We used claims data to investigate how procedures shift out of the hospital setting to enable better predictions of site-of-care shift. With a better sense of how procedures shift, health care leaders can make more informed investment and partnership decisions.
The main takeaway: While the pace of outpatient shift remains slow, some procedures did shift rapidly out of the hospital. This rapid shift happens when regulatory and market forces align, emphasizing that hospitals can’t take their market share for granted, and payer, physician, and life science stakeholders can all play a role in accelerating the pace of shift.
We analyzed two national claims data sets, CMS’ Physician/Supplier Procedure Summary file and Optum’s de-identified Clinformatics® Data Mart Database, to explore how 27 procedures shifted across care settings between 2014 and 2019.
Want more detail on our findings and methodology? Check out our full piece on Understanding how procedures shift out of the inpatient setting.
While procedures tend to shift slowly across care settings, rapid shift can happen when regulatory and market forces align.
Stakeholders looking to maintain their share of procedure volumes should monitor local market forces to anticipate change. And stakeholders looking to spark shift to lower-cost care settings should take an active role in shaping the market forces that (along with regulation) enable and sustain outpatient shift.
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