Declining use of cardiac service lines reflects shift to outpatient services

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 - Time for Change

Hospitals and some specialties should anticipate the need to “right size” as value-based care gains momentum, according to analyses of inpatient trends in several metropolitan areas. The studies found steep declines in use rates of interventional cardiology and cardiology service lines.

Kaufman Hall, a consulting firm based in Skokie, Ill., initially designed a study using proprietary, provider and Illinois inpatient databases as well as Census Bureau data to track utilization trends in a seven-county region between 2010 and 2012. The sample included 71 hospitals that served 8.5 million residents. They then applied the methodology to markets in eastern Massachusetts; Newark, N.J.; and central Indiana.

They found that inpatient utilization in the Chicago region decreased across all age groups in the two-year period, for an average of 5 percent. Looking at use rates per 1,000 population, the interventional cardiology service line saw a drop of 14 percent, vascular surgery fell 10 percent, and cardiovascular surgery fell 5 percent.

The decline was more dramatic in Newark, where utilization for interventional cardiology service lines dipped by 26 percent and cardiology by 17 percent. In eastern Massachusetts and central Indiana, cardiovascular care experienced drops of 14 percent and 7 percent, respectively.

“The inpatient-centric healthcare model is declining in the region [Chicago], and the depth of the inpatient utilization drop suggests that structural factors are at work in changing healthcare provision in the region, and not solely recession-linked factors,” the analysts wrote.

To assess whether early care management may be a factor, they looked at “ambulatory care sensitive admissions,” which may indicate that outpatient care for patients with chronic conditions such as congestive heart failure is helping to keep them out of the hospital. The Agency for Healthcare Quality and Research has designated 16 diagnoses as ambulatory care sensitive admissions.

Applying those 16 categories to service line results in Chicago, they identified eight service lines where discharges for patients deemed an ambulatory care sensitive admission fell, including interventional cardiology (a drop of 23.5 percent) and thoracic surgery (12 percent). Using the same methodology, they calculated utilization for cardiovascular care service lines in central Indiana dropped 24.1 percent and in eastern Massachusetts, utilization for cardiovascular surgery service lines decreased 15 percent.

The results suggest that hospitals and physicians in the specialties showing decreases are transitioning to preventive care models akin to accountable care organizations.

Kaufman Hall analysts projected a continued decline in the Chicago area, which could lose as much as 1,900 inpatient discharges a day. “This provides an early signal that the greater Chicago region—and by analogy many other regions in the nation—are likely not to need as many hospital beds or hospitals going forward.”

They recommended hospital administrators restructure inpatient care to match volume trends, develop flexible business models that can respond to changes in healthcare and evaluate staffing needs.

Kaufman Hall published the Chicago analysis earlier this year and released the results on May 20 for Massachusetts, Newark and Indiana.