Hospitals report a decrease in admissions in Q4

Some systems see an increase in outpatient visits

Hospital admissions at 13 large hospital systems declined by 1.4% during the third quarter of 2014 compared with the same period in 2013, spurred in part by changes related to the Affordable Care Act (ACA), Modern Healthcare's Rachel Landen reports.

Specifically, inpatient admissions at the hospital systems declined from 625,880 in third quarter (Q3) 2013 to 616,939 in Q3 2014.

For example, hospital admissions declined at the 11-hospital Cleveland Clinic Health System by 3.3%, from 40,186 in Q3 2013 to 38,880 in Q3 2014. Meanwhile, admissions for outpatient observations increased over the time period by 14.1%. Cleveland Clinic officials said in the health system's Q3 financial statement, "The shift in patient volumes from admissions to observations is partially attributable to the implementation of the 'two-midnight' census rule by CMS in October 2013."

Under the two-midnight rule, an admission is assumed to be appropriate for a Medicare Part A payment if a physician expects a patient's treatment to require a two-night hospital stay and admits him or her under that assumption.

How is the two-midnight rule affecting your bottom line?

In addition, the increase in plans with high deductibles, copayments, and coinsurance has decreased demand from patients for some inpatient procedures, according to Modern Healthcare. However, not all of the 13 large hospital systems experienced declines in admissions. For example, inpatient admissions at Dignity Health increased by 3.1% from Q3 2013 to 151,335.

Overall, nine of the 13 large hospital systems surveyed by Modern Healthcare experienced declines in inpatient admissions ranging from 0.24% at Orlando Health to 5.28% at ProHealth Care, while four experienced increases ranging from 0.04% at North Shore-Long Island Jewish Health System to 6.49% at Froedtert Health (Landen, Modern Healthcare, 12/31/14 [subscription required]).

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