As lower-acuity cases continue to migrate out of the hospital, the patients who remain in inpatient beds are increasingly complex, according to an October report from Chicago-based Strata Decision Technology.
The report, “Strata Performance Trends Report: Market Insights from H1 2026,” draws on Strata’s Comparative Analytics data, which covers more than 2,200 hospitals, and its StrataSphere encounter dataset, which aggregates U.S. hospital billing data representing about 25% of provider spend.
Here are five takeaways from the report:
1. In service lines where more than 90% of volume occurs in outpatient settings, inpatient case mix index has risen roughly 1% to 3% year over year from the first quarter of 2024 through 2026, the report found. Strata characterized the changes as gradual and attributed them to lower-acuity cases shifting to outpatient settings, leaving a sicker mix of patients in the inpatient setting.
2. Gynecology offers one of the clearest examples. Inpatient gynecology volumes declined 8% in the first half of 2026, while the service line’s median case mix index rose 2.17% since the first quarter of 2024. Strata linked the trend to the broader migration of hysterectomy procedures to outpatient settings, driven in part by minimally invasive techniques, including robotic hysterectomy.
3. Breast health moved in a different direction. Inpatient breast health volumes grew 17.2%, and the service line posted the largest case mix index increase Strata highlighted, at 3.21%. The report noted that increased breast cancer testing and diagnoses and changing surgical patterns may provide context, but that its data do not identify the cause.
4. The acuity shift has different implications depending on a hospital’s size. Hospitals with more than 500 beds earn nearly half of their gross operating revenue from inpatient care, compared with roughly 10% for hospitals with 25 or fewer beds, according to the report. Midwest hospitals had the lowest inpatient revenue share of any region.
5. Meanwhile, health system operating margins opened 2026 in negative territory before turning positive in March and reaching 0.7% in June, down from 1% to 1.5% in late 2025.
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