is expanding to include additional older, younger, and sicker patients. Technical advancements will also allow for earlier treatment with partial joint replacements. Neurosciences are expected to see a 4.8% increase in inpatient volumes, due in part to technological advances in imaging and surgical guidance enabling more aggressive brain surgeries. The largest increases are predicted in craniotomy and intracranial procedures. Another factor is an expected volume growth in degenerative disorders due to improved and earlier diagnosis of Alzheimer’s disease.
In a nutshell, in the next five years, on a national level, expect to see outpatient cardiac and vascular procedures performed in the Cath Lab Suite shift from diagnostic to more treatment. The number of treatments will, at the same time, grow in volume. Similarly, as technology advances we can expect to see simple spine cases moving to the outpatient setting. At the same time, diagnostic outpatient service volumes like MRI, CT, Blood Draw, EEG, and EMG will continue to increase to support this shift.
On the inpatient side, these same technological advancements in treatment will facilitate the ability to take on more aggressive surgeries, resulting in a backfill of inpatient beds with a generally older and sicker patient population. Future healthcare trends may be cloudy, but cardiac, neuroscience, and vascular services will surely lead the way in forming a blueprint for the future.
What does it mean in terms of the hospital? Perhaps we will see some new models of care delivery, such as a Comprehensive Neuroscience Center including multiple acuities on the same unit, and rehab therapy. Maybe the orthopedic joint camp unit model, with larger patient rooms to accommodate rehab activities and spaces for group therapy on the unit, will become more popular.
Stay tuned for more developments.
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