The Transformation of the American Hospital, Assessment to 2020

Focus Shifts from Patient Volumes to Value-based Outcomes and Collaborative Care

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The US hospital industry is in the midst of a major transformation of clinical and operational strategy, moving from a “heads to beds” provider-centric delivery system to a collaborative care continuum, with the patient at the epicenter of attention. Research analysis covers how reimbursement cuts and regulatory changes contribute towards the evolving role of hospital-based care in the United States. It examines the current financial status of US hospitals; the emerging partnership models between hospitals and ambulatory care providers; and the decentralization of diagnostic imaging and clinical laboratory services from within hospitals to free-standing service providers. A vision of care provision in 2020 and beyond ends the study.

Market Overview

Ambulatory Care Services Set to Revolutionize the US Healthcare Market

Hospitals in the United States currently operate in a financially challenging, regulatory and competitive environment. Reduced reimbursements, consolidations between major health insurers, declining inpatient volumes and rising low-cost ambulatory service providers have forced hospitals to innovate new business models in order to remain competitive. With a 5 percent reduction in the hospitals’ inpatient volume and an anticipated 21 percent increase in revenue from ambulatory care, hospitals seek to sustain the competition by collaborating with other care providers to provide affordable and high-quality care to patients. Subsequently, hospitals are devising new partnership models with a broad spectrum of care providers, in a bid to help patients avail integrated care and services.

Table of Contents

1. Research Methodology
2. Executive Summary
3. Influencers Impacting US Hospital Transformation
Evolution of New Models of Care Delivery
Competitor Influence
Pressure hospitals face
Moving beyond acute care setting
Re-structuring for consolidation
Lean Innovations and Management Principals to be Key
Infrastructure
Technology
Financial
Process Management
People
Rise of Smart Hospitals
Enterprise Connectivity
Devices and Sensors
Healthcare IT
Mapping the Transformation of Care Provision
Assessing the Vendor Opportunity Landscape
4. US Hospitals—Overview
Snapshot of Current Status
What Keeps Hospital CEOs Awake at Night
Key Hospital Objectives
Challenges Posed by the Affordable Care Act (ACA)
Financial Status—For-profit Hospitals
Financial Status—Not-for-profit Hospitals
Hospital-owned Insurance Plans
Financial Status—Rural Hospitals
5. Consolidations and Acquisitions among Hospitals
Healthcare Spending Landscape in the United States
Hospital Consolidation Overview
Hospital Services Expansion
Analysis of the 1,500 Hospital Acquisition Deals Between 2006 and 2014
6. Accountable Care Organizations (ACOs)
Role of ACOs
CMS Stipulations for Medicare ACOs
ACO Quality Measures—4 Key Domains
Patient / Caregiver Experience
Care Coordination / Patient Safety
Preventive Health
At-Risk Population
Role of ACOs in Chronic Disease Management
Accountable Care Organization—Infrastructure Landscape
Accountable Care Organization—Segment Landscape
Accountable Care Organization—Patient Coverage
Accountable Care Organization Model—Analysis
Changing Reimbursement Models
Types of Value-based Payments
Shared Savings
Shared Risk
Bundled Payments
Capitation
Bundled Payments Landscape
7. Impact of Medicare on Hospitals
Inpatient Landscape by Payor
Hospital Reimbursement Landscape
