With improvements in home health care and other services available to provide subacute continuity of care outside of the hospital setting, early discharge has become one of the means whereby hospitals were able to reduce the overall number of inpatient care to remain profitable (Shi & Singh, 2015). Because of improvements in health care delivery, the Hill-Burton Act's bed-to-patient ratio has been below its target since 1998. The decline in the number of available beds can be attributed to closures, mergers and acquisitions that have affected over 700 facilities since the 1980s (Shi & Singh, 2015). However, this is balanced by increasing efficiency in the use of available resources, due in part to advances in medical technology and improvements in the types of services available to patients on an outpatient basis. The effect of managed care on the hospital