Transitions in Care Symposium - Franciscan Health...Ambulatory Service Growth Hits Less- Acute,...

Utilization Trends Across the Continuum Transitions in Care Symposium

Lisa Slama, PhD Principal, Sg2

2 Confidential and Proprietary © 2018 Sg2

Patient Volumes at Your Organization Are Like What ’90s TV Show?

A. Full House—We are crushed everywhere, all the time.

B. Saved by the Bell—We often come close to capacity, but we somehow manage.

C. ER—We’re doing ok, but our ED is bursting at the seams.

D. Northern Exposure— We experience seasonal volume shifts.

E. Empty Nest—Our doors are open!

?


2007 2008 2009 2010 2011 2012 2013 2014 2015

Historic Inpatient ALOS Trends

Historic Inpatient Discharge Volume Trends

–7% 2008–2014

We Called It: Admissions Declined as Length of Stay Creeped Up

+2.3% 2012–2015

Sources: Healthcare Cost and Utilization Project (HCUP) Database. https://hcupnet.ahrq.gov/#setup. Agency for Healthcare Research and Quality. Accessed May 2018; Sg2 Analysis, 2018.


Sg2’s Impact of Change® Forecast Methodology

IP and OP Baseline Volumes

Market Data

Institutional Data

National Data

IP Discharges,

Days

Population Epidemiology Economy & Consumerism

Policy Innovation & Technology

Systems of CARE

National Impact Factors

OP Volumes


Sg2 Impact Factors Defined

Estimates the impact of population growth using Claritas demographic data

Quantifies expected changes in disease incidence and prevalence rates

Accounts for micro- and macroeconomic factors and impact of price sensitivity

Measures impact of health care policy initiatives and insurance coverage shifts

Accounts for the impact of care coordination and provider integration across care sites

Examines new technology and clinical innovation that impact site of care, resource use and health management

Population

Epidemiology

Economy & Consumerism

Policy

Innovation & Technology

Systems of CARE

Confidential and Proprietary © 2018 Sg2 6

Agenda Inpatient Projections Ambulatory Care Trends


Sg2 ANALYTICS

14% 0%

3% –2% –2%

–13%

0%

Pop Eco &Consum

Epi Innov &Tech

Policy SoC GrandTotal

25

30

35

2018 2023 2028

Despite Population Estimates, Admissions Are Stable Over Coming Decade

Adult Inpatient Forecast US Market, 2018–2028

Note: Forecast excludes 0–17 age group. eco = economy; epi = epidemiology; innov = innovation; SoC = System of CARE; tech = technology. Sources: Impact of Change®, 2018; HCUP National Inpatient Sample (NIS). Healthcare Cost and Utilization Project (HCUP) 2015. Agency for Healthcare Research and Quality, Rockville, MD; Claritas Pop-Facts®, 2018; Sg2 Analysis, 2018.

Sg2 IP Forecast Population-Based Forecast

Discharges Millions 5-Year

+7%

+0%

+14%

+0%

10-Year

Adult Inpatient Forecast Impact Factors US Market, 2018−2028


Sg2 ANALYTICS

4.5

4.7

4.9

5.1

20

70

120

170

2018 2019 2020 2021 2022 2023 2024 2025 2026 2027 2028

Growing Elderly Population and Rising Acuity Drive IP LOS and Days Increases

Discharges, Total Days and ALOS Forecast 2018–2028

Discharges: +0%

Days: +4%

ALOS: +4%

ALOS Bed Days and Discharges Millions

Note: Forecast excludes 0–17 age group. Sources: Impact of Change®, 2018; HCUP National Inpatient Sample (NIS). Healthcare Cost and Utilization Project (HCUP) 2015. Agency for Healthcare Research and Quality, Rockville, MD; Claritas Pop-Facts®, 2018; Sg2 Analysis, 2018.


