When patients undergo treatments, procedures, or checkups, they have the option of receiving health care services in inpatient or outpatient care centers. A key aspect of comparing inpatient vs. outpatient care includes understanding the definition of each.
Inpatient care describes treatments and procedures that require observation of the patient by physicians, clinicians, or other medical professionals overa number ofdays. Patients stay at inpatient care facilities such as hospitals overnight. Amid the current pandemic, inpatient care remains critical for COVID-19 patients with respiratory issues that require the use of life-saving respirators over many days — even weeks andmonths.
Outpatient centers are typically used by patients undergoing treatments and medical procedures that do not require overnight stays. The shift away from inpatient services helps ensure that resources are available for those with the most severe symptoms.
What Is Inpatient Care?
Inpatient care refers to medical services that require a patient to be admitted by a doctor into a hospital or other health care facility so they can stay overnight for medical observation. Inpatient care patients typically have serious conditions or are recovering from life-threatening traumas that require monitoring by physicians or nurses over more than one day.
For a patient to receive inpatient status, a doctor must make the request. However, the process does not merely involve a doctor or hospital signoff. Guidelines published in the Medicare Benefit Policy Manual help health care providers determine which patients should be given inpatient status. According to the guidelines, not every patient who stays more than one day is considered inpatient. Some receiveobservation status, which, according toVerywellHealth, can be more costly than inpatient care services.
When it is not necessary, avoiding inpatient care can result in significant cost savings for the party responsible for paying the cost of care — for example, the patient’s insurance plan. Even so, patients may opt for inpatient services in certain instances despite the costs, such as when they are undergoing substance abuse disorder rehabilitation or managing clinically complex problems such as Alzheimer’s disease. These patients can receive the necessary care in long-term facilities that provide physical, cognitive, and emotional well-being and psychological support.
Types of Inpatient Care
Types of inpatient care include the following:
- Childbirth. Labor can take anywhere from an hour to more than a day. Sometimes, a cesarean section is required to help ensure both the mother’s and the newborn’s safety, which requires an overnight stay for observation.
- Complex surgeries. From organ transplantation to bypass surgeries of the heart or gastric organs, complicated surgeries require recovery and observation over several days under the watchful eyes of medical professionals.
- Serious health issues. Patients with serious health issues need constant monitoring from health care professionals. Examples of severe health issues include patients with severe respiratory problems that require intubation, those experiencing seizures from brain damage, and those in comas.
Different Inpatient Care Facilities
Various types of facilities can provide inpatient care. Examples include:
- Acute care facilities. These facilities typically provide inpatient medical care for short-term illness and acute conditions, as well as surgery services for injuries.
- Rehabilitation centers. Patients recovering from a stroke or brain injury may require intensive medical care in an inpatient rehabilitation facility.
- Addiction treatment facilities. From drug abuse to alcoholism,addiction treatment facilitiesoffer around-the-clock medical care and emotional support, and keep patients safe from exposure to outside triggers.
- Psychiatric hospitals.Brain injury, intense depression, and other mental disorders can lead to self-harm. Psychiatric hospitals provide inpatient care to reduce suicidal risks and provide treatment in safe environments.
- Long-term care facilities. Long–term care facilities, including nursing homes, skilled nursing facilities, and assisted living facilities, help people unable to care for themselves with medical and personal care services.
Inpatient care is designed to treat conditions that require the patient to stay at least one night in a care-related facility. Several facility types fall under this category, including acute care facilities, rehabilitation centers, addiction treatment facilities, psychiatric hospitals, and long-term care facilities.
Inpatient Care Resources
These resources provide more details about inpatient care facilities, including inpatient care costs, types of patient care services, and tools for patients and health care practitioners.
- This American Society of Health-Systems Pharmacists resource written for pharmacists provides information about inpatient care practitioners.
- Becker’s Hospital Reviewoffers figures about expenses in inpatient care across 50 states.
- TheCenters forDisease Control and Prevention (CDC) provides health care systems and facilities with guidance on the use of inpatient care during the pandemic.
- Mental Health Americaprovidesinformation about inpatient mental health treatment services.
- Thisglossary of health care terms is fromthe Centers for Medicare and Medicaid Services (CMS).
