Sometimes patients need to see the doctor more than once a year or even for more than a few days in a row. When a hospital trip comes around, you’ll need to pack more than just your clothes and a toothbrush. After this episode you’ll know the differences between inpatient and outpatient care as well as how to prepare for any long or short healthcare journey.
When thinking of how to get medical care, you’re probably imagining a visit to the doctor’s office or a telemedicine app. In any case you’re in and out the same day. That’s outpatient (or ambulatory) care. You can visit a hospital for regular office care—think of how a square is a rectangle (i.e. getting outpatient care anywhere) and how a rectangle isn’t always a square (i.e. inpatient care nearly always occurs at the hospital). Regardless, spending more than one night in that kind of facility means you’re an inpatient. Most patients don’t wake up wishing to go to the hospital. Inpatient medicine happens when you’re admitted for an emergency, planned care ahead of time, or for a particular service like childbirth. In any case, you get a bed and room with around-the-clock monitoring. Once the doctors and staff feel that you don’t need more care, the discharge process begins. When you leave the hospital, the discharge notes should have instructions along the lines of getting medications, following up with your usual doctors, or miscellaneous guidance. A bit later we’ll dive into how you can be 100% ready before, during, and after inpatient care. Knowing the actual scope of inpatient versus outpatient medicine gives necessary perspective.
More people are going to the doctor’s office for less than a day than others staying overnight or longer. Although knowing the split between outpatient and inpatient care remains imprecise, McKinsey and Company analysts provided some insight. That company reviewed ~$490B in 2016 commercial insurance claims then analyzed that dataset in 2020. The results showed 62% of those dollars being ambulatory, 11% as inpatient, and 27% as mixed-setting care. However, the insurance claim volume behind the money tells a different story. 97.4% of the claims were ambulatory and just 1% were inpatient-related! That disparity in costs between healthcare settings affects the whole country’s purse.
Hospital expenses take up ~31% of America’s annual healthcare spending—that’s $1.2T out of $4.1T. Based on 2020 data collected by the American Hospital Association, there are ~33M admissions per year, which is around 10% of the US population. What’s the point of these stats? Patients should be vigilant when they need inpatient care because a little guidance improves the odds of a successful hospital trip.
A typical, same-day trip to the clinic usually involves costs for procedures, lab tests, in-office medication, and the doctor’s time. At the hospital you have worry about those items and more, including medical equipment, administrative costs, nurses’ time, specialists’ time, more intensive medications, tests, and boarding. It should be no surprise that health insurance companies want you to avoid this. Health plans have a couple incentives among many: 1) to cover preventative care screenings (barring a deductible) lowering the odds of an expensive inpatient trip later and 2) requiring more permissions/authorizations to cover inpatients. When picking health insurance, keep hospital coverage in mind, especially if you don’t need more than a couple routine visits and labs per year. If you’re not visiting the hospital for an emergency, your doctor is probably doing the formal work to admit you. Although Covid had other ideas in 2020 and 2021, most patients get an elective or direct admission. Elective care involves you going at a specified time for a known condition. A direct admission is your doctor arranging your stay directly per their recommendations. Sometimes you might need to go in advance for lab tests or general monitoring for an issue like a heart or lung condition. Because hospitals tend to have specialized equipment and facilities, certain procedures are only possible in an operating room. Feel comfortable asking your regular doctor what kind of admission to expect when inpatient care is needed.
Having a better inpatient experience involves a few helpful tips beyond the usual prep I’ve mentioned for outpatient care in past episodes. Before any hospital stay, a simple packing list is a great start. Besides the minimum of phone/wallet/keys, do bring emergency contact info, all insurance cards, and your primary doctor’s office and fax number. For the medical side in particular, get a written list of medications, allergies, past surgeries, and known family history of conditions in order. Your doctor may forward this EHR info ahead of time. If nothing else, make sure your meds are updated. Inpatient physicians need to make quick decisions for you. Missing drug information alone can be the difference between a shorter and longer hospital stay. In the hospital you’ll see more than just doctors and basic staff. Nurses spend a ton of time administering medications, contacting other staff, checking vitals, and prepping you for procedures. Most hospital physicians do rounds throughout the facility to check on the inpatients. Other doctor-extension staff like physician-assistants and nurse practitioners are present as well. Social workers and hospital administrators round things out. While you’re getting settled in a room, ask your nurse what the doctor’s visitation hours are and who your case manager is. Case managers track your overall stay. After all this preparation, let the hospital staff do their job, but do ask them questions along the way as needed.
After the care itself, you have another step to finish before the hospital journey is over. Staff must officially discharge you. Inpatient discharge handouts include why you were at the hospital (or whatever your health issue was), the next steps for care (i.e. getting medications, following up with someone), and why you need to do those steps. Contact your case manager ASAP if you don’t get a discharge note with those aforementioned points. Also double-check that your primary doctor is getting any forwarded notes and lab results. You could access your EHR to move everything directly instead. Be thorough so you don’t need to return. Just because you leave the hospital for a given condition doesn’t mean you get an automatic one-year pass to go back for help with the same issue. Unnecessary re-admission is a risk all patients should work to prevent with the help of their providers. The clinical resource website called UpToDate offers a few a more checklists both doctors and patients can follow to avoid re-admissions. Besides a complete discharge handout, you should have clear, written points on how to get home, what family members to seek for assistance, knowing if your home is the best place to rest, a plan to get medications, and outpatient follow-up. Before going home, let the staff have you explain the major discharge instructions back to them. This final step raises the chance to prevent unnecessary inpatient care.
There’s no doubt that inpatient medicine is complicated. In reality, you won’t always have time or a clear mind to make decisions on any kind of healthcare. It’s hard to make smart choices when in a coma or cardiac arrest. Patients can avoid these problematic situations with a healthcare proxy’s assistance. Next week’s theme covers the pros and cons of having someone manage your healthcare when your ability to choose disappears. Subscribe and stay tuned to Friendly Neighborhood Patient for more healthcare system insight. I’ll catch you at the next episode.
