I have posted a number of previous notes about the greater emphasis being placed on ambulatory care and bedless hospitals (see, for example: Hospitals Investing Capital in Variety of Outpatient Facilities: IT Serves as the Glue; Some Additional Ideas About the Bedless Hospitals of the Future). I had not come across hard numbers about this phenomenon until now. A recent article discussed the case of the "disappearing hospital beds" (see: The case of the disappearing hospital beds). Below is an excerpt from it:
Healthcare is leaving the traditional four walls of hospitals. As patients, payers, and providers seek to reduce costs and improve quality, they are relying less on inpatient stays and more on outpatient services. A growing reliance on outpatient services could drive healthcare costs down as costly inpatient services are increasingly reserved for patients who truly need them. Hospital beds have been on their way out for a while. Over the past 20 years, the general trend to provide more value and less volume has driven down the number hospital beds available to patients nationwide. There were a total of 901,056 hospital beds across the country in 1994....That number fell to 786,874 by 2014. Inpatient admissions ticked upwards slightly during that time, but admission rates per 1,000 visits dropped from 118 to 103.7. Around 2.3 million more patients were treated at hospitals in 2014 than in 1994, but they spent 26.7 million fewer days in the hospital.
Meanwhile, utilization of outpatient services has increased. There were a little less than 383 million outpatient visits in 1994 and more than 693 million in 2014. The number of outpatient surgeries performed each year increased from 13.2 million in 1994 to 17.4 million in 2014. The number of outpatient surgery centers serving patients has increased by 407 from 2009 to 2014, from 5,039 to 5,446. As a smaller percentage of patients require shorter inpatient stays, hospitals are removing their beds.....The University of Pittsburgh reduced its beds in service across its network of hospitals by 8.4% from 2013 to 2014....While some providers remove beds, others aren’t offering inpatient services at all. In 2014, Montefiore Health System opened a massive 12-story ambulatory surgical hospital without any inpatient beds.....[The] MetroHealth System [recently] opened the Brecksville Health and Surgery Center in Ohio. The facility will feature an always-open emergency department, laboratory and imaging services, and primary care services, but it will not offer inpatient services....In one review of relevant studies,...researchers determined outpatient surgeries were associated with cost savings averaging 16.6% to 57.6%, with most of the savings in nursing and room costs.
The professional services rendered by pathologists in hospitals consist of the interpretation of tissue biopsies and surgically resected tissues and the management of clinical laboratories. Let's call this set of services pathology diagnostics for the sake of this discussion. I believe that the following set of changes will have a major effect on the volume of pathology diagnostics: (1) the shift to outpatient services including outpatient surgery; (2) increased adoption of telemedicine and home monitoring (see: Telemedicine and Home Monitoring Will Promote Healthcare Transformation); (3) value-based care driving more surveillance and a reduction of lab testing driven, in part through the deployment of "laboratory expert systems" (see: Reduction in Unnecessary Clinical Laboratory Testing Through Utilization Management at a US Government Veterans Affairs Hospital); (4) increased home lab testing and "wearables"; (5) adoption of predictive analytics and big data that will squeeze more useful information from generic lab tests; (5) increased competition from national reference labs as more retail drug stores install walk-in clinics and patient service centers for national reference labs.
In terms of the most significant and impending effect on the volume of pathology diagnostics, I would suggest we look at the increase in outpatient services and outpatient surgeries as noted above. Historically, far fewer tests are ordered for outpatients than inpatients. This is due, in part, to the fact that outpatients are less sick and that inpatients undergo more complex surgeries. However, part of the growth in the number of outpatient surgeries has been based on the fact that new techniques and technologies allow more complex cases to be performed on this basis (see: Tug of War between Hospitals and Surgicenters for Knee Replacements). As outpatient services expand, I predict that the number of tests per patient visit may increase but not to the former inpatient levels. In short, I think that the total volumed of pathology diagnostics will decline in upcoming years.