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NATIONAL DAILY HOSPITAL

Executive Briefing

Wednesday December 10th, 2025

> Site-neutral payments may further strip hospitals of their most profitable services
> Readmissions reveal cracks in LOS compression strategy
> Hospital-at-Home growth requires reliable homecare staffing escalation
>Outpatient control will determine which hospitals survive financially

GLOBAL & HEALTH SECTOR HEADLINES

Site-neutral payment and outpatient migration accelerate nationwide.
CMS continues expanding site-neutral reimbursement and ASC-eligible procedures, driving outpatient diagnostics, infusion, and surgery away from hospital outpatient departments and into lower-cost settings.
https://www.aha.org/news/headline/2025-11-21-cms-issues-cy-2026-opps-final-rule

Post-acute and outpatient capacity now constrain hospital throughput.
National discharge-delay data confirm that shortages in SNF, LTAC, and home health staffing increasingly delay hospital discharges and worsen ED boarding.
https://www.aha.org/press-releases/2022-12-06-new-aha-report-finds-delays-ability-discharge-patients-increase-strain-patients-and-hospitals

HOSPITAL FINANCE — MARGIN PRESSURES (PRIMARY THEME)

Site-neutral payment continues to shift high-margin services out of hospitals.
CMS expansion of site-neutral reimbursement and ASC-eligible procedures continues to redirect outpatient radiology, lab, infusion, and surgical volumes from hospital outpatient departments (HOPDs) into lower-cost non-hospital settings. Because hospitals rely on these services to subsidize emergency, inpatient, and unprofitable essential services, each percentage shift in outpatient migration directly compresses operating margins.

Hospital margins remain structurally fragile despite revenue recovery.
Even as patient volumes rebound, expense growth—especially labor, contract staffing, pharmaceuticals, and supplies—continues to outpace reimbursement, leaving many hospitals at or near breakeven.
https://www.healthcarefinancenews.com/news/hospital-expense-growth-outpacing-revenue
https://www.beckershospitalreview.com/finance/hospital-margins-steady-amid-disruption-5-notes.html

EVIDENCE OF OUTPATIENT MIGRATION & SITE-NEUTRAL IMPACT

Source + Explicit Link	What It Shows / Why It Matters
Health Care Cost Institute (HCCI) https://healthcostinstitute.org/all-hcci-reports/trends-in-utilization-and-prices-for-site-neutral-services-in-hospital-outpatient-and-physician-office-settings	Across 57 services, HOPD prices were 1.27×–13.5× higher than offices.
Ambulatory Surgery Center Association (ASCA) https://www.ascassociation.org/advancingsurgicalcare/aboutascs/industryoverview/apositivetrendinhealthcare	Confirms sustained migration of surgical volume into ASCs.
Healthcare Finance News https://www.healthcarefinancenews.com/news/ambulatory-surgery-centers-expand-revenues-investments-surge	ASC revenue $45B (2024) → $57B (2030) with 9% growth.
American Journal of Managed Care https://www.ajmc.com/view/pricing-and-insurance-networks-in-outpatient-surgery-markets	Commercial insurers pay more for identical cases in HOPDs.

HOSPITAL TRANSITIONAL CARE & POST-STAY FOLLOW-UP

Breakdowns in post-discharge follow-up now drive readmissions.
Outpatient follow-up reduces 30-day readmissions by 32%.
https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2840895

Timely post-discharge contact significantly reduces early readmission risk.
Follow-up calls reduced readmissions by 23.1%.
https://pmc.ncbi.nlm.nih.gov/articles/PMC3128446/

Poor discharge processes increase post-discharge safety events.
Weak discharge coordination increases ED returns.
https://bmchealthservres.biomedcentral.com/articles/10.1186/s12913-024-11047-3

HOSPITAL-AT-HOME

Hospital-at-Home programs reduce readmissions when properly supported.
https://pmc.ncbi.nlm.nih.gov/articles/PMC10023005/

Outcomes depend heavily on homecare staffing stability.
https://essentialhospitals.org/the-crucial-role-of-skilled-nursing-facilities-in-reducing-hospital-readmissions/

QUALITY METRICS TO SHARE WITH YOUR TEAM

Metric Description + Explicit Link	Why It Matters
30-Day All-Cause Readmission Rate (National Avg ≈ 13.9%) https://hcup-us.ahrq.gov/reports/statbriefs/sb304-readmissions-2016-2020.jsp	Directly affects margin, LOS rebound, and CMS penalties.
State-Level Readmission Performance Ranges (≈10–19%) https://www.definitivehc.com/resources/healthcare-insights/average-hospital-readmission-state	Benchmarks competitive and payer-mix performance.
All-Payer Hospital Operating Margin Trend (8.8% → 2.7%) https://www.medpac.gov/wp-content/uploads/2024/03/Mar24_Ch3_MedPAC_Report_To_Congress_SEC-1.pdf	Confirms national structural margin compression.
Margin Stratification by Payer Mix (Urban vs Rural) https://www.kff.org/health-costs/hospital-margins-rebounded-in-2023-but-rural-hospitals-and-those-with-high-medicaid-shares-were-struggling-more-than-others/	Identifies survivability tiers by geography and payer.
HOPD vs Office Price Differential (1.27×–13.5×) https://healthcostinstitute.org/all-hcci-reports/trends-in-utilization-and-prices-for-site-neutral-services-in-hospital-outpatient-and-physician-office-settings	Explains payer steering and outpatient migration.
ASC Market Growth ($45B → $57B by 2030) https://www.healthcarefinancenews.com/news/ambulatory-surgery-centers-expand-revenues-investments-surge	Confirms rapid shift of profitable surgical volume.
Hospital-at-Home Readmission Performance https://pmc.ncbi.nlm.nih.gov/articles/PMC10023005/	Reduces readmissions only when homecare staffing is reliable.

Executive Interpretation (Board-Level)

Margins are compressing nationally, especially for rural hospitals.
Outpatient revenue is rapidly exiting hospital control.
Readmission rates now function as margin early-warning signals.
Hospital-at-Home only works with stable staffing pipelines.

📍 Published at National Daily Hospital News
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Tuesday, December 9, 2025