Sg2 ANALYTICS

22%

0%

15%

5%

20%

9% 11% 11%

13%

18%

7%

13%

3%

13%

8% 11%

7%

12%

Critical Care Discharges and Days Will Grow as Acuity Rises

Inpatient Forecast, Top ICU CARE Families US Market, 2018-2028

Note: Forecast excludes 0–17 age group. Sources: Impact of Change®, 2018; HCUP National Inpatient Sample (NIS). Healthcare Cost and Utilization Project (HCUP) 2015. Agency for Healthcare Research and Quality, Rockville, MD; Claritas Pop-Facts®, 2018; Sg2 Analysis, 2018.

Discharges Days

Acute Respiratory

Failure

Dysrhythmia and Cardiac

Arrest Hemorrhagic

Stroke Myocardial Infarction Septicemia Shock

Skull Fracture and Major Brain

Injury Spinal Cord

Injury Total

2018 Discharges 465K 760K 132K 653K 1.83M 6K 201K 16K 4.1M


Sg2 ANALYTICS

Although Overall IP Surgery Volumes Will Decline, Expect Pockets of High Growth

Note: Analysis excludes 0–17 age group. Surgeries listed fall under the Major Therapeutic Procedure Group category in the inpatient forecast. Sources: Impact of Change®, 2018; HCUP National Inpatient Sample (NIS). Healthcare Cost and Utilization Project (HCUP) 2015. Agency for Healthcare Research and Quality, Rockville, MD; Claritas Pop-Facts®, 2018; Sg2 Analysis, 2018.

10-YEAR % CHANGE 2018 VOLUMES Overall Surgeries –3% 8,193,100 Endovascular Procedure—Cerebral 127% 62,800 Transcatheter Valve Procedure 120% 39,800 Motion Preservation Procedures 72% 5,500 Revision Knee Replacement 58% 50,800 Revision Hip Replacement 49% 38,900 Ventricular Assist Device and Artificial Heart 45% 4,900 Neurostimulator Procedure 41% 15,200 Lobectomy and Pneumonectomy 35% 38,800 Bone Marrow Transplant 26% 15,800 Transplantation—Lung 24% 2,000 Ventricular Assist Device—Percutaneous 23% 2,400 Transplantation—Heart 19% 2,200


Many Services Are Shifting Out of Inpatient Status but Still Remain in the Hospital

85

95

105

115

2017 2022 2027

Hospital Forecast, All Service Lines US Market, 2017–2027

Volumes Millions 5-Year 10-Year

+7%

+3%

+14%

+7%

Sg2 Hospital Forecast Pop Hospital Forecast

Notes: Analysis excludes 0–17 age group. OP site of care = hospital OP. OP discharges = Procedures–Major, Procedures–Minor, Visits–Observation. HOPD = hospital outpatient department; Obs = observation. Sources: Impact of Change®, 2017; HCUP National Inpatient Sample (NIS). Healthcare Cost and Utilization Project (HCUP) 2014. Agency for Healthcare Research and Quality, Rockville, MD; OptumInsight, 2015; The following 2015 CMS Limited Data Sets (LDS): Carrier, Denominator, Home Health Agency, Hospice, Outpatient, Skilled Nursing Facility; Claritas Pop-Facts®, 2017; Sg2 Analysis, 2017.

Included in Hospital Forecast: IP Discharges

HOPD Procedures—Major/Minor

Visits—Obs in HOPD


Sg2 ANALYTICS

Short Stay Patients Will Predominate, Impacting Throughput and Financials

Hospital Forecast, All Service Lines US Market, 2018

Inpatient

Obs

HOPD

Hospital Forecast, All Service Lines US Market, 2028

10%

65%

26%

9%

62%

28%

111M 116M Notes: Analysis excludes 0–17 age group. OP site of care = hospital OP. OP discharges = Procedures–Major, Procedures–Minor, Visits–Observation. Sources: Impact of Change®, 2018; HCUP National Inpatient Sample (NIS). Healthcare Cost and Utilization Project (HCUP) 2014. Agency for Healthcare Research and Quality, Rockville, MD; OptumInsight, 2016; The following 2016 CMS Limited Data Sets (LDS): Carrier, Denominator, Home Health Agency, Hospice, Outpatient, Skilled Nursing Facility; Claritas Pop-Facts®, 2017; Sg2 Analysis, 2018.

