Abby Burns (00:12):
From Advisory Board, we're bringing you a Radio Advisory, your weekly download on how to untangle healthcare's most pressing challenges. I'm Abby Burns. In June, a health system strategy leader reached out to Advisory Board with a question. They had seen some softenings of their volumes in Q1 and they wanted to gut check with our team. Is this a phenomenon specific to our market? Is this something more widespread? A week or so later, we heard the same question from another provider in an entirely different market, and then another and another. Two is company, three is a crowd, four is officially verging on anecdata. So for our researchers, it was time for a fact-finding mission. Let's dig into the nationwide data trends and understand first if this volume decline is in fact real, and second, if it is real, why it may be happening. Today, I've invited Advisory Board experts, Vidal Seegobin and Clare Wirth back to the podcast to share what they found. Clare, Vidal, welcome back to Radio Advisory.

Clare Wirth (01:12):
Thanks for having us back.

Vidal Seegobin (01:13):
Happy to be here.

Abby Burns (01:15):
Can we start here with a researcher nerd moment? I feel like so often the kinds of questions we're getting from members live almost entirely in the gray. There's no clear right answer to what it might be. Obviously, we're going to get there with the question beneath the question we're discussing today, but Vidal, it must have been such a nice change of pace to be on the receiving end of a high priority question that actually has an empirical answer.

Vidal Seegobin (01:41):
Yeah, I would agree. It's not every day you get a question where clearly the answer is either yes or no or 15 or 20. And so the invitation to figure out and confirm whether or not this particular member was seeing volume declines and whether or not that was a kind of corroborated in our data and happening in other parts of the country was a great opportunity. But anyone who plays with data knows that it very rarely tells you a single answer. And so it did kick up a lot more questions, which I think will probably impact over time.

Clare Wirth (02:13):
And it turned out it wasn't an isolated market phenomenon or something we could dismiss with noise. And the headline here is not that this was one quarter was weak, but we have multiple volume indicators that are all moving in the same direction at the same time.

Abby Burns (02:27):
Yeah. So what was it that they were actually seeing and what did you see in the data?

Vidal Seegobin (02:32):
So there was a couple of cuts that we wanted to understand first and foremost. So the first thing was whether or not outpatient presentations were shifting and changing, so particularly on the hospital outpatient department. And then that instigated a question around what's happening in terms of emergency department presentations. And so we double clicked into that in particular because there's a couple of theories that we have about what might be happening in the wider economy. And one thing you'd want to understand is with emergency department volumes, which people usually can't ignore, whether or not that was shifting or changing within the market and within the time span of a year.

Abby Burns (03:08):
What did you see?

Vidal Seegobin (03:10):
So there's two things. I would split apart the decline. So we've seen, I think, top line decline in a whole host of types of hospital and outpatient presentations across both Q1 of 2026. But also if you look back far enough, you start to see some of these volume slides happening as early as Q4 in 2025. So first thing, what we were seeing was emergency department presentations down. We were seeing hospital outpatient department surgeries down. And we were also seeing operating room cases and lab tests also declining, particularly pronounced starting in January of 2026, which we can see if you look at the trend line, a pretty sharp drop.

Abby Burns (04:00):
Can you give me a sense of scale here when we say they're down, down by approximately how much?

Clare Wirth (04:06):
So the number of hospital visits declined in three out of the four first months of the year. So down negative 3% January, same for March, down 7% in April. And then for same site patient day declines, it was all four months, 10%, 13%, 17%, 17%.

Abby Burns (04:25):
Those don't feel like small changes. Those feel like kind of meaningful changes, especially at a time when providers can really use some predictability around their volumes, especially as they're looking to scenario plan for the very real financial headwinds that are facing them. When you look at those numbers and as we look at the trend line across the first half or so of the year, how concerned should providers be about this?

Vidal Seegobin (04:50):
So part of the issue that we had was at Q1 of any year, you'd expect there to be some softness in volume as people wait for deductibles to clear and financial situations to kind of play in their favor. And so part of what Clare just shared I think is important because you would imagine January, February, and March can be a slower volume period of demand compared to the last quarter of the year. The second thing that when we're doing some qualitative data, qualitative interviews to figure out what might be going on here, we had also heard that the flu season can have disproportionate impact on the volumes at that period of time.

Abby Burns (05:31):
That makes sense.

Vidal Seegobin (05:32):
A lot of feedback we were hearing from the market was that 2026 flu season was a lot milder, and so that might've contributed to a drop in volume, but not as much as what we'd seen. And so there's other factors we think are at play for why that drop is so pronounced. And as you mentioned earlier in the double digits when you look at the month, a year past.

