In its annual Impact of Change® forecast, Vizient’s subsidiary Sg2 projects inpatient volumes will return to pre-pandemic levels in 2022 and grow 2% over the decade. This is attributed to increased acuity as patients age and present to the hospital setting with more complex conditions. Additionally, volumes that can be safely shifted to outpatient settings will begin to reach a floor for select conditions. This is welcome news for hospitals and health systems as 2021 brought another year of pandemic-related suppressed volumes across the care continuum but increasing volumes may create capacity constraints requiring new strategies for patient care delivery.
“The demand that we’re going to see in health care will be exacerbated by a rise in chronic disease and mental health services. The rising acuity, along with shifts in sites of care to those lower cost settings, will lead to capacity constraints that may require service line prioritization, service distribution or care at home investment initiatives to mitigate,” says Madeline McDowell, MD, FAAP, senior principal and medical director of quality and strategy for Sg2.
The Impact of Change forecast reveals trends across the care continuum:
- Inpatient: Inpatient volumes are expected to return in 2022 and grow 2% over the decade. In addition to volume growth, expect average length of stay to modestly rise over the decade. Patients remaining in the hospital setting are more complex and require longer lengths of stay.
- Outpatient: Like the inpatient setting, 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 growth estimates based on population alone. The aging population, increased survivorship and rise in chronic disease are the main drivers of growth.
- Emergency department: The decline in emergency department visits is expected to plateau with demand projected at -2% over the next 10 years. Visits will remain significantly below 2019 volumes as a result of lower acuity volumes shifting to alternative care sites including virtual triage. Infectious diseases such as asthma, chronic lung disease, and cystic fibrosis are expected to return this year with a 3% increase in visits before decreasing 10% by 2032.
- Surgical site shift—New care models and site of care shifts brought on by the pandemic accelerated the shift of patient volumes to lower cost settings across the care continuum. Ambulatory surgery center procedure growth is projected at 25% by 2032, and physician office and hospital outpatient department procedure volumes will grow by 18% each.
In addition, the forecast projects that telehealth will become more defined by service line as it increases over the next decade. “The pandemic taught us which specialties are more amenable to virtual visits depending on the services or diagnostics required during the visit,” says McDowell. Behavioral health experienced the highest proportion of visits performed virtually throughout 2021. Orthopedics saw the largest reversion to in-person visits, though virtual continues to be deployed for postoperative visits. Telehealth overall is expected to resume its climb and by 2032 account for 27% of all evaluation and management (E&M) visits. And as a result of this shift, in-person visits are forecasted to decline by 17%.
Sg2 forecasts that a shift of medical volumes to home care will grow 10% by 2032 with gains in several areas, including E&M visits (19%), home hospice (13%) and home physical and occupational therapy (10%). “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,” says McDowell.