Confidential and Proprietary © 2018 Sg2 13

Agenda Inpatient Projections Ambulatory Care Trends


Sg2 ANALYTICS

3.0

3.5

4.0

4.5

2018 2023 2028

At a High Level, OP Growth Will Mirror Population Estimates

Adult Outpatient Forecast US Market, 2018–2028

Note: Forecast excludes 0–17 age group. Sources: Impact of Change®, 2018; OptumInsight, 2016; The following 2016 CMS Limited Data Sets (LDS): Carrier, Denominator, Home Health Agency, Hospice, Outpatient, Skilled Nursing Facility; Claritas Pop-Facts®, 2018; Sg2 Analysis, 2018.

Volumes Billions

Adult Outpatient Forecast Impact Factors US Market, 2018−2028

+8%

+7%

+15% +14%

5-Year 10-Year

Sg2 OP Forecast Population-Based Forecast

Pop Eco &Consum

Epi Innov &Tech

Policy SoC GrandTotal

+14% –4% +5% –1% 0% +1% +15%


Sg2 ANALYTICS

Growth Opportunities Exist Across Sites; Capturing Growth Requires Integration

Office/Clinic Urgent/Retail Care

Home

2018 Site of Care Volumes and 10-Year Forecast, Adults US Market, 2018–2028

+19% Volume

3.5M

SNF

+25% Volume

250M

+5% Volume

2.5B

+9% Volume

7.3M

+1% Volume

106M

ED

0% Volume

30M

Inpatient

+13% Volume

507M

Hospital OP/ASC Volume in 2028

255M

In 2028, 17% of all E&M visits will be delivered in a virtual care setting.

Virtual

Acuity

Note: Analysis excludes 0–17 age group. ASC = ambulatory surgery center; CARE = Clinical Alignment and Resource Effectiveness; E&M = evaluation and management; SNF = skilled nursing facility. Sources: Impact of Change®, 2018; HCUP National Inpatient Sample (NIS). Healthcare Cost and Utilization Project (HCUP) 2015. Agency for Healthcare Research and Quality, Rockville, MD; OptumInsight, 2016; The following 2016 CMS Limited Data Sets (LDS): Carrier, Denominator, Home Health Agency, Hospice, Outpatient, Skilled Nursing Facility; Claritas Pop-Facts®, 2018; Sg2 Analysis, 2018


Expect Continued Surgical Shift to Less-Acute Care Sites

Hospital OP Surgery

ASC

Hospital IP Surgery

+30% (14.4M)

–3% (8.2M)

+19% (19.6M)

Note: All percentages represent Sg2’s 10-year growth forecast, adults only. Numbers in parentheses are 2018 baseline volumes. IP surgery is defined as Procedure Group: Major Therapeutic. OP surgery is defined as Procedures: Major and Endoscopy: Arthroscopy. Hospital OP surgery is filtered for site of care detail: Hospital OP. ASC OP surgery is filtered for site of care detail: ASC. ASC = ambulatory surgery center. Sources: Impact of Change®, 2018; HCUP National Inpatient Sample (NIS). Healthcare Cost and Utilization Project (HCUP) 2015. Agency for Healthcare Research and Quality, Rockville, MD; OptumInsight, 2016; The following 2016 CMS Limited Data Sets (LDS): Carrier, Denominator, Home Health Agency, Hospice, Outpatient, Skilled Nursing Facility; Claritas Pop-Facts®, 2018; 2018; Sg2 Analysis, 2018.

Sg2 10-Year Growth Projections (2018–2028)


Sg2 ANALYTICS

Orthopedics/Spine Top Outpatient Growth for Surgical Procedures

Note: Forecast excludes 0–17 age group. OP surgery is defined as Procedures: Major and Endoscopy: Arthroscopy. Sources: Impact of Change®, 2018; OptumInsight, 2016; The following 2016 CMS Limited Data Sets (LDS): Carrier, Denominator, Home Health Agency, Hospice, Outpatient, Skilled Nursing Facility; Claritas Pop-Facts®, 2018; Sg2 Analysis, 2018.

