Tim L. Hingtgen - Community Health Systems, Inc.
Management
Sure. This is Tim Hingtgen. I'll take that one. I'll start with the ED decline, and 90% of our ED volume decline was on the outpatient side, largely attributable to some of the industry dynamics, including urgent care growth, freestanding ED competition in select markets. Again, it was not across the board, but in select markets. Also, from an inpatient admission decline standpoint, that does correlate strongly with our observation increase that we've talked about as a key contributor to the admission decline in the second quarter. So, for us, the strategy to combat that, obviously, as I said are to build more access points, make sure we've got the right primary care base in the markets to support the primary care needs of these patients. And then also, the transfer centers and service line strategy that we've been working on for several quarters are certainly showing benefit in many of our core markets. We do expand that into those that are showing some of the softening. From a surgery standpoint, again, the majority of that is also on the outpatient side, about 80% of the decline. And more of that was attributable than we had expected in the divestiture markets. About 20% of the drop was in markets that are leaving the portfolio. We have had some ASD competition from non-joint venture, but also we've had some strategic decisions that we made to invest in ASDs in core markets, which has moved some of the business out of the hospital operating environment into a non-consolidating JV ASD. But we think that's the right thing for us to do in the long-term relative to WorkCare's migrating. And then in select markets, we also had some decreases in GI and pain management procedures. Not necessarily the highest revenue book of business, but losing one or two providers in a market can certainly drive up that stat comp relatively quickly. And then, in some cases, we also had elective service line discontinuations following a portfolio margin review of certain hospitals. So we think those are, frankly, good volume declines. Unfortunately, the volume declines in the second quarter certainly were greater than the number of hospitals that posted some pretty considerable volume increases. Wayne mentioned Grandview. We have a long list of core markets that had double-digit surgery increases with the successful recruitment and development of service line. They just got muddied out by the declines in some of those other markets.