Abby Burns (05:53):
Yep.

Clare Wirth (05:54):
All to say concerned that providers should be going back and we've had this assumption for a long time that we view volume disruptions as temporary. COVID happened, volumes returned. This is not that same moment in time and it's time to be scenario planning.

Abby Burns (06:09):
Yeah. And I want to get into this because one of the things that you all did in your analysis, once you dug into the data and saw, yes, this is happening, is you started devising theories and you've already started to get into a couple of them as to what might actually be going on. And this is the question beneath the question, what is causing the decline in volumes? Is it temporary or structural? Before we dig into that, I also want to get a sense for, we're painting with a very broad brush. Is this a nationwide trend? Are there markets that seem to be immune from these declines?

Vidal Seegobin (06:38):
So good news is in advance of this recording of the podcast, I ran some of the most recent numbers to figure out what the geographic spread could look like. So if you're reading the report that Clare, Monica, Chelsea, and I worked on, that data set stops in April, but these declines continue, particularly on the emergency department side well into June. Some markets geography-wise or geographically are a little bit more immune. So the Midwest and Great Plains part of the country is essentially flat. Where you see the most pronounced declines are the Northeast and the South. And essentially the West looks a little like the Midwest and Great Plains, so essentially flat, but lower than where we would expect it to be a year ago.

Abby Burns (07:25):
Interesting. I feel like usually when the Great Plains comes up in these conversations, they are having the most challenging dynamics of the national landscape.

Vidal Seegobin (07:32):
Yeah. And you explained part of the issue is like, "Oh, you find something interesting." And you're like, "Wait, why is that happening?" And then you just kind of cascade into more questions.

Abby Burns (07:40):
And let's dig into those questions i.e., why this is happening. So as you were looking at the data, what theories emerged for you?

Clare Wirth (07:48):
We landed on three plausible explanations. First, the demand is suppressed and it's largely temporary. Second, demand has shifted, shifted to different sites and modalities of care. The third one is that this is just the new normal. This is the new normal for hospital demand post-pandemic now that we are five, six years out of that. And I do want to call out these explanations are not mutually exclusive. In fact, the more likely answer is that there's a combination of all of these things happening simultaneously.

Abby Burns (08:23):
You preempted my next question, which was going to be, I want to explore all three options, but do we have kind of a stake in the ground or a stake in the sand as to which is really driving trend here?

Clare Wirth (08:34):
The strongest longitudinal evidence points to the second one, which is site of care shift. We have long argued that care would move from inpatient to outpatient, from procedural to medical management and increasingly from clinical interventions to pharmaceutical therapies. So it's not a surprise that this is happening. We've been tracking this for a long time. The surprise is just how visible it is in this volume data.

Abby Burns (09:01):
Yeah, actually empirically. Okay. I don't want to put the cart before the horse. Let's start off with digging into your first theory here. This is simply short-term dampen demand. This is temporary, not structural. What's the evidence that you all see in the data that could lead us to believe that this volume decline is in fact temporary?

Clare Wirth (09:21):
The two main pieces of the puzzle here are affordability pressures and declines in insurance coverage. There is a credible case for both of these affecting demand. People are facing higher energy costs, price growth for everyday necessities. I know I certainly feel like my grocery bills are going up and up and up, and we should not underestimate the impact of households having to make difficult trade-offs between healthcare and other expenses. And then at the same time, as you all have covered here extensively, we are seeing insurance coverage declining. This year alone, Affordable Care Act exchanges, those costs went up 26% and we saw 2.9 million people leave the exchanges.

Abby Burns (10:01):
Right, with the sunsetting of the subsidies at the end of 2025.

Clare Wirth (10:05):
And coming up, looking to 2027, we have Medicaid eligibility changes as well. So all to say, this could be the start of what the loss of insurance coverage will be doing to hospital volumes. And we know the Congressional Budget Office estimates 10 million people will lose insurance coverage by 2034 because of the One Big Beautiful Bill Act. And I just want to underscore this, that this is really significant. Our research has shown time and time again that insurance coverage is the single greatest driver of whether a person seeks out non-emergency care.

