Declining average daily census. Part 1: Implications and options.

A national trend toward declining average daily (inpatient) census (ADC) started in late 1982 even before the Medicare prospective payment system began. The decrease in total days will continue despite an increasing number of aged persons in the U.S. population. This decline could have been predicted from trends during 1978 to 1983, such as increasing available beds but decreasing occupancy, 100 percent increases in hospital expenses, and declining lengths of stay. Assuming that health care costs will remain as a relatively fixed part of the gross national product and no major medical advances will occur in the next five years, certain implications and options exist for facilities experiencing a declining ADC. This article discusses several considerations: Attempts to improve market share; Reduction of full-time equivalent employees; Impact of greater acuity of illness among remaining inpatients; Implications of increasing the number of physicians on medical staffs; Option of a closed medical staff by clinical specialty; Unbundling with not-for-profit and profit-making corporations; Review of mergers, consolidations, and multihospital systems to decide when this option is most appropriate; Sale of a not-for-profit hospital to an investor-owned chain, with implications facing Catholic hospitals choosing this option; Impact and difficulty of developing meaningful alternative health care systems with the hospital's medical staff; Special problems of teaching hospitals; The social issue of the hospital shifting from the community's health center to a cost center; Increased turnover of hospital CEOs; With these in mind, institutions can then focus on solutions that can sometimes be used in tandem to resolve this problem's impact. The second part of this article will discuss some of them.