10-YEAR % CHANGE 2018 VOLUMES

Overall Surgeries 23% 40,658,000 Primary Knee Replacement 1,105% 61,000 Primary Shoulder Replacement 971% 14,000 Primary Hip Replacement 712% 43,000 Lumbar/Thoracic Spinal Fusion 211% 31,000 Motion Preservation Procedures 153% 15,000 Partial Knee Replacement 139% 77,000 Revision Knee Replacement 120% 4,000 Primary Ankle Replacement 110% 2,000 Cervical Spinal Fusion 90% 103,000 Prostatectomy 62% 12,000 Intracardiac Catheter Ablation 51% 236,000 Arthroscopy 35% 3,557,000 Neurostimulator Procedure 30% 448,000


Ambulatory Service Growth Hits Less-Acute, Lower-Cost Settings

ED

+1% (106M)

Urgent/Retail Care Center

Note: All percentages represent Sg2’s 10-year growth forecast, adults only. Numbers in parentheses are 2018 baseline volumes. ED site of care is defined as all volumes under site of care: ED. Urgent/retail care site of care is defined as all volumes under site of care: urgent/retail. Sources: Impact of Change®, 2018; OptumInsight, 2016; The following 2016 CMS Limited Data Sets (LDS): Carrier, Denominator, Home Health Agency, Hospice, Outpatient, Skilled Nursing Facility; Claritas Pop-Facts®, 2018; Sg2 Analysis, 2018.

+9% (7.3M)



Sg2 ANALYTICS

84

88

92

96

100

2018 2023 2028

Nonemergent ED Visits Shift to Lower-Cost Settings

Note: Forecast excludes 0–17 age group. Sources: Impact of Change®, 2018; OptumInsight, 2016; The following 2016 CMS Limited Data Sets (LDS): Carrier, Denominator, Home Health Agency, Hospice, Outpatient, Skilled Nursing Facility; Claritas Pop-Facts®, 2018; Sg2 Analysis, 2018.

ED Visit Forecast US Market, 2018–2028

+2%

+2%

+4%

+9%

Sg2 Forecast Population Forecast


35

40

45

50

55

2018 2023 2028

Emergent and Urgent Visit Forecast US Market, 2018–2028

+10%

–4%


–2%

+6%

Emergent Visits Urgent Visits


Urgent Care Market Sees Growth and Consolidation

Independent Locations Concentra 290 MedExpress/Optum 146 American Family Care/DRX 145 NextCare 123 FastMed 88

Hospital/Multispecialty Locations US HealthWorks/Dignity 166 MedPost (Tenet Subsidiary) 39 Aurora Health 35 Carolinas HealthCare 31 Intermountain Healthcare 30

National estimates range between 7,100 and 9,000 clinics

Growth moderates Market consolidation builds Larger players making

acquisitions Telehealth strains expansion

in saturated markets

Source: Merchant Medicine. The ConvUrgentCare Report. July 2015.



Freestanding Imaging Center

Hospital OP Imaging

+12% CT

(29M)

+10% MR

(10M)

?% CT

(?M)

?% MR (?M)

Note: All percentages represent Sg2’s 10-year growth forecast, adults only. Numbers in parentheses are 2018 baseline volumes. CT imaging at hospital OP is defined as advanced imaging: CT, filtered for site of care detail: hospital OP. MR imaging at hospital OP is defined as advanced imaging MR, filtered for site of care detail: hospital OP. Sources: Impact of Change®, 2018; OptumInsight, 2016; The following 2016 CMS Limited Data Sets (LDS): Carrier, Denominator, Home Health Agency, Hospice, Outpatient, Skilled Nursing Facility; Claritas Pop-Facts®, 2018; Sg2 Analysis, 2018.



