In the article "The Changing Geography of Outpatient Procedures," the Leonard Davis Institute of Health Economics notes "Outpatient surgical visits now account for about two-thirds of all surgical visits in the U.S."  No surprise, considering the benefits the outpatient setting poses to a population of patients in pursuit of convenience, while forced to tighten their proverbial purse straps.

Ongoing medical advancements and an economic climate that calls for more focused fiscal consideration support the continued growth of the more expense-sensitive outpatient model.  Findings in Health Leaders Media's " Outpatient Trends Fact File" show that stand-alone outpatient facilities like ambulatory surgery centers (ASCs) gained market share most rapidly in medical therapy and major surgery service lines from 2007 to 2009, with hospitals showing the most growth in diagnostics and major imaging categories.
 
These recent shifts in healthcare have brought about specialist job movement and increased demand for clinical and technical resources and personnel. So, what does all this mean for the future state of the US healthcare system?


Spotlight on Physician Alignment
Spurred by consumer demand for a more convenient alternative to inpatient procedures, the proliferation of specialist position opportunities in outpatient settings over the past decade brought with it a reasonable amount of MD job movement.  As healthcare organizations continue to investigate accountable care organization (ACO) avenues, where success will largely be determined by the depth of the healthcare consumer base the organization is able to attract (without the HMO in-network demands of yesteryear, mind you), the importance of recruiting physicians with a broad patient following is crystal clear.  A recent Medical Group Management Association survey revealed a 75% increase in the number of active doctors employed by hospitals since 2000.

In " Hospitals' Race to Employ Physicians - The Logic behind a Money-Losing Proposition," The New England Journal of Medicine illustrates the value of the hospital-owned physician practice approach, stating, "if payment systems move toward population health management and risk-based reimbursement, then large outpatient networks will allow a system to shift patients away from higher-cost, hospital-based care and recapture lost revenues as shared savings or capitation surpluses."

This "if you can't beat 'em, join 'em" approach has created a competitive landscape for MDs, with the lure of higher earning potential and greater lifestyle flexibility through fewer practice management burdens - making a strong case for hospital employment over private practice.  Not a whole lot has to change in a care delivery sense, meaning many of these changes will go undetected by consumers: same MD; same setting; just a different financial and organizational structure, all designed to (eventually) stack up to better organized care for patients. 

Long Term Threats and Trends
As outpatient sprawl continues and the landscape grows more and more competitive, the reduced cost-to-consumer aspects of the outpatient care model - provided those persist - will inevitably amount to narrower profit margins.  Will a shift to incentive-driven compensation linked to quality outcomes be the answer to keeping high caliber physicians in these positions?

What additional areas of service realignment will follow?  Will the inpatient market continue to contract as traditionally inpatient service lines, like medical imaging, continue to make the move to the outpatient setting? As outpatient markets expand, there will undoubtedly be an emergence of new facilities targeting geographic areas with high patient income levels and low patient health incidence.  How will the healthcare industry deal with disparate patient populations?   Will there be a divide among resources for the affluent versus the indigent, and will that be felt most within the hospital or outpatient market?  Will facilities buckle under the weight of uncompensated care and limited resources to recruit good talent?

Weigh in with your thoughts via the discussion going on now at HITR.com.



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