Nurses should note that health care is shifting more and more from inpatient to outpatient settings. A comparison of U.S. hospital outpatient vs. inpatient revenues reports that in 1991, outpatient revenue accounted for only 24% compared to 76% of inpatient revenues. By 2011 outpatient revenue increased to 43% compared to 57% of inpatient revenues.
Why is care moving to outpatient settings? Several reasons include:
- The need to control health care costs. The aging Baby Boomers create more demand on our health care system. Hospital care is much more costly than outpatient care, so reducing unnecessary hospital admissions and readmissions is increasingly important to payers such as Medicare.
- New and better health care technologies. Many surgical and other procedures are less invasive than before. Many procedures can be performed in outpatient settings, reducing the need for inpatient admissions. Telemedicine and home monitoring devices also extend the reach of health care and reduce the need for hospitalization.
- An emphasis on health care rather than disease care. The Patient Protection and Affordable Care Act of 2010 (PPACA) mandates the development of medical homes and new approaches to promote population level health care. Directing funding toward prevention and health promotion rather than treatment and procedures requires more focus on outpatient health care. Fewer hospital days also reduce the risks of preventable infections and complications for patients.
How will this shift from inpatient to outpatient settings affect nurses and nursing care? My recent book Economics and Financial Management for Nurses and Nurse Leaders helps nurses anticipate and respond to changes in the health care industry. Nurses can find new opportunities in the trend to outpatient care, for example:
- Developing new programs. Nurses can work with the hospital team to develop programs such as pediatric asthma clinics or home visit follow-up care for patients with congestive heart failure.
- Entrepreneurship. Nurses can start their own nonprofit agencies or businesses. Case management, health education and health promotion services are examples of primary outpatient health care that nurses can operate in the community.
- Improved practice and nursing care outcomes. Nurses can lead efforts to reduce preventable readmissions and complications. These initiatives will improve both the quality of patient care and the financial health of the institution.
As my book Economics and Financial Management for Nurses and Nurse Leaders explains, nurses represent the largest segment of health care workers in the U.S., with hospitals as the major employer. The job growth rate for nurses is expected to increase for physician offices, home health and long-term care, and will likely decrease for hospital employment. Nurses who understand health policy and financing will find new opportunities as care moves to outpatient settings.