What Is The Difference Between Inpatient And Outpatient Care?

Anyone who has been to a hospital may have heard of inpatient and outpatient care. Inpatient care refers to any care which requires extended/overnight stay in a hospital or treatment facility. Outpatient care refers to any treatment that does not require an extended/overnight stay. Other than the length of stay, inpatient and outpatient care main differences lie in cost and services. Below are some general descriptions of inpatient and outpatient plus some examples of each.

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Inpatient Care

Inpatient treatment requires the patient to be admitted into the hospital to be monitored during and after a medical procedure. You are under the care of doctors, nurses, and others within the hospital. Typically, inpatients are admitted into a specific service like Neurology, Cardiology, Orthopedics, Oncology, and General Surgery based on their needs. Other reasons for inpatient services are surgery, illness, childbirth, or traumatic injury. Substance use and mental illness can be means for inpatient admittance. Inpatient care is often planned except in the case of an emergency. Typically, if you need monitoring, inpatient care is required. Inpatient care can get expensive. One must pay for treatment plus any administrative costs, pharmacy costs, lab tests, costs for nurses/radiologists/technicians/ and specialists, equipment, and supplies.

Examples of Inpatient Care

Examples of inpatient care include complex surgeries, an illness requiring monitoring, baby delivery/childbirth, rehabilitation services, and severe illness (like flu, stroke, or heart attack).

Outpatient Care

Any medical treatment where you do not stay at the treatment facility overnight is considered outpatient care. Outpatient (also called ambulatory) treatment means that the medical procedure does not need hospital admission or could potentially happen off the premises. Outpatient care allows for the patient to recover at home. Outpatient costs are typically lower than inpatient costs. Patients may be able to shop around for MRIs, PET, and CT scans for the best prices. Outpatient screenings like mammograms and colonoscopy are considered preventative care and are often covered by one’s health plan. Most treatments, like minor surgeries, procedures, and medical screenings do not require an overnight stay.

Examples of Outpatient Care

Examples of outpatient care include imaging like X-rays and MRI’s, bloodwork and lab tests, colonoscopies, mammograms, consultations and follow-ups, and chemotherapy/radiation treatment, laser surgery, hand/foot surgery, mole removal, Lasik eye surgery, treatment of long-term illness or dialysis, and annual check-ups.¬†

Grey Area

There is a grey area between inpatient and outpatient care that could affect medical costs. Physicians may give the patient observation status while determining if hospitalization is needed. Primary care physicians are typically outpatient care providers. Physicians can split time between inpatient and outpatient services. Part B Medicare covers outpatient care and physician-related services for inpatient care. Hospital services like rooms, meals, and general nursing for inpatient care covered by part A Medicare. If you stay overnight under observation status, Medicare will consider you an outpatient and not cover care in a skilled nursing facility.

Final Word

From a financial perspective, outpatient treatment is the best option, if possible. Your physician will let you know if you need inpatient services. If you go for outpatient treatment and feel you need to be admitted and observed, express those concerns to your physician. It is always best to ask ahead of time and clear up the terms of your care with your insurance and physician.

References

https://www.cigna.com/individuals-families/understanding-insurance/what-is-inpatient-vs-outpatient-care

https://www.gohealthuc.com/UCvsER

https://www.pbmchealth.org/news-events/blog/difference-between-inpatient-and-outpatient-care

https://www.sgu.edu/blog/medical/inpatient-versus-outpatient/

https://www.wahiawageneral.org/inpatient-vs-outpatient-services/#:~:text=OUTPATIENT%3A%20DISTINGUISHING%20THE%20DIFFERENCES%20IN,the%20hospital%20to%20stay%20overnight.&text=Outpatient%20care%2C%20also%20called%20ambulatory,that%20doesn’t%20require%20hospitalization.

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