Vidal Seegobin (10:36):
I totally agree with everything Clare said, but I just wanted to add a layer on to why I didn't stop or why we all didn't stop just debating this as the only option. I think every time you show up to the gas pump, you're immediately going to be like, "How are people affording anything right now?" And it's not a surprise also with the way we structured health insurance products that you're facing more financial obligation in those products, and so you might want to ration a lot more and more aggressively as a household. The two data points that I think are just important to put into context for why this is not likely the only thing happening is first, we're seeing a lot of volatility in terms of the consumer sentiment, so how people think about the future. When we were starting to write this piece, we were seeing a correction in terms of people's sentiment about what the future was going to look like and whether or not the economy was heading in the right direction.

(11:29):
So in so far as people were being driven by the sense of the future and affordability and that changing how people were seeking out care, there was at least another data point to say that this was not always heading in this direction of entirely negative.

Abby Burns (11:43):
That actually really surprises me because I feel like the number of times affordability has come up in conversation with insert healthcare stakeholder here, it just seems to be ramping up and up. So that's really interesting that we're actually seeing something different in consumer polling.

Vidal Seegobin (11:56):
Yeah, and that was June. And so I think if you look at the pulse of where we are maybe today and then the next month, it might change. But I think when we were just trying to understand what was a slam dunk case, that added more fuzziness to it. Actually, the second one was, and this comes from Monica Westhead was one of our co-authors. She said, "Well, if people are self rationing or economic rationing, wouldn't you expect to see an increase in the number of people buying over-the-counter pain meds?" Because one of the things that instigates people going to the emergency department is unmanageable pain. You're just generally, at least at that period of time when we were publishing this, did not see a growth rate in terms of over-the-counter medication volumes. In fact, you saw a decline in that. So another kind of chink in that armor around it being economic rationing.

(12:43):
And the third, which I am the most kind of persuaded by, is something I mentioned earlier on, and that relates to emergency department volume. Emergency department volume has been declining, at least in our trend line, as far as back as September in 2025. Now, I think there was some economic uncertainty happening in that point in time. It's hard to remember which of the series of events was the case, but we are seeing a longer term decline that actually predates the Q1 of 2026, and it's emergency department volume, which I would imagine is a lot more difficult to self-sort and ration compared to other types of volume which you could pursue as a patient.

Clare Wirth (13:23):
So not a slam dunk, Abby.

Abby Burns (14:24):
Really what I'm hearing is non-clinical barriers to access are probably part of the story and are certainly part of the story for some patients, but they're not the whole story behind the volume shift. Your second theory, and Clare, this is the one that you said, and we probably stand most firm behind this one, speaks to some of the deeper structural changes that you called out earlier. Are volumes disappearing or in fact, are they just shifting out of the hospital or to other ambulatory sites of care as we've been following at this point for more than a decade? Are they shifting to pharmaceutical management instead of procedural management? Lay out the case for me here.

Vidal Seegobin (15:00):
Where we started was away from visits, but I still think instructive in terms of understanding how care is shifting and what we're doing to serve the patient populations and communities that we are in. So first, if you look at the proportion of revenue generated between inpatient and outpatient, generally for the last two years has been pretty stable. Looking at the national level, somewhere between 56% of revenue comes from the outpatient side and 35 or 34% comes from the inpatient side. At the very beginning of 2026, you start to see a pretty noticeable divergence. So we bump up to 59% of gross revenue coming from outpatient and then a drop down to 33% of gross revenue coming from the inpatient side. So obviously there are pricing dynamics that have to do with why that could be a different pattern, but I think it points to something, as Clare mentioned, that we've been saying for a number of years is that how care gets delivered and what sites of care are the dominant care model is shifting and changing.

(16:08):
And just to put that in additional perspective, some of the more dramatic graphics in the piece show that on HOPD, so volumes on the ambulatory surgery side for health systems, you're starting to see a pretty noticeable decline in those surgery volumes as well. And for certain health systems, that becomes a huge revenue drop for them because as that shift has been happening, that's a little bit more of a controllable shift.

Abby Burns (16:34):
Vidal, let me jump in for a moment because I want to name the distinction that you just made, which was you started off talking about the change in revenue, where revenue is coming from, and then you move smoothly into the change in volumes. Can you just align those things for us for a second?

Vidal Seegobin (16:48):
Yeah, for sure. So I think when you see the revenue numbers, anyone who's been tracking healthcare will know, well, could that be a function of changing prices or just negotiating patterns or things of that nature that could not be necessarily volume related? And since the piece we're talking about is volume, the next question was, well, what does it look like on the outpatient volume side and is that tracking in the same direction? What I'll say is that the two graphics that we have in the piece show that there is a little bit more inconsistent but growing demand and what I would consider to be medical management in the outpatient space, which is something we've been talking about for a number of years. Demographically, we know that we're moving from surgery to a medical model of healthcare. And then you're also seeing at the same time hospital outpatient department surgeries with a pretty noticeable decline that goes back all the way to August of 2025.

