• Divya Malhotra

Outpatient Market Share Data- An unattainable goal?


Every conversation I have had with hospital executives in the past few years about true market share information is clouded by lack of good data. As the market dynamic changes for healthcare providers shifts from inpatient to outpatient, the traditional state hospital association data with inpatient market share information is falling short and only giving providers only a slice of competitive market information.This has created a skewed look at the hospital market share information.


A hospital typically has access to inpatient data from the local hospitals through the state hospital associations or government payers. However, there is a lack of outpatient data as the outpatient services market is organized outside of hospital organizations, including in settings such as physician practices, surgery centers, diagnostic centers and urgent care centers. Historically, hospitals derived most, if not all, of their revenue from inpatient activities. Outpatient services, were limited to some key outpatient departments such as radiology. Even in those departments , the profitability margins were minimal. Most profits were derived from inpatient settings. So the focus of the data collection and sharing was inpatient only. However, over the past 30-40 years, with changes in the healthcare financing, payer landscape changes and the advent of advanced technology , a lot of the disease conditions are now treated and cured in the outpatient setting.


But, hospital and health systems slowly caught up to creating strategies to tackle this shift. However, most still are driving blind when it comes to outpatient market outlook.


A few workarounds that I have come across in my experience, which help with making some sense of the ever-evolving market share dynamic:


1. Buying an "off the shelf" software which has limited but a 360 degree view of your market. Usually vendors of claims data sets have anywhere from 4-40% of market data. These are usually created off the claims datasets which are not 100% complete, but merely a sample of the overall dataset. However, "something is better than nothing" philosophy only pays off in some markets where care is monopolized by a few systems/medical groups. If you are in a crowded, metropolitan area, chances are the data will have huge holes. More importantly, it may or may not have information about your direct competitors.


2. Creating outpatient penetration rates as a proxy for outpatient market share. Using your own outpatient volume and market penetration over time to understand how your share has grown is a tactic I have seen organizations apply to get a handle on their outpatient strategies. Even though this is in an incomplete view of the overall market share picture, it still helps with gaining an understanding of the market's trajectory and your own presence in it.


3. Using medicare publicly available data to derive market trends. Medicare data, is very restricted as it pertains to only a sub-section of the demographic. However, for certain conditions and procedures that are seen in the 65+ years population , Medicare data can be a good representation of the overall utilization. Below is the link to their outpatient data sets:


https://www.cms.gov/Research-Statistics-Data-and-Systems/Statistics-Trends-and-Reports/Medicare-Provider-Charge-Data/Outpatient2017.html


As healthcare organizations compete in various market, it can be argued that having good market share data helps restrict utilization by deterring hospitals and other provider organizations from going into markets where competition is already tough.


Please feel free to share your thoughts on your experience with outpatient market share data in your organizations.





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