There are a lot of factors that affect how much you pay for a medical procedure. These include things like insurance network, the type of doctor you see, the state you live in, and the type of facility you go to. To learn more about what determines how much a medical procedure costs, check out our recent post on the topic. In this article, you’ll learn how inpatient vs. outpatient care can affect the cost of your medical procedure and what this means for you, as a patient. Let’s take a look.
What is the difference between inpatient vs. outpatient healthcare facilities?
Healthcare facilities exist on a spectrum and can range from big-name hospitals with thousands of staff members to small, local clinics where the front desk staff know your name. Each type of facility comes with its own set of benefits and disadvantages.
There are two main types of facilities you can have medical procedures done at: inpatient and outpatient centers. The main difference between the two is how long you have to stay in the facility after your medical procedure.
What is inpatient care, and which facilities provide it?
To qualify as an inpatient, you have to be admitted to the hospital by your doctor and stay for a minimum of one night after your medical procedure. You’re considered an inpatient from the day you are admitted to the day you’re discharged.
Usually, inpatient care is given at a hospital. The hospital can either be a non-profit, for-profit, or state or local government facility — all of which have different price points (more on that below).
What is outpatient care, and which facilities provide it?
If you are cleared to leave the facility on the same day you have your procedure, you’re considered an outpatient. However, some people who get outpatient services can stay overnight, especially if they need to be observed for complications.
Outpatient care facilities include ambulatory surgery centers, hospital outpatient centers, and perhaps surprisingly, hospitals. Some outpatient services are done at a primary physician’s office, too.
It’s important to note that a facility being inpatient vs. outpatient doesn’t affect the quality of care. As long as it’s an accredited facility with board-certified, experienced doctors, the quality of care you receive should be the same.
Can you choose between inpatient and outpatient care?
It depends on your overall health, as well as the medical procedure you need. More and more procedures can be done at outpatient facilities but you’ll need to check with your doctor to see if outpatient care is an option for you.
What is the cost difference between inpatient and outpatient care?
A survey done by the Centers for Disease Control (CDC), found that, “in 2014, outpatient surgeries constituted 65.9% of total surgeries.” That number is steadily rising as more and more outpatient surgery centers open. But is there a significant cost difference for patients, depending on whether they have a procedure as an inpatient or outpatient?
Good question. The reality is that there are many factors that affect cost, even within the context of which facility you go to.
Overall, it makes sense that inpatient care would be more expensive because there are more costs associated with an overnight stay in the hospital. But it’s not exactly that cut and dry.
Let’s take a look at which factors affect the cost between facilities:
- Which type of facility you go to — Ambulatory surgery centers and physicians offices require less overhead than hospitals do. This can translate into lower medical procedure costs for you. Hospitals tend to cost more, depending on where they’re located.
- Whether you stay overnight in a hospital and how that stay is classified — You generally won’t stay overnight at an ambulatory surgery center or a doctor’s office. But since you can get both types of care at a hospital, cost boils down to whether your doctor admits you as an inpatient vs. outpatient, and which one your hospital bills you for.
- Whether they are in-network or not — Of course, whether a facility is in- or out-of-network can really impact the cost. In-network facilities will almost always cost less than those that haven’t negotiated a rate with your insurance company.
- The billing rate for your insurance company — Some insurance plans cover inpatient and outpatient care at the same rate. Others charge different rates for each. Depending on your copay, deductible, and coinsurance, this could add up to a lot of money saved — or spent.
Inpatient vs. outpatient as a Medicare patient
The type of insurance you have can make a big difference in the cost of care. In fact, an article published at StatNews highlights that people with Medicare could pay higher rates for outpatient care. “People entitled to benefits under Medicare who had heart stents inserted as outpatients faced hospital bills that were $645 higher on average than those who had the same kind of procedure as inpatients, the Health and Human Services inspector general has found.
The billing discrepancies stem partly from Medicare’s complicated design. Beneficiaries pay a deductible for inpatient care, currently $1,288 per stay. Outpatient care is billed differently, with beneficiaries responsible for 20 percent of the cost of services, after a small deductible.” Medicare does outline its definition of each but there’s still not a lot of confidence about what a patient will have to pay.
There’s a reason people are confused about the difference between inpatient and outpatient care. Thankfully, there are plenty of ways to navigate the system and ensure you’re getting a fair price:
- Contact your insurance company and find out what the billed rate is for inpatient and outpatient care
- Always check to see if a facility is in-network before receiving care
- Look for outpatient facilities when possible
- If you get a high medical bill, you can ask the hospital to check which codes they used to classify your stay
- If you’re on Medicare, be sure to address any billing discrepancies you find
- If you have a high deductible health plan or are going to pay for your medical procedure out-of-pocket, you can save 40-80% with Patient Assist.
It’s time to stop paying more than you should for medical procedures
In-network, out-of-network. Inpatient, outpatient. The ins and outs of healthcare costs are confusing. New Choice Health advocates for you, letting you compare cost and facilities, save money, and get high-quality care. Use New Choice Health now!
Worried about how you’re going to afford care? Learn more about New Choice Health’s Patient Assist program now!