Hospitals to experience financial strain over the next decade, report says

By Susan Morse for Becker’s Hospital Review

Hospitals will experience a slowing of inpatient admissions but an increase in the length of adult inpatient stays, the latter being fueled in part by long COVID-19 and a rise in chronic conditions, according to a new report from Vizient and its subsidiary Sg2.

This will lead to greater financial strain due to a rise in patient acuity over the next decade that will outpace inpatient volume and impact patient length of stay.

Fueled in part by COVID-19 and its lingering effects, healthcare organizations can potentially expect an increased number of patients with more complex conditions creating capacity constraints that may require new strategies for patient care delivery.


Hospitals will need to do a fundamental restructuring of their operations and invest in resources, such as the hospital-at-home model, according to the annual Impact of Change Forecast.

Acute hospital care at home that was allowed during the pandemic would need to be made permanent.

Other home care is also expected to gain traction over the next five years, including home evaluation and management visits at 19% growth, home hospice at 13%, and home physical and occupational therapy at 10%.

Advances in digital infrastructure, remote monitoring and diagnostics under the pandemic, as well as payer reimbursement, will continue the growth of virtual visits, home diagnostics, infusions, physical therapy and hospital-at-home services, the report said.

“While case mix varies by hospital, it is likely this combination of increased inpatient volume, patient complexity and length of stay may require healthcare organizations to rethink service line prioritization, service distribution, investment in care-at-home initiatives,” said Dr. Maddie McDowell, senior principal and medical director of quality and strategy for Sg2.

Competition will grow across ambulatory sites throughout the decade, with surgeries projected to grow 25% at ambulatory surgery centers and 18% at both hospital outpatient departments and physician offices.

Increased payer scrutiny, cost-saving measures, hospital-based capacity and resource constraints, combined with the rise in aging and chronic disease populations, will drive this increased demand in outpatient surgeries.

Emergency department visits will remain below 2019 volumes, as lower acuity volumes shift to alternative care sites.

The decline in emergency department visits experienced during the pandemic was sharp but is expected to plateau with a decline in demand projected at -2% over the next 10 years.

Additionally, as pandemic-era protocols decline, infectious diseases, such as asthma, chronic lung disease and cystic fibrosis, are expected to return with a 3% increase this year in ED visits before decreasing 10% by 2032, the report said.


The report found:

  • Adult inpatient volumes will recover from pre-pandemic numbers but will grow only 2% over the next decade.
  • Adult inpatient days are expected to increase 8% during that same time, with additional increases of about 17% in tertiary inpatient days.
  • The shift of inpatient surgical volumes to outpatient is projected to soften to modest growth of 4% in procedures performed inpatient by the end of the decade.
  • Led by behavioral health, neurosciences and medicine, telehealth is expected to resume its climb and by 2032 account for 27% of all evaluation and management visits.


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 population estimated growth.

Additionally, the aging population, increased survivorship and rise in chronic disease are the main drivers of growth.

Though telehealth levels have come down since the height of the pandemic, the future of virtual care is coming into sharp focus as the industry determines which service lines are best suited for it. Led by behavioral health, neurosciences and medicine, telehealth is expected to resume its climb and by 2032 account for 27% of all evaluation and management visits.


“Virtual health visits have a strong path forward over the next decade, particularly for specialties where frequent touchpoints support positive outcomes,” McDowell said. “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.”

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