Medicare Advantage (MA) Plans
8. Hospital Inpatient Volume Snapshot
Inpatient Statistics Analysis
Hospital Inpatient Volume Trends
Causes of Declining Hospital Inpatient Volumes (2006–2010)
Causes of Declining Hospital Inpatient Volumes (2011–2015)
Financial Impact of Hospital Consolidations
9. Hospital Outpatient Volume Snapshot
Outpatient Statistics Analysis
Ambulatory Surgical Center Trends
10. Synergies of Tomorrow—Evolving Partnerships Between Hospitals and Ambulatory Care Providers
Ambulatory Care Provider Model 1—Retail Clinics
Future of Retail Clinics
Transition of Retail Clinics
Health Systems Partnerships With Retail Clinics
Ambulatory Care Provider Model 2—Urgent Care Clinics
Health Systems Partnerships With Urgent Care Clinics
Case Studies
Partnership Model
Hospital Set-Up Model
Ambulatory Care Provider Model 3—Bridge Clinics
Case Study: John Hopkins Heart Failure Clinic
Ambulatory Care Model 4—Virtualization of Primary Care
Ambulatory Care Model 5—Telemedicine in Rural Hospitals
Case Studies
Grande Ronde Hospital
VA Mayo Clinic Arizona
Lincoln Hospital
11. Current Therapeutic Service Lines Driving Hospital Revenues
Hospital Revenues by Key Specialties
Clinical Specialty Area 1—Orthopedics
Drivers
Constraints
Clinical Specialty Area 2—Cardiovascular Diseases (CVDs)
Clinical Specialty Area 2—Emergence of TAVR
Clinical Specialty Area 2—Emergence of TMVR
Clinical Specialty Area 3—Behavioral Health
American Adults (Ages 18 and Over)
American Children (Ages 13–18)
Clinical Specialty Area 4—Long-term Care (LTC) Hospitals
Hospital Acquired Infections—A Major Hospital Challenge
Solution for HAIs—CMS Partnership for Patients Program
12. Focus on Future Technologies Enabling Hospitals
Personalized Genetic Medicine
Case Studies
Mayo Clinic
Intermountain Precision Genomics
Cleveland Clinic
Children’s Hospital of Wisconsin
3D Printing
Nano Medicine
13. Snapshot of Current and Future Trends in Medical Imaging
Summary of Medical Imaging Trends
Financial Challenges to Medical Imaging
Future Financial Challenges
Partnerships of the Future
Technical Reimbursements—Target of Medicare Cuts
Imaging Procedure Landscape
Imaging Centers—Facing a Tough Economic Environment
Joint Ventures—An Attractive New Model of Collaboration
Benefits of Joint Ventures
Health System Benefits
Mutual Benefits
Imaging Center Benefits
Replacement of Joint Ventures—Rise of Hybrid Models
Hybrid Partnership Models—Examples
14. Snapshot of Current and Future Trends in Clinical Laboratories
Summary of Clinical Laboratory Trends
Financial Challenges to Diagnostic Labs
Future Models of Partnership
Point of Care (PoC) Testing
Clinical Laboratories in the United States—Snapshot
Clinical Laboratories—Key Specialty Areas of Focus
Decentralization of Clinical Laboratory Testing
Hospitals and Independent Labs—Types of Partnerships
Independent Clinical Labs—Consolidation Trends
Point of Care Testing—The Next Big Thing
15. An Ideal Vision of the Future of Care Provision in the United States
Evolution of the Healthcare Landscape: 2010–2020
Key Healthcare Trends: 2016–2020
From Episodic to Managed Care
A Healthcare Utopia—Vision for 2020 and Beyond
Healthcare Innovation will Drive New Market Opportunities
Facilitating Continuum of Care Services
Role of Big Data
Creating Big Data Analytics Solutions
Imaging files
Genomic data
Clinician notes
Others
16. Legal Disclaimer
17. Appendix
Definitions of Key Terms
18. The Frost & Sullivan Story
Value Proposition: Future of Your Company & Career
Global Perspective
Industry Convergence
360º Research Perspective
Implementation Excellence
Our Blue Ocean Strategy

