Over the last few years, hospitals have seen a decline in the volume of inpatient stays while outpatient use has increased dramatically. This trend is expected to continue, with outpatient volumes expected to increase 17 percent over the next five years.  This shift to the outpatient setting, driven both by technological advances and financial pressures, is creating dramatic change in how care is delivered and paid for in the U.S. Consider the 2014 Hospital Outpatient Prospective Payment System (OPPS) final rule, which contains the biggest payment changes since Medicare was established. Starting Jan. 1, 2014, hospitals use one HCPCS code to bill Medicare for all provider-based clinic visits (instead of five CPT codes). Hospitals will receive payment for all observation services with one Ambulatory Payment Classification (APC); Yet, CMS increased the payment dramatically. This move by CMS may be a bid to reinforce the use of outpatient services unless there’s a medically necessary reason for patients to cross two midnights in the hospital and become inpatients. For more valuable insight into the changes, check out the very popular webinar, “2014 OPPS Overview,” onAppeal Academy’s Jan 10, 2014 “Finally Friday” program. Becker’s Hospital Review has an interesting article: “The Future of Hospitals:  Visions of the Healthcare Landscape in 2035”. But what do you think? What major operational changes has your health system experienced in 2013? How are you handling the increased volume of outpatient services?