Vizient, Inc. released its annual Impact of Change Forecast from its subsidiary Sg2, projecting hospital resources will experience even greater strain due to a rise in patient acuity over the next decade that will outpace inpatient volume and impact patient length of stay.
Fueled in part by COVID and its lingering effects, healthcare organizations can potentially expect increased number of patients with more complex conditions creating capacity constraints that may require new strategies for patient care delivery.
The report forecasts adult inpatient volumes recovering from pre-pandemic numbers but growing only 2% over the next decade. However, fueled by an increase in chronic conditions, adult inpatient days are expected to increase 8% during that same time, with additional increases in tertiary inpatient days (17%). The shift of inpatient surgical volumes to outpatient is projected to soften to modest growth (4%) in procedures performed inpatient by the end of the decade.
“While case mix varies by hospital, it is likely this combination of increased inpatient volume, patient complexity and length of stay may require healthcare organizations to rethink service line prioritization, service distribution and investment in care at-home initiatives,” said Maddie McDowell, MD, FAAP, senior principal and medical director of quality and strategy for Sg2.
Outpatient trends
Like the inpatient setting, 2021 outpatient activity remained below 2019 levels, though outpatient surgery fully recovered in the second half of the year. Over the next decade the Impact of Change forecast notes:
Outpatient volumes are projected to return to pre-pandemic levels in 2022 and then grow 16% over the next 10 years, three percentage points above population estimated growth. The aging population, increased survivorship and rise in chronic disease are the main drivers of growth.
The shuffle of surgical volumes across ambulatory sites will continue throughout the decade, with surgeries projected to grow 25% at ambulatory surgery centers and 18% at both hospital outpatient departments and physician offices. Increased payer scrutiny, cost saving measures, hospital-based capacity and resource constraints, combined with the rise in aging and chronic disease populations are driving this increased demand in outpatient surgeries.
The decline in emergency department (ED) visits experienced during the pandemic was sharp but is expected to plateau with a decline in demand projected at -2% over the next 10 years. ED visits will remain significantly below 2019 volumes as a result of lower acuity volumes shifting to alternative care sites including virtual triage. Additionally, as pandemic-era protocols decline, infectious diseases such as asthma, chronic lung disease, and cystic fibrosis are expected to return with a 3% increase this year in ED visits before decreasing 10% by 2032.
Significant growth of telehealth and home care
The pandemic ushered in advances in digital infrastructure, remote monitoring and diagnostics, and payer reimbursement that have led to enduring care delivery changes to not only virtual visits but also home diagnostics, infusions, physical therapy and hospital at home services. Home care is also expected to gain traction over the next five years, including home evaluation and management visits at 19% growth, home hospice at 13% and home physical and occupational therapy at 10%.
Though telehealth levels have come down since the height of the pandemic, the future of virtual care is coming into sharp focus as the industry determines which service lines are best suited for it. Led by behavioral health, neurosciences and medicine, telehealth is expected to resume its climb and by 2032 account for 27% of all evaluation and management visits.
"Virtual health visits have a strong path forward over the next decade, particularly for specialties where frequent touchpoints support positive outcomes,” McDowell said. “While scalability for care at home is difficult, care redesign efforts can leverage remote-patient monitoring and artificial intelligence to improve patient monitoring, drive operational efficiencies and lower costs by shifting patients to the home setting, when appropriate.”