Abby Burns (17:46):
Wow. Okay. So extending a little bit further back.

Vidal Seegobin (17:48):
Yeah. Yeah.

Abby Burns (17:50):
I also know that the shift to outpatient is not the only shift that's at play in this sort of theory of the case.

Vidal Seegobin (17:57):
Yes. And so the other element I think we want to be just inclusive of is that more and more of how we treat medical conditions and what we're able to treat in terms of conditions in general are probably drug related. And I think at the exact same time that we're seeing that volatility in outpatient demand, we are seeing a pretty consistent increase in the trend line when it comes to prescription volume. And that was measured through hospitals retail pharmacy distribution, and that trend line is as dramatic in the positive direction as much as that ED volume is dramatic in the negative direction.

Clare Wirth (18:35):
So someone could look at all of this and say, "Don't worry, the volume didn't disappear. It's just moved." And what it all just outlined, there's evidence behind, but this is not a moment where we get to say, "Case closed. It's all ambulatory migration. We solved it." We dug deeper and the ambulatory visit data is surprisingly messy. Some months go up, some are down, and the trends are more volatile than many people would expect if outpatient growth alone were explaining the full decline. And so in fact, when we look at ambulatory surgery volumes, they also don't show that kind of sustained acceleration that would fully account for what's happening in hospitals. So there's a denominator problem here. We can clearly see volumes are down. What we can't fully observe is where every patient is going to instead. Some ambulatory settings, some are getting their conditions managed pharmaceutically, some may be delaying care altogether.

Abby Burns (19:33):
Some may be going outside of our system or not seeking care at all.

Clare Wirth (19:37):
Exactly. So this answer alone is not the full story, but site of care shift is probably the single biggest explanation, but again, not the only explanation.

Abby Burns (19:50):
So let's run with this for a minute. If the drop in hospital volumes is tied to site of care shift, which I think it's fair to say, we think it is, the question is not, is this happening? It's to what extent is this happening? How much of the volume change does it account for? I want to play out what this means for different types of provider organizations because not all provider organizations are equally poised to capture that outpatient shift. Who's most at risk here? Who is best positioned to succeed? What does this mean for different types of systems?

Clare Wirth (20:20):
I'd say the winners are organizations that own multiple points of care across the continuum. So integrated delivery systems with robust ambulatory networks can allow that volume to migrate somewhere and they're still retaining and maintaining that patient relationship. I think those that are at greater risk are rural and critical access hospitals where that volume decline may have an outsized financial consequence.

Vidal Seegobin (20:42):
My guess would be that organizations with a strong primary care footprint and that excel on access are going to be able to harness this transition towards an outpatient model. And if you're thinking about the revenue consequences is where we started, the ability to direct the appropriate clinical conditions to the ambulatory surgery center or the outpatient setting that's appropriate for them is also going to be mission critical and I think would reflect on how they should be thinking about their ambulatory footprint and network and the capabilities that it brings to the overall health system.

Clare Wirth (21:20):
Yeah. And those that can build, acquire, or partner their way into ambulatory growth.

Abby Burns (21:25):
Yes. I was about to say, it probably bears saying for organizations that don't already have a robust ambulatory footprint, when you're looking at cost of capital, when you're looking at cost to build, the idea of physically building an outpatient network, particularly in competitive markets where there's already a wealth of ambulatory assets, could be pretty intimidating. I am interested to see how organizations that don't currently have robust ambulatory infrastructure move forward and essentially gain access to it.

Vidal Seegobin (21:53):
The other thing I would just add, which I think is one of the underlying strategic questions for why someone asked us to look at this begin with is if you are in a market where private equity or capital allocator are partnering with physician groups, that volume could now be moving into a blind spot that you just don't see and you're seeing the HOPD volume decline and you kind of want to know, well, where is that going? Is that going anywhere? Did it evaporate? Did someone else ate my lunch? And I think there's reason to believe that that's also happening as well, right? So the market, the healthcare industry is doing this shifting itself. It's not just happening because of reasons. There are players that are actively trying to make this shift happen.

Clare Wirth (22:34):
Or hypothetically, is volume really going away and we're fully recalibrating, which is the third potential explanation.