- These resources from theCDC regardinglong–term care facilitiesinclude fact sheets for clinical staff,checklists, and training tools.
What Is Outpatient Care?
Outpatient care describes any medical procedure or treatment that does not require a patient to stay overnight. When considering inpatient vs. outpatient care, whether or not the patient has an overnight stay is what typically defines the difference between the two, but exceptions exist. For example, an emergency room (ER) visit is generally considered an outpatient service, even if a patient will likely require an overnight stay. If an ER visit results in an extended stay and a doctor formally admits the patient to the hospital, that patient’s status changes to inpatient.
Typically, outpatient care can include physical examinations or one-time and ongoing treatments, such as chemotherapy for cancer patients. When surgeons order lab work before performing surgery, patients can visit labs in outpatient centers to save time and costs. The information obtained in the outpatient care visit is then shared with the surgeon, enabling them to determine if underlying health issues may cause complications during a surgical procedure.
Hospitals typically generate more revenue from inpatient services. However, in recent years, a shift toward outpatient care has been growing. The American Hospital Association reports that the revenue gap between outpatient and inpatient services is closing. A large portion of the revenue generated in health care derives from Medicare patients.
According to data from the Kaiser Family Foundation, thetotal number of Medicare beneficiaries as of 2018 was close to 60 million people. When it comes toinpatient vs. outpatient care,the distinction is critical to ensuring proper payment of health care services for Medicare patients:Medicare Part A pays for inpatient care, while Medicare Part B pays for outpatient care, such as preventive services.
Types of Outpatient Care
Outpatient care encompasses everything from patients seekingsubstance abuse treatment in outpatient rehabilitation centers to athletes undergoing surgical procedures for minor injuries. Additional examples include:
- Chest X-rays and CT scans.These can be used to help diagnose causes of chest pain, breathing issues, abnormal heart rhythms, and more.
- Urinalysis: Doctors use this type of test to find causes of kidney pain and bladder infections, and to test for chronic diseases such as diabetes.
- Blood tests: Thesecommon tests are used to checkfor a range of issues, including levels ofpotassium, sodium, and electrolytes that help regulate body functions.
Outpatient care is administered without an overnight stay in a facility. Outpatient treatments can include routine physical examinations, blood work, urinalysis, CT scans, and chemotherapy sessions.
Different Outpatient Care Facilities
Various types of facilities provide outpatient care. For example, a doctor’s office can provide annual physicals, preventive care, and pre-surgery blood work. Additional examples of outpatient care facilities include:
- Clinics. Outpatient services in clinics range from wellness, prevention, and weight-loss programs to some surgeries, procedures, and chemotherapy.
- Emergency rooms.A doctor can write an order for a patient to receive outpatient services at a hospital such as observation, surgery, X-rays, and more without having to stay overnight.
- Ambulatory surgery centers. Ambulatory patient services offered in these outpatient facilities offer same-day surgeries for procedures that do not require an overnight hospital stay, such as endoscopies.
Outpatient Care Resources
The following resources provide further information on outpatient care.
- Johns Hopkins Medicine provides various examples of tests performed in outpatient facilities.
- The American Hospital Association provides information about various long-term and rehabilitation topics.
- Health care practitioners can access various rural outpatient care resources in this online library published by the Rural Health Information Hub.
- The U.S. Department of HealthandHuman Services (HHS) provides information regarding COVID-19 and outpatient care.
Clinic vs. Hospital: What’s the Difference?
Clinics and hospitals offer different kinds of care. Clinics are much smaller than hospitals and do not offer overnight stays. Clinics are ideal for healthy patients who are undergoing routine preventive care such as immunizations, and those seeking a doctor’s opinion for routine ailments.
Hospitals, on the other hand, offer a wide range of medical specialty services,from outpatient services to inpatient care. Typical examples include cardiology, allergy and immunology, sports medicine, vascular surgery, and urology. In an emergency such as a life-threatening injury or an acute illness, individuals can go to a hospital without an appointment. For nonemergencyissues, patients generally must schedule an appointment with a primary care provider, who can then refer them to a specialist if necessary. In addition to emergencies and specialist appointments, patients go to hospitals to receive specific medical treatment or undergo surgery.
