Pandemic trends could hurt hospital revenues

Physicians could benefit from surgery center ownership

The COVID-19 pandemic has accelerated shifts in health care delivery that will lead to decreasing revenues for hospitals, according to an analysis by Moody’s Investors Service financial firm.

However, specialty care, an aging population and general population growth may offset those trends, said the report, “Pandemic Accelerates Shift from Hospital-Based Care, Crimping Revenue and Margins.”

The firm examined changes in reimbursement models, drugs, technology, and growing investments in outpatient services such as ambulatory surgery centers (ASCs).

All will “drive down inpatient care, the traditional measure of market share and presence,” continuing effects that began before the COVID-19 pandemic. Hospital outpatient revenue has exceeded inpatient revenue every year since 2016, according to Moody’s data.

During the pandemic, emergency department visits declined and telehealth consultations skyrocketed. Telehealth usage is declining as patients return to in-person visits, but “it will likely remain higher than pre-COVID levels, especially for certain specialties,” the report said.

Hospitals and health care systems already were using at-home acute care models and many more will look to do so.

Moody’s predicted more growth for ASCs, free-standing facilities not on hospital campuses. “Physicians often prefer the ASC setting because of the ability to more efficiently schedule operating room procedures,” the report said.

Doctors currently own most of the nation’s ASCs -- 64% -- “due in part to better control and financial benefits.” Ownership could provide doctors with more incentives to treat patients at ASCs instead of hospital-based outpatient or inpatient surgery centers.

Another 24% of ASCs are co-owned by a physician-hospital group, the report said. Hospitals nationally “will accelerate investments in outpatient services,” including telehealth, urgent care facilities and ASCs.

Advances in drugs and devices will continue to reduce hospitalizations and hospital-based procedures, particularly for cardiology and orthopedics.

As for reimbursement, “governmental and commercial insurers will continue their efforts to incentivize providers to offer more cost-effective and quality care,” shifting away from “more expensive inpatient settings” and causing a decline in revenues, the report said.

Hospitals with a strong focus on complex care likely will sustain demand for inpatient services better than those offering less complex care, the report said.

“In the near term, many hospitals will see greater demand for inpatient services because of a rise in the number of higher-acuity patients who delayed care during the pandemic,” according to Moody’s. “Beyond the effects of the pandemic, an aging population will help drive the need for inpatient care.”