Outpatient Services

Did you know?

• Outpatient services are broad in nature and now include “provider-based services,” previously thought of as your physician’s office.
• In the future, outpatient services may increase in total utilization to account for provider-based services and new technologies (e.g., telehealth).
• This will not represent “true” gains but will adhere to the new healthcare delivery system’s mandate: to give patients the right care in the right place at the right time and for the right cost.

Why should I care?

• Identify your underutilized service lines and which of those reflect the greatest demand in your service area.
• Monitor and control high-volume, high-cost outpatient procedures.
• Flag and address improper utilization practices before CMS has a chance to review the related claims. A tool like the Protection Assessment Tool can help you prioritize those services under scrutiny.

What should I do?

• Review the most current utilization data internally for your hospital, and externally for your immediate service area, to understand the utilization shifts in “real time.”
• Compare your services internally and against your competition to learn which variations exist and why.
• Identify which services are being treated in an alternative setting to determine if you are successfully transferring care within your own system (an affiliated physician office, for example), or losing to a competitor. Easy access to care is a cornerstone of patient loyalty.