The Role of a Nurse Practitioner in Inpatient and Outpatient Care
According to the American Association of Nurse Practitioners, 14.5% of nurse practitioners (NPs) work in hospital outpatient clinics, while 12.1% work at inpatient hospital units. Inboth inpatient and outpatient care settings, they help ensure optimal care delivery, but their daily functions may vary.
Nurse practitioners can serve as both primary and specialty care providers. Their responsibilities can extend to include administration, teaching, and research. Specializations in inpatient settings include the following:
- Nurse practitioners (NPs).A nurse practitioner can provide various health care services in a wide range of health care settings, including performing physical exams, ordering diagnostic tests, writing prescriptions, anddiagnosing and treating diseases.
- Psychiatric mental health nurse practitioners (PMHNPs).PMHNPsassess, diagnose, and treat mental health needs. Patients can consult PMHNPs for therapy services, psychosocial assessments, and emergency psychiatric care. PMHNPs can develop treatment plans and prescribe medications.
- Adult–gerontology acute care nurse practitioners(AGACNPs).From acute care management to disease prevention, adult–gerontology acute care nurse practitioners provide care for adult and gerontology patients with complex conditions. They often work in intensive care, trauma departments, or critical units within hospitals.
- Women’s health nurse practitioners (WHNPs).:Women’s health nurse practitioners provide health services such as breast cancer screening and diagnosis,pregnancy testing, urinary tract health, prenatal and after pregnancy care, and general health management throughout a patient’s life.
Nurse practitioner specializations in outpatient settings include the following:
- Pediatric nurse practitioners (PNPs).As nurse practitioners focused on treating younger populations, pediatric nurse practitioners perform health examinations, prescribe medications, assess the mental health of children, and manage acute and chronic disease. PNPs typically work with their patients from birth through young adulthood.
- Family nurse practitioners (FNPs).Family nurse practitioners work with people of all ages, managingpatients’ healththroughout their lives. They provide preventive care, long-term health monitoring, disease management, and more.
- Psychiatric mental health nurse practitioners (PMHNPs).Psychiatric mental health nurse practitioners working in outpatient settingshelp individuals with cognitive and psychiatric disorders through diagnosis and treatment, including psychotherapy and medicines. They also work in group settings.
- Adult-gerontology primary carenurse practitioners (AGPCNPs).AGPCNPsfocus onelderly patients,providingphysical and cognitive care, diagnosingdiseases, and prescribingmedications to manage pain and chronic disorders. They can also order diagnostic tests and provide preventive care and health care education services.
Prepare for the Role of Nurse Practitioner
Whether in inpatient or outpatient facilities, nurse practitioners serve a critical role. Medical innovations, the increased digitization of health care, and advancements in care have made it possible for nurse practitioners to take leading roles in patient care. In many states, they can serve as primary caregivers. An advanced degree such as a Doctor of Nursing Practice can help nurses advance their careers and take on leadership roles in various health care settings.
Infographic Sources:
American Hospital Association, Post-Acute Care
Johns Hopkins Medicine, Tests Done Before Surgery
MedicareResources.org, What Is Inpatient Care?
WebMD, Ambulatory Patient Services, Also Called Outpatient Care
FAQs
What is the difference between inpatient and outpatient care? ›
Generally speaking, inpatient care requires you to stay in a hospital and outpatient care does not. The big difference is whether you need to be hospitalized or not.
What is an example of an outpatient? ›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.
What is classed as an outpatient? ›If you have an appointment in a hospital or clinic but do not need to stay overnight, it means you're being treated as an outpatient or a day patient. You may be having an appointment for treatment, diagnosis or a procedure.
What is an example of an inpatient facility? ›Types of inpatient facilities include acute-care hospitals, rehabilitation centers, psychiatric hospitals, addiction treatment centers and nursing homes.
Why is outpatient care better than inpatient? ›Outpatient surgeries are usually much less complicated than inpatient surgeries. This means that patients are discharged home after their procedure. Inpatient surgeries are more complex thus, patients must stay in the hospital to be monitored by health professionals.
What does outpatient treatment mean? ›What is outpatient treatment? Outpatient treatment is when you don't need to stay overnight in hospital for your treatment, but you will still attend a hospital or clinic for any diagnostic tests, treatments or therapies you need.
