The kind of medical care you are receiving, either inpatient or outpatient, affects everything from the therapies you get to how your insurance pays. It's essential to understand the difference between the two. While some consumers believe that location alone determines whether care is inpatient or outpatient, in reality, the distinctions are less clear and involve additional factors, including how long you stay.
Inpatient vs. Outpatient: Comparing Two Types of Patient Care
Inpatient care is delivered when you are staying in a hospital and receiving medical care there as directed by your physician or another medical provider. Inpatient stays can be very brief or several weeks long. Some examples of inpatient services include surgeries, both routine and complex, childbirth, and rehabilitation services of all kinds. If you are in the hospital, many types of professionals other than doctors may assist in your care, such as laboratory technicians, pharmacists, respiratory therapists, and more.
Outpatient care, sometimes called ambulatory care, is any service you receive without being admitted to a hospital or for a stay shorter than 24 hours. Some examples of outpatient services are X-rays and other imaging procedures, minor surgeries, some cancer treatments, and routine physicals. Outpatient care may be delivered in many settings, including your home, in a physician's office, or in some departments of a hospital. For example, when you go to the emergency room, you receive outpatient care until the medical team decides that you must be admitted to get the care you need. Once you are formally admitted, you are registered as an inpatient, and your care continues on an inpatient basis until you leave the hospital.
Under Observation Care
One form of care, known as under observation, is a hybrid between inpatient and outpatient care. Your physician may order that you spend the night in the hospital so that your medical condition and metrics can be monitored, testing can be done, and data can be gathered to assist with diagnosis and develop a further plan of care. With under observation care, your treatment is still outpatient unless your doctor decides that you need to stay longer, at which point your care becomes inpatient.
Primary Care and Specialists
Primary care practitioners, such as your family doctor or a nurse practitioner you see for routine care, are generally considered providers of outpatient care. Specialists are often thought of as inpatient providers. However, both of these assumptions are incorrect. Physicians and other medical professionals usually split their time between inpatient
and outpatient settings. For example, pediatricians may see patients in a private practice clinic for routine physicals and treatment of minor illnesses. Still, those same professionals provide care to acutely ill children in the hospital.
The Cost of Inpatient and Outpatient Care
Insurers, including Medicare, pay different rates for inpatient and outpatient care. Inpatient care is usually more expensive as it includes the operating costs of the facility. In contrast, the prices of outpatient care generally only cover the test or procedure itself and the physician's fees. Inpatient care can cost from a few thousand to hundreds of thousands of dollars and varies based on how long you are in the hospital and what kind of treatment you're receiving. Your insurance coverage determines how much you have to pay out of pocket. Specific to Medicare, outpatient and physician services for inpatient care is covered by Part B, while Part A covers hospital meals, room costs, and nursing for inpatients.
To care for patients effectively, inpatient and outpatient care must work together. Understanding the similarities and differences between inpatient and outpatient care helps you become a more informed consumer. If you're facing behavioral health challenges of your own or with someone you love, contact St. Anthony's Behavioral Health Hospital. We're happy to help you understand your options.