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Discussion: Anticipating Utilization Trends

Discussion: Anticipating Utilization Trends

Discussion: Anticipating Utilization Trends

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who have more understanding, to tr)̂ to gain more perspective. “The more philosophies and experience you bring to the table in understand- ing the right call for a given situation,” he says, “the higher the chances that the right decision will be made ifthe situation presents itself again.’ Referring to hoth refereeing and husiness, Heilsherg says, “You have the best chance to make an even better call when you take the time to become better informed and keep open your- self to other people’s perspectives.”

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Anticipating Utilization Trends Key to Adapting in an Evolving Market

Dawn Samaris

The following excerpt recently appeared on the hfm

Healthcare Finance Blog, hfma.org/hfmblog. The blog

includes posts from a wide range of experts in healthcare

finance, with new posts appearing at ¡east weekly.

Hospitals and health systems must prepare for utiliza-

tion declines as they navigate healthcare reform cou-

pled with changing demographics. Having a thorough

understanding of the organization’s current positioning

and the likely impact of healthcare reform and market

forces is essential if a provider is to project utilization to

support an accurate multiyear financial plan. From

there, the provider can project trends in the communi-

ties it serves and develop and implement strategies to

achieve its objectives.

There is some debate about hov/ the forthcoming

changes will affect patient volumes, but we believe that

current trends and increasing market pressures will

drive overall utilization down over time. Inpatient vol-

umes already are on the decline. In a recent study,

encompassing nearly half of the U.S. population, we

found that inpatient use rates per 1,000 people fell

more than 5 percent between 2006 and 2011 in

71 percent of participating states.

By contrast, outpatient utilization Increased. That

trend is expected to continue in the short term, driven

largely by increased physician visits through expansion

of health coverage to about 32 million uninsured

Americans under the Affordable Care Act. But

opposing forces ultimately will counteract that growth.

With “more skin in the game,” patients are likely to

seek fewer services as they assume greater responsi-

bility for the cost of care with higher déductibles

and copayments.