Why do patients prefer outpatient services? ›The majority of respondents (36.7 percent) said the lower costs associated with outpatient care was the biggest advantage. Outpatient care is not subject to hospital room charges or other related fees, making outpatient substantially less expensive than inpatient care, the authors explained.
What are the five main types of outpatient services? ›...
Terms in this set (25)
- Wellness and Prevention (counseling)
- Diagnosis (lab tests)
- Treatment (surgery)
- Rehabilitation (PT)
Common procedures that are now routinely performed on an outpatient basis include tonsillectomies, hernia repairs, gallbladder removals, some cosmetic surgeries, and cataract surgeries. Given the millions of procedures performed every year, complications from outpatient procedures are relatively uncommon.
Does inpatient mean overnight? ›Inpatient care tends to be directed toward more serious ailments and trauma that require one or more days of overnight stay at a hospital. Health insurance plans require you to be formally admitted into a hospital for a stay for a service to be considered inpatient.
What is an outpatient limit? ›
This means you will only be covered up to that number of consultations, and for no other kind of outpatient diagnostics or treatment. Conditional limit – You can choose a conditional outpatient limit with some insurers. This means you're covered for your outpatient treatment if it meets certain specified conditions.
Is day case the same as outpatient? ›Outpatient – a patient who comes into the hospital for a short appointment – this may be a consultation with your specialist, a test or a scan. You will not need to stay at the hospital overnight. Day-case – a patient who comes in for a more involved procedure than an outpatient.
What does going inpatient mean? ›What is an inpatient? In the most basic sense, this term refers to someone admitted to the hospital to stay overnight, whether briefly or for an extended period of time. Physicians keep these patients at the hospital to monitor them more closely.
What's another word for inpatient? ›In this page you can discover 13 synonyms, antonyms, idiomatic expressions, and related words for inpatient, like: outpatient, in-patient, , intensive-care, , acute care, day-patient, daycase, , inmate and a-e.
What counts as being admitted to hospital? ›People are admitted to a hospital when they have a serious or life-threatening problem (such as a heart attack). They also may be admitted for less serious disorders that cannot be adequately treated in another place (such as at home or in an outpatient surgery center).
Why is outpatient care cheaper? ›Such surgical services, as well as rehabilitation treatments and mental health services, are available as outpatient care. Outpatient is generally less expensive as it utilizes less of the hospital's resources.
Is outpatient care cheaper than inpatient? ›Outpatient care is almost always less expensive than inpatient care, which is another huge advantage. One night of inpatient hospital care can increase the cost of treatment by thousands of dollars. Even patients with good health insurance coverage may benefit by opting for outpatient treatment over inpatient care.
What is the basic premise of outpatient care? ›Outpatient care is made up of medical procedures, tests, and services that can be provided to the patient in a setting that doesn't involve an overnight hospital stay. These services include: Wellness and prevention services, such as psychological counseling and weight-loss programs.
What is the purpose of an outpatient clinic? ›Outpatient clinics and urgent care facilities often serve as an alternative place to receive healthcare when individuals are unable to get to a hospital. In the midst of a public health emergency, these settings may see an increase in the number of patients they treat.
Is therapy considered outpatient treatment? ›Individual therapy, group therapy, family therapy, and couple's therapy can all be provided in an outpatient setting. Sessions can range in frequency, including weekly, twice per week, every other week, and monthly, depending on the individual client's need and progress in treatment.
What are the benefits of outpatient care? ›
- #1. Outpatient Care Provides Flexibility.
- #2. Support from Loved Ones.
- #3. Cost-Effective.
- #4. Put What You Learn Into Practice.
- #5. You Have Access to Community Resources.
One reason for the growth in outpatient care might be health systems' strategies to perform well under these arrangements by reducing inpatient care by shifting patients to outpatient settings.
Why are inpatient services shrinking? ›As large providers have expanded their networks, they have also gained inpatient beds that are no longer in demand — thanks to improved surgical techniques and other improvements that are shortening hospital stays. Hence the closures.
Is dental considered outpatient? ›If you add dental care to your health plan, you will usually receive dental treatment as an out-patient. You'd also typically visit a dental surgery rather than a hospital, unless, for example, you were in hospital because of an injury.
