Recently a relative of mine has been hospitalized. He lives in a state far away from me and I was speaking with the other family members about what was going on at the hospital. It was very opaque and confusing to them.
Therefore, I wanted to write a blog on how hospitals work for patients and family members.
Outpatient and Inpatient Services
Hospitals today provide both outpatient and inpatient services. Outpatient services mean that you are not ‘admitted’ and you typically go home the same day that you visited the hospital.
Examples of Outpatient Services include:
- Imaging (CT scans, MRIs, X-rays, etc.)
- Lab (blood draws, called ‘phlebotomy’ in medical terms)
- Procedures (colonoscopies, upper GI endoscopies, etc.)
- Other Testing (cardiac stress tests, echocardiograms, etc.)
- Surgery (carpal tunnel release, ovarian cyst removal, etc.)
- Infusion of some chemotherapy for cancer
Inpatient services mean you have been admitted to the hospital and you will stay overnight, several nights or even weeks to months. Generally, inpatient services can be broken down into two categories: Surgical and Non-Surgical.
Examples of Inpatient Surgery include:
- Total knee or hip replacement
- Spine surgery
- Tumor removal
- Emergency surgery (appendectomy for appendicitis, trauma from motor vehicle accident)
Examples of Non-Surgical Inpatient Services include:
- Heart attack (the medical term of which is a myocardial infarction or MI for short)
- Severe skin infection requiring IV antibiotics
- Emphysema exacerbation (the medical term of which is COPD)
- Stomach or intestinal bleeding
- Administration of some chemotherapy for cancer
- Psychiatric admission for extreme psychosis or depression
Of course, the list could go on and on, but you get the idea.
Additional, there is a situation ‘between’ being an Outpatient and an Inpatient and that is called Observation (sometimes called a 23-Hour Stay).
To you, the patient, it seems like an Inpatient Stay because you invariably ‘stay’ overnight at the hospital. However, observation is a status used by the hospital for billing purposes — it is a requirement of Medicare, Medicaid, and insurance companies. More details about observation stays is beyond the scope of this blog, but suffice it to say that billing for once-over-night-stays often get messed up. So if you only stay at the hospital one night, be prepared to have to deal with billing problems in the future.
There are 4 ways to be admitted for an Inpatient or Observation Stay:
- Scheduled Admit: typically done for scheduled surgery. Of note, scheduled surgery is referred to as Elective Surgery. Now, you could have a tumor that ‘has to be removed,’ so YOU might not think it is ‘elective.’ However, what is ‘elective’ is the date and time of the surgery. Accordingly, the opposite of elective surgery is Emergency Surgery (i.e. one cannot ‘elect’ when to have the surgery, you have to have it right away e.g. appendectomy for appendicitis).
- Emergency Admit: probably THE most common route of admission is via the emergency department (abbreviated ED; hospitals don’t like to call it an ‘emergency room’ anymore, it is now considered a ‘department’). Typically, you will go to the ED with some type of symptom (e.g. pain, difficulty breathing, bleeding, etc.)., the emergency physician determines that your condition cannot be addressed just in the ED so he or she admits you ‘to the floor’ (which means into the hospital).
- Direct Admit: you could have gone to a doctor’s office appointment and the doctor finds you to be so ill that he or she can call the hospital and have you directly admitted to the hospital. Additionally, you could talk to your doctor over the phone and based on the phone conversation the doctor decides that you need to go directly to the hospital. An example of this last scenario is most frequently not an ‘illness,’ but rather a direct admit for labor & delivery (i.e. having a baby)
- Transfer: you could be at a hospital or you could be at one of these ‘free-standing’ urgent care centers or ‘ERs’ and you could be transferred to another hospital. Typically the reason for this is that the ‘accepting’ hospital has some capability that the other facility doesn’t (e.g. cath lab to place a stent for a heart attack).
To learn some quick tips that you should take during the hospital discharge process, check out a previous post on the topic here.
For the sake of this blog not getting too long, I will stop there.
As healthcare consumers, it is important to know how a hospital works, just as it is important to understand how going to a stadium to watch a sporting event or going to a school works. Also, if you have a friend or family member that is ill, it is important for you to understand how a hospital works so that you can understand what is going on too.
As employee benefits professionals, it is important for you to understand the actual ‘process’ of how a hospital functions, because these functions are what generate healthcare claims and costs. To write the checks for healthcare and not understand how your money is being spent is to not understand the ‘supply-chain’ for employee benefits. Understanding that supply-chain better is to manage that supply-chain better.
To learn more about how Compass works to activate employees in their own health and promote healthcare consumerism visit compassphs.com