Abby Burns (22:42):
Which underscores why I think every player across the ecosystem is so focused on data sharing right now, and if they aren't, probably should be because as hospital volume data becomes a less reliable indicator of how patients are utilizing care and what care they're utilizing, plan data becomes that much more important because they are able to better track where a given individual is seeking care, what all of their care seeking behavior adds up to.

Clare Wirth (23:09):
And if you wanted to better understand where patients are going, Advisory Board just developed its market intelligence tool where they could see where people are going instead, which they could be going somewhere else or it's possible that volumes are ticking down and that is just a new normal, which is the third potential explanation here.

Abby Burns (23:26):
Yeah. So let's go there now. Your third scenario essentially proposes today's volume drop isn't necessarily related to access issues or site of care shift or shift of pharmaceuticals, but that we are simply recalibrated to a new post-pandemic normal. What data drew you to that theory?

Vidal Seegobin (23:44):
So when we looked at nearly every type of volume data we had available through Strata's market intelligence tool, you can see a 2024 number and then a 2025 volume number that's dramatically larger than the 2024 number, and then 2026 drop. And so you've got this camel hump, which is 2024 and 2026 are the low points, and then 2025 is the high point. And so my potential theory here is that where we set our baseline expectations needs to not be 2025 because 2025 was a watermark year for which we will no longer replicate again for a whole host of reasons.

Abby Burns (24:26):
Just tease for us, what are some of those reasons?

Vidal Seegobin (24:28):
So I think partly we don't always talk about this in an everyday conversation anymore, but we did go through a once-in-a-hundred-year pandemic and understanding how long it takes for the American or any healthcare industry to process all of that delayed demand might be three or four years. And so we might have passed that cresting point of where we fully moved through all the backlog, and so our new normal is something that looks a lot more similar to 2026 or 2024 and just not 2025.

Clare Wirth (25:01):
And at the same time, the 2026 data has another really fascinating signal, which is that length of stay is moving up. After years of national level improvement, length of stay is moving up, which also suggests that patients are more complex and resource intensive, which could be another indication that the pandemic backlog has worked its way through the system.

Abby Burns (25:26):
Man, that is so tough because I don't know about the two of you, but I haven't spoken to any health system in the past, call it three years that hasn't been laser focused on reducing length of stay. It's got to be a bit disheartening if we do see those numbers trending back up nationally, even though we know that the average HTC score in the high acuity band is higher than it was pre-pandemic. And when we look at the percent of hospital stays, to your point, Clare, that are high acuity has also gone up.

Vidal Seegobin (25:54):
That also points to why we wanted to move pretty quickly on this analysis, even though more data and more time series are always going to be more clarifying, is that we have seen hard fought wins on health system margins that have been achieved over the last particularly two years. And if part of that last two years of financial recovery, which is not even that generous, was a function of a one-time big surge in volume that's just not going to be around next year or the year after, I think it just calls into question how much of your organic growth volume story is going to be a lever you're going to be able to pull to be able to succeed into the future. So it's a bit of a warning flag for health systems if this holds out to be the major reason it's happening and continues to happen to the future.

Clare Wirth (26:44):
A warning flag, but a little early to solidly call this a new normal. So we're going off of four months of data, and so if I were going to give my pushback to this theory of the cases that we're going off of just a handful of months at this point.

Abby Burns (26:57):
Yeah, we need a little bit longer to see has it rebalanced or is there still more volatility before it finds a settling point?

Vidal Seegobin (27:03):
Yeah, the same kind of cursory query that we did in advance on the different regions is that I haven't seen spike towards recovering volume in the subsequent months after April. So May and June largely hold with a flattening, if not a declining ED volume in particular. And so I don't necessarily see a sign that we're out, but I think Clare's point is well taken that we still always need more data.

Abby Burns (27:29):
As we start to wind down our conversation, I want to push us toward action. If we roll this tape forward, hospitals are going to see fewer volumes in general, especially fewer volumes for lower acuity patients, which means it's the story that we've been talking about, right? Higher acuity patients tend to be more medical than surgical, case mix index is harder. The playbook that most health systems are following to combat these sort of margin pressures, as we've talked about a lot on Radio Advisory, as we talk about a lot at Advisory Board, seems to be centered around capturing more commercial volumes to offset these costs. For hospitals and health systems that are trying to scenario plan around this sort of volume volatility, please tell me you have something new to add to that short list.

Clare Wirth (28:16):
We do because everybody is chasing commercial volumes and commercial lives. So if overall demand is lower, simply competing for that same segment is not going to be enough. That means the health systems need broader patient acquisition and retention strategies across all different payer categories, that looming Medicaid coverage changes are going to make this even more important in the organizations that understand this and they understand how demand is changing and proactively adapting to it and not just pursuing the same patients more aggressively are going to help them win. So growth needs to become more diversified than many health systems have traditionally considered.

