Inpatient Admissions Decreasing; Implications for Hospital-Based Labs

I have commented previously about the decrease in the yearly number of hospital inpatients (see: Need for More "Disruptive" CEOs of Health Systems; What Does This Mean?; The Case of the "Disappearing Hospital Beds"; Implications for Pathologists). Evidence of this decline was provided in the following article: Trends in Hospital Inpatient Stays in the United States, 2005-2014. For the period 2005-2014, graphs in this article show that all types of inpatient stays declined by 6.6%, medical declined by 5.3%, and surgical defined by 12.0%. This trend continues unabated to this day (see: HOSPITAL ADMISSIONS DOWN, COSTS RISE). Contributing to the decline in surgical admissions is probably the growth of standalone surgicenters which have developed outpatient hip and knee replacements that are less expensive than hospitals (see: Tug of War between Hospitals and Surgicenters for Knee Replacements). For this reason, they are often favored by health insurance companies and corporations for their employees.

There is thus unanimity of opinion and data indicating that inpatient admissions are in a continuing decline. I have also suggested in previous blogs that a new first tier of primary outpatient care is emerging in the form of walk-in retail health clinics like CVS's MinuteClinics and urgent care centers (see: Physicians Are Disappearing from the Front Line of Healthcare; Rapid Growth of Urgent Care Clinics; Cost Competition for Hospital ERs). Inpatients historically have accounted for the majority of lab tests performed because they are sicker and undergoing more complex surgical procedures. These first-tier facilities will soon compete with health systems and private physician offices for ambulatory care patients.

What will be the result of all of these changes on the volume of lab tests performed in hospital-based labs? On the one hand, precision medicine tests are obviously increasing because of the new technology and science that stands behind them. On the other hand, a decreasing number of inpatients could result in lower test volume overall. At the first tier of healthcare, the majority of lab testing performed for patients in walk-in clinics such as MinuteClinics and urgent care centers may be grabbed by the large national reference labs. The latter are building out patient service centers (PSCs) in retail drug and grocery stores (see: National Reference Labs Expand Their PSC Footprint in Groceries & Retail Pharmacy). Hospital-based labs have historically benefitted from a "captive audience" for test blood draws when outpatient visits occurred in their facilities. This advantage disappears when patients seek primary care at drug store clinics or urgent care centers.

One more factor that may drive down the lab test volume of hospital-based labs is telemedicine/virtual care. I believe that the majority of outpatient visits will be virtual in the near future; this is already the case for the huge Kaiser Permanente Health system (see: It's Time for the Integration of Virtual Health Services Based on a Timeline). To restate the obvious, patients receiving care via telemedicine when sitting in their living rooms may find it most convenient to drive to the nearest CVS for blood draws. CVS and Quest/LabCorp are anticipating this by establishing PSCs in retail drug stores. In time, they may also deploy point-of-care testing in these stores with a turnaround time of minutes for lab test results.