Becker's Hospital Review

Finance, Revenue Cycle & ICD-10 36 7 Forecasts on Hospital Inpatient, Outpatient Volumes By Bob Herman I npatient and outpatient volumes have already begun shifting at hospitals over the past several years, and looking five to 10 years out could help organizations refine their financial strategies. Sg2, a healthcare analytics firm, has released national and regional forecasts for hospital inpatient and outpatient volumes. Here are seven predictions on long-term hospital volumes. 1. Overall growth. Outpatient volumes are expected to grow 17 percent over the next five years, while inpatient discharges may decrease 3 percent, according to Sg2's report. 2. Bariatric surgery and advanced imaging. Bariatric surgery and advanced imaging are expected to be major drivers of outpatient growth in the next five years. Sg2 predicts outpatient bariatric surgery alone may increase by 75 percent. 3. Cardiovascular. Inpatient cardiovascular discharges have been on the decline at hospitals for many years. Inpatient angioplasties are still expected to drop as more cases shift to the outpatient setting. However, over the next five years, outpatient cardiovascular services are expected to swell by 16 percent. Certain cardiovascular surgeries, electrophysiology and vascular intervention are also expected to grow in both the inpatient and outpatient settings. 4. Cancer. Advanced cancer surgical techniques, such as neoadjuvant treatment, are expected to boost inpatient oncology services. 5. Neurosciences. Admissions for inpatient stroke treatments are expected to stabilize, and admissions for stroke interventions like tissue plasminogen activator treatment could increase up to 59 percent over the next five years. 6. Orthopedics. Orthopedic surgeries have exploded in the outpatient setting, but Sg2 still expects hip replacements and knee replacements will grow 11 percent and 16 percent, respectively, over the next five years in the inpatient setting. 7. Women's health and pediatrics. National neonatal intensive care unit admissions are expected to fall by 2 percent over the next five years. n 11 Statistics on Hospital Debt-toCapitalization Ratios S&P: Cost of Hospital Services Mildly on the Rise By Bob Herman  By Bob Herman  F or most hospitals and health systems, debt-to-capitalization ratios fell between 2009 and 2011 as many organizations looked to refinance debt and build cash on hand. Debt-to-capitalization is the hospital's long-term debt divided by the sum of long-term debt and unrestricted net assets. This ratio essentially shows how much debt a hospital has compared to the hospital's overall equity. Here are 11 statistics on median hospital debt-to-capitalization ratios over the past several years from two credit rating agencies, Standard & Poor's Ratings Services and Moody's Investors Service. Note: All data are medians. S&P's data reflects only standalone hospitals in its portfolio, while Moody's data reflects standalone hospitals and single-state health systems in its portfolio. T he average per capita cost of hospital services covered by Medicare and commercial payers increased 2.02 percent from April 2012 to April 2013, a tick up from the 1.91 percent increase recorded in March, according to Standard & Poor's Healthcare Economic Indices through April. Healthcare economic indicators have fallen and stagnated over the past six months. Even though revenue growth rates for hospitals and health systems from payers were up in April, they are still lower than rates recorded in September, when S&P's Hospital Index hit its lowest annual rate (3.84 percent) since January 2005. Hospital growth from commercial payers is still at some of the lowest levels in years. Through April, the Hospital Commercial Index was 1.89 percent, a new record low. In September, that index was at 5.1 percent. S&P median hospital debt-to-capitalization ratios 2006: 37.4 percent 2007: 36.1 percent 2008: 39 percent 2009: 39 percent 2010: 38.1 percent 2011: 36.9 percent S&P Healthcare Economic Indices (12-month moving average) Moody's median hospital debt-to-capitalization ratios 2007: 37.6 percent 2008: 41.1 percent 2009: 42.1 percent 2010: 41.6 percent 2011: 40.4 percent n Hospital Index: 2.02 percent Hospital Medicare Index: 2.15 percent Hospital Commercial Index: 1.89 percent Here are the latest S&P healthcare indices through April 2013. Composite Index: 3.16 percent Medicare Index: 1.06 percent Commercial Index: 4.54 percent Professional Services Index: 4.23 percent Professional Services Medicare Index: -0.80 percent Professional Services Commercial Index: 6.88 percent n

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