Thursday, September 3, 2015

Hospital stays are down. Does that mean Obamacare is working?

Among its many worthy goals, the Affordable Care Act (AKA Obamacare) aims to nudge the U.S. health care system from sick care to well care. By increasing the focus on routine checkups, preventive care, and better patient outcomes, Americans will be healthier. They will need less intensive, expensive health care. Health goes up, hospitalizations-and costs-go down.

Hospital stays are down. Does that mean Obamacare is working?

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A female patient in a hospital bed with an IV drip in the foreground. Selective focus on the IV drip.
A female patient in a hospital bed with an IV drip in the foreground. Selective focus on the IV drip. iStockphoto

Among its many worthy goals, the Affordable Care Act (AKA Obamacare) aims to nudge the U.S. health care system from sick care to well care. By increasing the focus on routine checkups, preventive care, and better patient outcomes, Americans will be healthier. They will need less intensive, expensive health care. Health goes up, hospitalizations—and costs—go down.

In Philadelphia and its suburbs, hospital stays and days have dropped steadily—down about 12 percent*—since the enactment of the Affordable Care Act in March 2010. On the measure of less hospital care, could Obamacare be working?

As the leader of the region’s hospital association, I can assure you that hospital leaders are indeed working to achieve the goals of the Affordable Care Act. They are rethinking how their organizations deliver health care. They are investing in new ways to keep patients healthier, to keep them out of the hospital. If hospitals were airlines, it would be like changing the wings on the airplane while in flight.

Is the drop in hospitalization the result of these efforts?

Like so much of health care, the answer is complicated. My organization, the Delaware Valley Healthcare Council of HAP, has been tracking declines in hospital use since before the Affordable Care Act. We found that as a result of the great recession of 2008–2009, many patients decided to postpone elective surgeries and other health care services.

What's more, our region's physician practices and hospitals have done their best to stay ahead of the curve. Efforts to reduce unnecessary hospitalizations by helping patients better manage chronic disease began years before the passage of the Affordable Care Act.

Regardless of the cause, the downward trend in hospital use is clear.

What’s most remarkable to me is the way hospital leaders view this trend. They see less reliance on inpatient care as what needs to happen. They see investment in initiatives and services to improve the health of their community as what needs to be done.

Navigating big changes—changes that will challenge, stress, and even disrupt your organization or constituency for the good of the community at large—isn’t that what leadership is all about?


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The Field Clinic reports and analyzes health care laws, government policies, and political trends that are transforming the care we receive and the way we pay for it. Read more about our panel of bloggers here.

This blog is produced in partnership with Kaiser Health News, an editorially independent program of the Henry J. Kaiser Family Foundation, a nonprofit, nonpartisan health-policy research and communication organization not affiliated with Kaiser Permanente. Portions of this blog may also be found on Inquirer.com and in the Inquirer's Sunday Health Section.

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Robert I. Field, Ph.D., J.D., M.P.H. Professor, School of Law & Drexel School of Public Health
Jeffrey Brenner, MD Founder of the Camden Coalition of Healthcare Providers, Medical Director of the Urban Health Institute at Cooper University Healthcare
Andy Carter President & CEO, The Hospital & Healthsystem Assoc. of Pa.
Robert B. Doherty Senior Vice President of Governmental Affairs & Public Policy American College of Physicians
David Grande, MD, MPA Assistant Professor of Medicine at the University of Pennsylvania
Tine Hansen-Turton Chief Strategy Officer of Public Health Management Corporation
Drew A. Harris, DPM, MPH Director of Health Policy Program at the Jefferson College of Population Health
Antoinette Kraus Director of the Pennsylvania Health Access Network
Laval Miller-Wilson Executive Director of the Pennsylvania Health Law Project
David B. Nash, MD, MBA Founding Dean of the Jefferson College of Population Health
Mark V. Pauly, Ph.D. Professor of Health Care Management, Business Economics and Public Policy at The Wharton School
Howard J. Peterson, MHA Managing Partner of TRG Healthcare, a national healthcare consulting firm
Paula L. Stillman, MD, MBA Healthcare consultant with special expertise in population health and disease management
Elizabeth A. W. Williams Senior Vice President & Chief Communications Officer for Independence Blue Cross
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