patient volume report post aca

What does the decline in ed volumes mean for outpatient care?

The ongoing decline in ED volumes has significant implications for both population health and hospital finances. Outpatient care could bounce back strongly unless future COVID-19 spikes force hospitals to again pause or scale back elective procedures.

Will the proportion of payouts withheld from hospitals increase over time?

The proportion of the payouts that is withheld from hospitals will undoubtedly increase over time. There are similar incentive components in the Physician Quality Reporting System (PQRS).

Why is CMS withholding Medicare payouts from hospitals?

Now, as part of the ACA’s Hospital Value-Based Purchasing Program [1], CMS is withholding 1 percent of Medicare payments—30 percent of which is tied to HCAHPS scores—to fund the incentives of the program [4]. The proportion of the payouts that is withheld from hospitals will undoubtedly increase over time.

Should hospitals focus on improving patient survey numbers?

Through both financial incentives and public disclosure, hospitals are being rewarded or penalized based on their patient experience scores. Dr. Parker is challenging the notion that these metrics are important for hospitals and asking whether hospitals should put resources towards improving their patient survey numbers.

Does the reduction affect the case mix index?

The reduction also affects case mix index (CMI) because a larger proportion of the remaining patients have severe conditions.

Will outpatient care bounce back?

Outpatient care could bounce back strongly unless future COVID-19 spikes force hospitals to again pause or scale back elective procedures.

Will the volume of hospitals decrease in 2020?

Recent reports from Kaufman Hall and TransUnion are among those quantifying the decline in volume throughout 2020. The reports also contain reasons for optimism, but plenty in the coming months will be out of hospitals’ control.

Is telehealth part of peak performance?

Telehealth also may be part of the path back to peak performance for hospitals and other providers. “What we saw was how much the consumer behavior impacted some of the operations and finances early on” in the pandemic, Swanson said.

Will ED volumes lag in 2021?

TransUnion projects that ED volumes will continue to lag, with Q2 2021 likely remaining at the pandemic-era baseline. “However, visits may gain some ground as patients become more comfortable returning to hospitals due to widespread vaccination administration,” the report states.

Do hospital volumes rebound?

Hospital patient volumes show signs of rebounding in some areas but continue to lag in others, especially in the ED.

Is outpatient care the wild card?

While inpatient volume trends are linked at least partially to ED volumes, outpatient care represents “the wild card,” Wiik said. Patients could be more comfortable returning for those services, but hospitals also may have to pull back on offering them in response to any future surges of COVID-19.

Update: August 12, 2021

McKinsey surveyed leaders at 100 private sector hospitals across the United States in late July to examine how COVID-19 continued to impact hospital volume. Emergency department and inpatient volumes have returned to 2019 levels, with respondents noting they expect it to be roughly 5 to 6 percent higher in 2022.

About the author (s)

Gretchen Berlin, RN, is a senior partner in McKinsey’s Washington, DC, office and a registered nurse. David Bueno is a partner in the Atlanta office. Kyle Gibler, MD, is a partner in the Charlotte office. John Schulz, MD, is an associate partner in the Chicago office. Joanna Wexler is a consultant in the New York office.

Why do physicians focus on patient satisfaction?

A significant portion of revenue is related to volume, which includes new and repeat patient visits. Although there are some publicly available quality metrics, like the results of the HCAHPS surveys [3], patients often make medical decisions based on reputation and word of mouth. Thus, physicians need to focus on patients’ satisfaction with care because it may drive patient volume more than technical acumen alone. Another reason physicians might focus on patients’ experience of care is that there is evidence suggesting that “the frequency with which physicians are sued is related in part to patients’ satisfaction with interpersonal aspects of medical care” [10, 11]. While these may not be the primary reasons for physicians to focus on patients’ experience of care, doing so may actually provide operational benefit, in addition to better patient care.

Why do physicians focus on patients' experience of care?

Another reason physicians might focus on patients’ experience of care is that there is evidence suggesting that “the frequency with which physicians are sued is related in part to patients’ satisfaction with interpersonal aspects of medical care ” [10, 11].

What is HCAHPS in healthcare?

HCAHPS is the most studied system for measuring patients’ experience of their care on an individual and hospital level [7] , so it is a useful step towards helping clinicians think more broadly about outcomes that matter to both them and their patients.

Why are patient experience scores important?

Patient experience scores may also have an association with more objective clinical quality measure scores. For example, hospitals with better patient experience scores also have some higher quality measures for acute myocardial infarction and aspects of surgical care [7-9]. There are two possible explanations for this relationship. First, hospitals that have better engagement with patients may encourage greater adherence to clinical standards of care and follow-up. Patients who are more satisfied with a practice may be more likely to come in for visits and follow the recommendations of the clinicians that they trust. Second, better patient experience scores could indicate that a hospital has stronger teamwork, organizational leadership, and commitment to improvement, characteristics that could be associated with better quality measures and patient experience scores. Both of these possible explanations suggest that there is benefit for clinicians in measuring and rewarding patient experience of care, since doing so has the potential to improve overall quality of care.

Is patient experience an indicator of quality?

As part of its “triple aim,” the Institute for Health Care Improvement describes the patient experience of care as including both care quality and patient satisfaction, suggesting that these features are interrelated [6]. Regardless of whether one considers experience an indicator of quality, improving patient experience ratings is beneficia l for patients and clinicians for a number of reasons.

Can physicians choose not to participate in incentive programs?

Physicians can no longer choose not to participate in, but they can decide how best to engage with, incentive programs. Hospitals and clinics are using these scores to justify greater investment in improving experience for patients—a big step for an industry not known for customer service.

Is patient satisfaction an objective measure of quality?

But all of these are objective measures. Patient satisfaction just isn’t an objective measure of care quality.”.

Can EPs choose one or more clinical sites of practice?

EPs may choose one (or more) clinical sites of practice to calculate patient volume (i.e., the calculation does not need to be across all of an EP’s sites of practice)

Is patient volume appropriate for EP?

Practice's patient volume is appropriate as a patient volume methodology calculation for the EP (i.e., if an EP only sees Medicare, commercial, or self‐pay patients, this is not an appropriate calculation)