What is inpatient and outpatient in medical billing? ›The term 'outpatient' refers to someone who requires medical care but without hospitalisation. Outpatient medical care includes doctor consultations, diagnostic tests, rehabilitation, etc. These procedures are conducted outside the hospital settings such as clinics, diagnostic centres, etc.
What does outpatient appointment mean? ›• Outpatient – being an outpatient simply means you are coming in to see us for an appointment. You don't stay overnight at this stage. • Consultant – this is the highly trained doctor who will guide you through the process and advise you about your condition.
How long do you stay after outpatient surgery? ›In general, most patients go home between one and four hours after outpatient surgery.
Why are so many surgeries outpatient? ›Many types of surgery are now being done on an outpatient basis. This is because more types of surgery are less invasive. It means they don't need large cuts (incisions). Because of that, problems after surgery are less common.
What procedures are on the inpatient only list? ›Examples of Inpatient Only surgeries include: Coronary artery bypass grafting (CABG) Gastric bypass surgery for obesity. Heart valve repair or valve replacement.
What is the 2 midnight rule? ›The Two-Midnight rule, adopted in October 2013 by the Centers for Medicare and Medicaid Services, states that more highly reimbursed inpatient payment is appropriate if care is expected to last at least two midnights; otherwise, observation stays should be used.
What is the 72 hour rule for Medicare? ›
The 72 hour rule is part of the Medicare Prospective Payment System (PPS). The rule states that any outpatient diagnostic or other medical services performed within 72 hours prior to being admitted to the hospital must be bundled into one bill.
Is a day patient an inpatient? ›Inpatient treatment involves all medical care requiring you to stay in a hospital bed overnight. This is most often after major surgery. For minor surgical procedures, the hospital might admit you as a day-patient.
Can you pay monthly for private healthcare? ›You'll pay a monthly premium for medical insurance which can cover the cost of private treatment, but you'll usually still have to pay an excess for each claim. Choosing a higher excess can bring the cost of your premiums down, but you have to be sure you'll be able to pay it should you need to make a claim.
What is outpatient medical insurance? ›Outpatient care covers treatment that does not require a day admission or an overnight stay at a medical facility. As you're generally not taking up as much of the hospital's time as you would with inpatient care, the treatments and processes are generally cheaper.
How long is a day case? ›What is Day Surgery? Day surgery, sometimes called day case surgery, means an operation or surgical procedure that does not involve an overnight stay in hospital. The patient is admitted on the day of surgery, and usually goes home on the same day, a few hours after the procedure, once they have recovered sufficiently.
Can someone accompany me to a hospital appointment? ›All people attending an outpatient appointment can be accompanied by one other person. Alternatively, you are welcome to have a relative or friend join you in your appointment virtually, by phone or video.
What is day patient treatment? ›In-patient treatment and day-patient treatment are when you need to stay in hospital and occupy a bed either for a day or overnight. Out-patient treatment is when you don't need to occupy a hospital bed for the day, but go to hospital for a few hours for a consultation, test or minor procedure.
What is considered inpatient hospitalization? ›You're an inpatient starting when you're formally admitted to the hospital with a doctor's order. The day before you're discharged is your last inpatient day.
What happens when you are admitted to a psychiatric hospital? ›You're likely to have access to a range of talking therapies and medication. Trained staff are around to support you, for example, if you feel like self-harming. You might feel you're getting a welcome break from stressful experiences or problems. It can provide structure in your day and there are people around you.
What is inpatient treatment for mental health? ›There are times when inpatient treatment, also known as residential treatment, is a necessity for patients suffering from mental health disorders. It provides intensive 24-hour care and risk monitoring. This can be essential when a patient poses a serious risk of harm to themselves and/or others.
What is another word for outpatient? ›
| case | patient |
|---|---|
| day patient | hospital patient |
| sick person | victim |
| inpatient | sick |
| valetudinarian | subject |
Definition of impatient
1a : not patient : restless or short of temper especially under irritation, delay, or opposition. b : intolerant sense 1 impatient of delay. 2 : prompted or marked by impatience an impatient reply.
Inpatient is commonly used as an adjective to describe treatment that requires a patient to be admitted to a hospital or other care facility for at least one night. Inpatient is used in contrast with the term outpatient, which describes treatment that does not require a patient to stay overnight.
