Inpatient vs. Outpatient
Patients are engaged in their medical care now more than ever. They’re partnering with physicians to make their wellness a priority. Much of that has to do with advancing health care technology. For example, early research indicates that patients’ ability to access their health records online encourages them to be more involved in their treatment.
But even individuals like you who actively participate in managing their health still have some blind spots when it comes to medical terminology. Keep in mind that providers spend years learning the lingo, so It makes perfect sense that you don’t know every term or how similar ones differ.
If you’re anything like other patients, understanding the distinction between inpatient versus outpatient care can be a particular point of confusion. What’s the difference and why does it matter? Consider this your go-to guide.
INPATIENT VS. OUTPATIENT: DISTINGUISHING THE DIFFERENCES IN CARE
In the most basic sense, an inpatient is someone admitted to the hospital to stay overnight. That can include a person who remains in the hospital for weeks to recover from a complicated surgery as well as an individual who only needs to stay briefly. Physicians keep these patients at the hospital to monitor them more closely.
Outpatient care, also called ambulatory care, is anything that doesn’t require hospitalization. An annual exam with your primary care physician and a consultation with your neurologist are both examples of outpatient care. But emergent cases can also be considered outpatient care. If you leave the emergency department the same day you arrive, you’re still considered an outpatient. And of course, any appointment at a clinic or specialty facility outside the hospital is considered outpatient care.
While there’s a clear difference between an inpatient and an outpatient, there is a little bit of grey area as well. Occasionally, physicians will assign a patient observation status while they determine whether hospitalization is required. This allows doctors a bit more time to evaluate you and make the most appropriate decision. That said, there are instances where a patient can remain under observation status for more than 24 hours.
Note that the location itself doesn’t define whether you’re an inpatient or outpatient. It’s the duration of stay, not the establishment, that determines your status.
INPATIENT VS. OUTPATIENT: COMPARING SERVICES
You’re probably starting to get a sense of what types of circumstances fit under each category. Here’s a little more detail about the types of treatments and services that are common for these two types of care.
INPATIENT CARE EXAMPLES
• Complex surgeries
• Serious illnesses or medical issues that require substantial monitoring
• Delivering a baby
• Rehabilitation services for some psychiatric conditions, substance misuse, or severe injuries
OUTPATIENT CARE EXAMPLES
• X-rays, MRIs, and other types of imaging
• Bloodwork and other lab tests
• Minor surgeries
• Colonoscopies
• Mammograms
• Consultations or follow-ups with a specialist
• Routine physical exams
• Stitches and other same-day emergent care
• Chemotherapy or radiation treatment
INPATIENT VS. OUTPATIENT: THE PROVIDERS IN EACH SETTING
Primary care physicians have traditionally been considered outpatient providers while specialists are thought of as inpatient physicians. But that’s really an oversimplification, particularly when you consider that hospitalists bridge the gap by providing general medical care to inpatients. Effective care requires a team effort anyway. Doctors need to work together, regardless of their specialty and setting.
Many physicians also divide their time between inpatient and outpatient services. OB/GYNs, for example, provide inpatient care when delivering babies and outpatient care when consulting with pregnant women during their prenatal checkups.
Generally speaking, inpatients interact with a larger group of providers. When you stay in a hospital, you could interact with physicians, nurse practitioners, lab technicians, physical therapists, pharmacists, and physician assistants.
INPATIENT VS. OUTPATIENT: COST CONSIDERATIONS
You may be asking yourself whether the difference between inpatient versus outpatient care really matters that much from a patient’s perspective. Your status might not influence the quality of care you receive, but it will ultimately affect your eventual bill. While you’re not usually able to influence your status, it’s still good to know what you can expect.
The cost of outpatient care consists of fees related to the doctor and any tests performed. Inpatient care, on the other hand, includes facility-based fees on top of those existing expenses. Overall cost for inpatients can range anywhere from a few thousand dollars to tens of thousands of dollars, depending on the length of stay and the treatment involved. The exact amount you pay also hinges on your insurance.
Things get a little more complicated if you have Medicare. Outpatient care and physician-related services for inpatient care are covered by Part B. Hospital services like rooms, meals, and general nursing for inpatients are covered by Part A.
But if you stay overnight in the hospital under observation status, that changes your overall cost since you aren’t considered an inpatient. Medicare will not cover care in a skilled nursing facility for you in this situation—you’re responsible for the entire cost. It can certainly be confusing, so don’t be afraid to ask the medical team about your status. They’re used to these types of questions.