Payment Pressures Shift Imaging to Low Cost Centers

Identifying the Gap Between Hospital and Free-Standing Prices

Healthcare Financial Management Association

Spring 2017

Anthem’s New Outpatient Imaging Policy Likely to Hit Hospitals’ Bottom Line

Modern Healthcare

August 27, 2017

Changes to Radiology Reimbursements on the Horizon

HealthTrust

June 7, 2017



E&M Office/Clinic Visits

Virtual Visits

17% (of all visits will be virtual in 10 years)

600+%

E&M Urgent/Retail Care Center

E&M Home Visits

+6% (24M)

+6% (5.6M)

–5% (1.1B)

Note: All percentages represent Sg2’s 10-year growth forecast, adults only. Numbers in parentheses are 2018 baseline volumes. E&M visits at office/clinic are defined as E&M visits, filtered for site of care: office/clinic. E&M visits at urgent/retail are defined as E&M visits, filtered for site of care: urgent/retail. E&M visits at home are defined as E&M visits, filtered for site of care: home. Virtual visits growth is defined as site of care: virtual visits (percent change from 2019–2028). Sources: Impact of Change®, 2018; OptumInsight, 2016; The following 2016 CMS Limited Data Sets (LDS): Carrier, Denominator, Home Health Agency, Hospice, Outpatient, Skilled Nursing Facility; Claritas Pop-Facts®, 2018; Sg2 Analysis, 2018.



Understanding Future Health Care Utilization Requires Thinking a Generation Ahead


Understanding Future Health Care Utilization Requires Thinking a Generation Ahead


Expect Virtual Health to Gain Momentum as Reimbursement and Consumerism Grow

40% of hospitals surveyed have listed virtual health as a high priority.

NUMBERS TO KNOW

of providers are offering virtual health services now or will in the near future.

of US consumers would use virtual health services.

200 virtual networks serve

have enacted private insurance parity laws.

more visits in fiscal year 2015 compared to 2014. 3,500 facilities.

29 states 93%

62% 74%

One virtual health vendor reports

Sources: American Telemedicine Association, 2016; Industry Benchmark and Data Report, 2016; Sg2 Analysis, 2018.


Post-Acute Care Demand Trickles Down to Lower-Cost Care Settings

Inpatient Rehab

–9% (293K)

Home Nurse Visits

+30% (139M)

Skilled Nursing Facility

+19% (3.5M)

Note: All percentages represent Sg2’s 10-year growth forecast, adults only. Numbers in parentheses are 2018 baseline volumes. Inpatient rehab is defined as Procedure: Inpatient Rehabilitation. SNF is defined as Procedure: SNF Stays. Home nurse visits are defined as Procedure: Home Nurse Visits. Sources: Impact of Change®, 2018; HCUP National Inpatient Sample (NIS). Healthcare Cost and Utilization Project (HCUP) 2015. Agency for Healthcare Research and Quality, Rockville, MD; OptumInsight, 2016; The following 2016 CMS Limited Data Sets (LDS): Carrier, Denominator, Home Health Agency, Hospice, Outpatient, Skilled Nursing Facility; Claritas Pop-Facts®, 2018; Sg2 Analysis, 2018.



Previous Timeline

Post-Acute Care Payment Reform: It’s Not If but When

MedPAC = Medicare Payment Advisory Commission. Sources: Medicare Payment Advisory Commission. Mandated Report: Developing a Unified Payment System for Post-Acute Care. June 2017; Sg2 Analysis, 2018.

2023 2022

CMS defines and begins collecting quality/cost measures; develops risk-adjustment tool.

2016 2017 2018 2019 2020 2021

CMS Report to Congress

MedPAC details feasibility of a PAC-PPS based on patient characteristics, not setting.

2024

Implementation


Proposed Timeline

Post-Acute Care Payment Reform: It’s Not If but When

2023 2022

MedPAC urges accelerated

PAC-PPS implementation.

2016 2017 2018 2019 2020 2021

Implementation

MedPAC details feasibility of a PAC-PPS based on patient characteristics, not setting.

2024

MedPAC = Medicare Payment Advisory Commission. Sources: Medicare Payment Advisory Commission. Mandated Report: Developing a Unified Payment System for Post-Acute Care. June 2017; Sg2 Analysis, 2018.