Vidal Seegobin (28:52):
One of the more common growth strategies I've heard with leaders is thinking about secondary and tertiary markets as being now even more critical to organic growth than it ever was before, right? So it's not just people that are within driving distance, but maybe even upwards of a hundred miles or more.

Abby Burns (29:12):
Which, depending on where the country you live, may still be driving distance.

Vidal Seegobin (29:15):
Exactly. And so part of that question is around how you start to build referral relationships and affiliations with medical groups or other types of providers in a wider catchment area than you traditionally kind of relied on. The second area I think that is going to be really important, I think there's a real plausible case that ensuring maximum coverage, both either commercial insurance or public insurance, is a necessary input for people seeking care. And to the extent that you can coordinate with your potential competitors, your state, your administrative bodies and legislative bodies to ensure that the maximum number of people retain coverage as we move through these work requirements and eligibility checks is going to be really critical to not adding to what I think we're observing is which is decline in volume because people will likely ration more if they lose coverage.

Abby Burns (30:10):
I'm so happy you mentioned that, Vidal. Clare knows I'm on a little bit of a soapbox about this right now. A lot of the conversation around the cross subsidy this year has felt like it's focused on the commercially-insured population and acquiring more share of wallet, book of business of the commercially-insured population. But we also need to focus on the other side of the legacy cross subsidy. So I really appreciate what you're saying, Vidal, about helping people maintain coverage and creating pipelines potentially from uninsured to Medicaid, potentially Medicaid to commercial, treating this as a whole rather than just treating the subpopulations. Before we finish, any other strategies we should name?

Vidal Seegobin (30:47):
I'm cribbing aggressively from our colleague, Shay Pratt. I think he was talking about the transition from subspecialty as a growth strategy to access as a growth strategy. I think if we're thinking about volumes declining commercial or otherwise, the ability to see a patient more quickly to be easily accessible to have multiple front doors to your system feels like a must do imperative for health systems looking to grow and succeed into the future.

Abby Burns (31:14):
Great point. And we'll link that conversation with Shay Pratt and Emily Heuser in the show notes. So Clare, Vidal, as we wind down, these volume trends are something that we are going to continue to watch. I imagine listeners, especially those in markets that are seeing these steep declines are also going to be watching. What should they be looking for or what questions should they be asking us to help them monitor in the months to come?

Clare Wirth (31:39):
Stop asking when will volumes come back and start asking what demand looks like now? That is the question that's going to shape strategy heading into 2027 and beyond.

Vidal Seegobin (31:50):
The other item that I'm curious to understand more is to the extent that volume is being shifted, changes and altered because of financial realities, are there things we can do at scale to allow for people to have greater visibility, predictability and planning around the financial outlay that will come if you need a healthcare service? So this is around I think consumer financial experience that is hard to do at scale or you may not want to be the first mover in this front, but how we accomplish that as an industry I think is another thing that we need to figure out if we acknowledge that there probably is some level of economic rationing that's impacting volume.

Abby Burns (32:35):
Yep. Making good on the original objective of price transparency legislation or regulation. Well, Clare, Vidal, thank you so much for coming back on Radio Advisory.

Vidal Seegobin (32:47):
Always fun.

Clare Wirth (32:49):
Thanks for having us back.

Abby Burns (32:56):
In this conversation, we laid out three very plausible reasons why many hospitals are seeing declines in their volumes across the first half of the year. And I hope you caught that Clare and Vidal actually debated their own findings across our conversation. That was intentional. There's no one right answer that explains these trends. And at the same time, as you've heard our experts say before, we can't wait for the perfect data to act. We're going to be continuing to monitor what's happening with volumes and the viable strategies health systems can pursue in light of them. Because remember, as always, we're here to help.

(33:42):
New episodes drop every Tuesday. If you like Radio Advisory, please share it with your networks, subscribe wherever you get your podcasts and leave a rating and a review. Radio Advisory is a production of Advisory Board. This episode was produced by Rae Woods, Chloe Bakst, Atticus Raasch, and me, Abby Burns. The episode was edited by Katy Anderson with technical support provided by Dan Tayag, Chris Phelps, and Joe Shrum. Additional support was provided by Dominique Del Gaudio. Special thanks to Monica Westhead and Chelsea Needham. We'll see you next week.