What is a code 44? ›The Use of Condition Code 44
In some instances, a physician may order a beneficiary to be admitted to an inpatient bed, but upon subsequent review, it is determined that an inpatient level of care does not meet the hospital's admission criteria.
| Rank | Principal diagnosis | Rate of stays per 100,000 |
|---|---|---|
| 1 | Liveborn | 1,106.5 |
| 2 | Septicemia | 679.5 |
| 3 | Heart failure | 347.9 |
| 4 | Osteoarthritis | 345.5 |
Purpose of Outpatient in a Bed
The OPIB designation provides a way to generally classify patients occupying acute care beds in a hospital without medical necessity.
Inpatient care is designed to treat conditions that require the patient to stay at least one night in a care-related facility. Several facility types fall under this category, including acute care facilities, rehabilitation centers, addiction treatment facilities, psychiatric hospitals, and long-term care facilities.
What does inpatient mean in medical terms? ›What is an inpatient? In the most basic sense, this term refers to someone admitted to the hospital to stay overnight, whether briefly or for an extended period of time. Physicians keep these patients at the hospital to monitor them more closely.
What's another word for inpatient? ›In this page you can discover 13 synonyms, antonyms, idiomatic expressions, and related words for inpatient, like: outpatient, in-patient, , intensive-care, , acute care, day-patient, daycase, , inmate and a-e.
What counts as being admitted to hospital? ›People are admitted to a hospital when they have a serious or life-threatening problem (such as a heart attack). They also may be admitted for less serious disorders that cannot be adequately treated in another place (such as at home or in an outpatient surgery center).
Does inpatient mean overnight? ›
The hospital care that you receive is considered inpatient until the day you're discharged. Despite a hospital stay, your care may be considered outpatient services, for example if you are receiving outpatient care on the same day that you are discharged from the hospital.
Why is it called inpatient? ›It's a combination of the word patient, referring to someone receiving medical treatment, and the prefix in-, which indicates that the patient will stay in the hospital or facility. Patients are called inpatients as soon as they're admitted for an overnight stay, but inpatients can stay for much longer than one night.
Why is inpatient care so expensive? ›As a result, the costs for inpatient care tend to be significantly higher; the patient and insurance policyholder are hypothetically using up more resources including beds at the facility and time and service provided by other medical professionals on staff, and these costs get passed along to both the insurance ...
What is considered inpatient hospitalization? ›You're an inpatient starting when you're formally admitted to the hospital with a doctor's order. The day before you're discharged is your last inpatient day.
Why is outpatient care important? ›With outpatient services, patients recover at home instead of staying in the hospital. Patients who receive care in an outpatient setting are at lower risk for hospital-acquired infections. Most payors reimburse hospitals more for outpatient services than for inpatient care.
What is outpatient in a bed? ›This designation provides a way to accurately reflect the needs of a patient in the following two categories: Social Admit: Patient is placed in a bed for the convenience of patient/family/doctor, often through the emergency department, while waiting for arrangements for an appropriate transition.
What is another word for outpatient? ›| case | patient |
|---|---|
| day patient | hospital patient |
| sick person | victim |
| inpatient | sick |
| valetudinarian | subject |
Definition of impatient
1a : not patient : restless or short of temper especially under irritation, delay, or opposition. b : intolerant sense 1 impatient of delay. 2 : prompted or marked by impatience an impatient reply.
anticipating, awaiting, expecting, hoping (for), watching (for)
What is a code 44? ›The Use of Condition Code 44
In some instances, a physician may order a beneficiary to be admitted to an inpatient bed, but upon subsequent review, it is determined that an inpatient level of care does not meet the hospital's admission criteria.
What is the most common reason for hospital admission? ›
| Rank | Principal diagnosis | Rate of stays per 100,000 |
|---|---|---|
| 1 | Liveborn | 1,106.5 |
| 2 | Septicemia | 679.5 |
| 3 | Heart failure | 347.9 |
| 4 | Osteoarthritis | 345.5 |
What rules apply when the patient needs to be admitted to the hospital? patient must receive approval-obtain certification-7 days in advance of scheduled surgery of hospital admissions & within 48 hrs after emergency admissions-or 1st business day following wked or holiday emergency admissions.