Note: Percentages in pie chart may not add to 100% due to rounding. Sources: Sg2 Insurance Estimates; Impact of Change®, 2018; HCUP National Inpatient Sample (NIS). Healthcare Cost and Utilization Project (HCUP) 2015. Agency for Healthcare Research and Quality, Rockville, MD; OptumInsight, 2016; The following 2016 CMS Limited Data Sets (LDS): Carrier, Denominator, Home Health Agency, Hospice, Outpatient, Skilled Nursing Facility; Claritas Pop-Facts®, 2018; Sg2 Analysis, 2018.

Growth in Medicare Will Alter Payer Mix, Impact Utilization

3% Self-Pay 40%

Medicare

33% Commercial

2024 National Payer Mix

35% Medicare

18% Medicaid

38% Commercial

3% Self-Pay

6% Other Governmental

2014 National Payer Mix


Payer Mix Erosion Hits All Sites and Services

Sources: Impact of Change®, 2018; HCUP National Inpatient Sample (NIS). Healthcare Cost and Utilization Project (HCUP) 2015. Agency for Healthcare Research and Quality, Rockville, MD; OptumInsight, 2016; The following 2016 CMS Limited Data Sets (LDS): Carrier, Denominator, Home Health Agency, Hospice, Outpatient, Skilled Nursing Facility; Claritas Pop-Facts®, 2018; Milliman. Analysis of commercial claims. 2015; Sg2 Analysis, 2018.

% Medicare Volumes 2018

% Medicare Volumes 2028

Commercial Reimbursement

as a % of Medicare

Inpatient 48% 51% 201%

Observation 45% 49% 391%

ED 21% 25% 346%

Hospital OP Surgery 34% 38% 224%

ASC 52% 58% 184%

Chemotherapy 57% 62% 232%

Radiology—CT 50% 55% 438%


Sg2 ANALYTICS

20% 1%

15% –4%

16% 0% 0%

–5% 18%

–3% 17%

9% 19%

–2% 6%

9%

20% 21%

17% 21%

14% 13%

4% 1%

21% 21%

16% 16%

13% 12%

6% 23%

Service Line Forecasts Reveal Variation Across the IP and OP Settings

Inpatient Service Line Growth Rates US Market, 2018–2028

Outpatient Service Line Growth Rates US Market, 2018–2028

Sg2 IP Forecast Population-Based Forecast Sg2 OP Forecast

Psychiatry

Orthopedics and Spine

Neurosciences

Cancer

Women’s Health

Medicine

Surgery

Cardiovascular

Psychiatry

Orthopedics and Spine

Neurosciences

Cancer

Women’s Health

Medicine

Surgery

Cardiovascular

Note: All service lines exclude 0–17 age group. Cardiovascular includes cardiology and vascular. Medicine includes allergy and immunology, dermatology, endocrinology, gastroenterology, medicine, infectious diseases, nephrology, pulmonology, and rheumatology. Surgery includes burns and wounds, otolaryngology, general surgery, ophthalmology and urology. Brain/CNS Cancer CARE Family is counted in both the cancer and neurosciences service line forecasts. Sources: Impact of Change®, 2018; HCUP National Inpatient Sample (NIS). Healthcare Cost and Utilization Project (HCUP) 2015. Agency for Healthcare Research and Quality, Rockville, MD; OptumInsight, 2016; The following 2016 CMS Limited Data Sets (LDS): Carrier, Denominator, Home Health Agency, Hospice, Outpatient, Skilled Nursing Facility; Claritas Pop-Facts®, 2018; Sg2 Analysis, 2018.

Sg2, a Vizient company, is the health care industry’s premier authority on health care trends, insights and market analytics.

Our analytics and expertise help hospitals and health systems achieve sustainable growth and ensure ongoing market relevance through the development of an effective System of CARE.

Sg2.com 847.779.5300

Date post:	09-Aug-2020
Category:	Documents
Upload:	others
View:	1 times
Download:	0 times

Transitions in Care Symposium - Franciscan Health...Ambulatory Service Growth Hits Less- Acute,...

Documents