Infographic



List of Figures & Charts

1. Financial Status—For-profit Hospitals
2. Median Annual Revenue Growth, United States, 2013–2014
3. Median Annual Expenditure Growth, United States, 2012–2014
4. Rural Hospital Closures, United States, 2010–Q32015
5. Healthcare Spending, United States, 2013
6. Healthcare Spending by Payer, United States, 2013
7. Hospital Acquisition Deals, United States, 2006–2010
8. Hospital Acquisition Deals, United States, 2010–2014
9. Growth in ACOs, United States, 2011–Q12015
10. Growth in ACO Contracts, United States, 2011–2014
11. Breakup of ACOs by Ownership, United States, 2015
12. ACO Population Coverage, United States, 2011–2020
13. Reduction in Number of Pioneer ACOs, United States, 2012–2014
14. Patients Treated in Hospitals by Payer, United States, 2013
15. Medicare FFS Payments for Hospital Inpatient & Outpatient Services*, United States, 2005–2013
16. Medicare Spending Trends
17. Medicare Advantage Enrollees, United States, 2009–2015
18. Distribution of Enrollees, United States, 2015
19. Inpatient Admissions/1,000 Population, United States, 2005–2013
20. Inpatient Surgeries Performed, United States, 2005–2013
21. Inpatient Days/1,000 Population, United States, 2005–2013
22. Total Inpatient Days, United States, 2005–2013
23. Markup of Hospital Charges Above Costs For Medicare Services, United States, 2005–2012
24. Top 50 Hospitals in Terms of Markups
25. Outpatient Visits/1,000 Population, United States, 2005–2013
26. Total Outpatient Visits, United States, 2005–2013
27. Total Outpatient Surgeries, United States, 2005–2013
28. ASC Growth Trends, United States, 2008–2014
29. Number of Retail Clinics, United States, 2009–2021
30. Patients Visiting Retail Clinics, United States, 2013–2021
31. Retail Clinic Revenues, United States, 2013–2021
32. Urgent Care Clinic Ownership, United States, 2015
33. Virtual Doctor Consultations*, United States, 2015–2020
34. Hospital Revenues by Key Specialties
35. Increasing Annual CMS Spending on Hip and Knee Bundles, United States, 2016–2020
36. Incidence of Aortic Stenosis, United States, 2015–2025
37. Incidence of Severe Mitral Regurgitation, United States, 2015–2025
38. Clinical Specialty Area 3—Behavioural Health
39. Rising Costs of LTC
40. Percentage Split of Medicaid Spending on LTC, United States, 2005–2013
41. Clinical Specialty Area 4 - LTC Facilities
42. Clinical Specialty Area 4 - Medicare Spending
43. Technical Reimbursement Component of Major Imaging Procedures, United States, 2011 and 2015
44. Professional Reimbursement Component of Major Imaging Procedures, United States, 2011 and 2015
45. Private Imaging Offices, United States, 2000–2012
46. Hospital Outpatient Departments (HOPD), United States, 2000–2012
47. Number of US Free-standing and Hospital Outpatient Imaging Centers United States, 2008–2013
48. Major Trends in Select Outpatient Imaging Center Chains (2015)
49. Clinical Laboratories Market: Revenues By Lab Type, United States, 2014–2018
50. Clinical Laboratories Market: Test Volumes by Specialty, United States, 2014
51. Clinical Laboratories Market, Market Share Analysis, US, 2014


1. The 12-step Market Insight Research Methodology Process
2. Lean Innovations and Management Principals to be Key
3. Rise of Smart Hospitals
4. Core Technology Architecture for Building a Smart Hospital—Enterprise Connectivity
5. Core Technology Architecture for Building a Smart Hospital—Devices and Sensors
6. Core Technology Architecture for Building a Smart Hospital—Healthcare IT
7. Mapping the Transformation of Care Provision
8. Assessing the Vendor Opportunity Landscape
9. US Hospitals—Snapshot of Current Status
10. What Keeps Hospital CEOs Awake at Night - Hospital Challenges
11. Key Hospital Objectives
12. Challenges Posed by the Affordable Care Act (ACA)
13. Hospital-owned Insurance Plans
14. Hospital Consolidation Overview
15. Role of ACOs
16. CMS Stipulations for Medicare ACOs
17. ACO Quality Measures—4 Key Domains
18. Role of ACOs in Chronic Disease Management
19. Changing Reimbursement Models
20. Types of Value-based Payments
21. Bundled Payments Landscape
22. Causes of Declining Hospital Inpatient Volumes (2006–2010)
23. Transition of Retail Clinics
24. Health Systems Partnerships With Retail Clinics
25. Ambulatory Care Model 5—Telemedicine in Rural Hospitals
26. Clinical Specialty Area 2—Cardiovascular Diseases (CVDs)
27. Clinical Specialty Area 3—Behavioral Health
28. Clinical Specialty Area 4—Long-term Care (LTC) Hospitals
29. Current HAI Prevention Measures Adopted by Hospitals
30. Solution for HAIs—CMS Partnership for Patients Program
31. Future Technology 1—Personalized Genetic Medicine
32. Future Technology 2—3D Printing
33. Future Technology 3—Nano Medicine
34. Benefits of Joint Ventures
35. Replacement of Joint Ventures—Rise of Hybrid Models
36. Hybrid Partnership Models—Examples
37. Clinical Laboratories in the United States - Lab Type
38. Emerging Trends in Key Specialty Areas
39. Hospitals and Independent Labs—Types of Partnerships
40. Acquisition of Outreach and Physician Office Labs
41. Acquisition of Specialty Labs
42. Point of Care Testing—The Next Big Thing
43. Evolution of the Healthcare Landscape: 2010–2020
44. From Episodic to Managed Care
45. A Healthcare Utopia—Vision for 2020 and Beyond
46. US Health Market Innovation Landscape - Technology Drives Innovation
47. Facilitating Continuum of Care Services
48. Role of Big Data
49. Creating Big Data Analytics Solutions



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