How Shifting to Outpatient Care Can Save Money for Consumers?

Recently, we have been witnessing a swift rise in outpatient care services. Outpatient care has become quite effective due to modern medical expertise like minimally invasive surgical capabilities, latest anesthesia methods, pain management procedures and provider engagement software. This help avoids potential medical complications and enables patients to get back to homes swiftly. Modern patient care software also helps healthcare providers monitor patients after their discharge.

Inpatient vs. Outpatient Care

Inpatient and outpatient care refer to the way that a healthcare service is provided. Inpatient care refers to medical services that require you to get admitted into a hospital. Such care usually involves serious ailments and trauma that requires a day or more of stay at the hospital.

Outpatient care is the medical service received when you are not required to stay back at a hospital. This includes routine checkups or clinic visits and simple surgical procedures that allow you to leave the hospital on the same day. 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.

So how do consumers save money if they shift to outpatient care? Let's take a look at a health report released by the Blue Cross Blue Shield Association and the Blue Health Intelligence. Their researchers applied advanced analytics to the medical claims database to analyze market developments and the affordability regarding healthcare measures.

The researchers scrutinized four procedures that can be carried out in either inpatient or outpatient settings. Of these, two (spine surgery/ hysterectomy and lumbar) predominantly recorded a shift towards ambulatory care and the remaining two (gallbladder removal and angioplasty) continued to remain stable through at different stages of outpatient care. The non-emergency nature of the chosen procedures gave patients the time they needed to look for healthcare professionals, consider the costs and decide on when and where they preferred to undergo the medical treatment.

Based on their report, let's consider how patient care continuum can be ensured while improving medical procedure outcomes and reducing health care costs.

1.  Outpatient Care is Cost effective

Medical procedures when performed in an outpatient setup, resulted in considerable cost savings. For instance, when patients preferred to undergo angioplasty in an outpatient setting, the saving in cost was to the extent of $1,062 /procedure as against procedure performed as an inpatient.  

The Angioplasty procedures in inpatient setup showed a steep rise. The inpatient cost for Angioplasty procedures registered 6.1 percent rise, while outpatient pricing showed a meager 1.4 percent increase over a time span of five years.

While outpatient utilization increased during the five-year study period, overall utilization did not increase - the outpatient utilization increases were offset by significant decreases in inpatient utilization.

2. Outpatient cost savings on the rise

The resultant cost savings with regard to the four procedures increased constantly, though varied significantly between inpatient and outpatient facilities. The total cost saving/procedure in 2014 was considerable ranging from $4,505 in case of hysterectomy to $17,530 as regards angioplasty. The rate of yearly cost escalation was on higher side with regard to inpatient procedures and resulted in a rising the total cost saving for outpatient procedures. The rate of escalation was influenced by various aspects including reimbursement guidelines, cost composition regarding the inpatient and outpatient system and dissimilarity in the patients’ health conditions.

3. Increase in outpatient procedure

During this study, Hysterectomies showed substantial shift towards outpatient procedures. The proportion of those medical processes raised from 36 percent to 64 percent, on the other hand the proportion of outpatient lumbar/ spine surgery raised to 82 percent from 61 percent. While, the share of Angioplasty outpatient grew marginally from 43 percent to 50 percent. On the other hand, laparoscopic gallbladder surgery continues to remain unaffected as this had shifted to outpatient by 2010 and recorded 80 percent.

4. Considerable cost savings in Hysterectomies

The outpatient procedures for hysterectomies produced authentic and raising cost savings. On average, the difference between the inpatient per-procedure cost and outpatient increased from $2,781 in 2010 to $4,505 by 2014. The patients saved up, on average, $483 out-of-pocket expenses in 2014 by opting for outpatient methods. The conventional abdominal hysterectomy, which is done in inpatient setting, continues to remain the most popular surgical method and account for nearly 50 percent of hysterectomies. But, abdominal and vaginal hysterectomies had to make way for the advanced laparoscopic and robotic-assisted laparoscopic operations, which are more compatible to outpatient setting.

5. Fall in out-of-pocket expenses in Lumbar/Spine Surgery

Regardless of mounting surgical expenses, outpatient lumbar/spine procedures showed increased savings in the cost, from an average saving per procedure of $5,269 in 2010 to $8,475 in 2014. The savings were $320 on average in out-of-pocket expenses by undertaking outpatient process. In the course of this study, lumbar/spine procedures moved to the outpatient system by just about 20 percentage points, to 82 percent from 61 percent. This shift to outpatient setting resulted due to drop in inpatient utilization by more than 50 percent. Consequently, the utilization for lumbar/spine remained unchanged, on the whole.

6. Big savings for outpatient Angioplasties

Outpatient angioplasties also gave in high cost savings in spite of modest growth of outpatient during the course of the study. The difference in procedure cost on average between outpatient and inpatient grew from $11,062 in 2010 to $17,530 in 2014. The savings in out-of-pocket expenses on an average were $1,062 by taking outpatient procedure in 2014. The ratio of outpatient angioplasty procedures grew modestly from 43 percent to 50 percent, during the study period, though overall utilization of angioplasties reduced. This was the outcome of a staff reduction in inpatient procedures, and a minor drop in outpatient operations.

7. Gallbladder procedures; outpatient savings increase

The outpatient gallbladder removals also recorded increasing cost savings in spite of having a steady ratio of outpatient procedures made in the period of study. The per-procedure cost difference between inpatient and outpatient increased on average from $8,299 in 2010 to $11,262 in 2014. The savings on average were $924 in out-of-pocket spending in an outpatient process. Most of gallbladder surgeries changed to outpatient setup because of innovative of laparoscopic procedures and modern minimally invasive technologies.

Conclusion:

Due to the advances in medical technology, treatments like minor surgeries and physical rehabilitation can be carried out as outpatient care. The utilization of Telehealth software makes the outpatient procedures even more effective.

Outpatient care provides many benefits for patients. First of all, they are able to recover in the comfort of their own home while enjoying their own food rather than the hospital food. They can also enjoy activities of their choice that does not contradict restrictions given by their healthcare provider. The patient provider communication is at the heart of outpatient procedures and contributes greatly to making the procedure very successful.  The best care will be driven through easy and convenient communications among providers, patients, caregivers, and specialists -- and a patient management and communications software platform can help with this experience.

More importantly, outpatient procedures usually cost less than the comparable inpatient procedures. Staying in a hospital even for just one night of observation isn’t cheap. Even those having good health insurance can make significant savings, of up to thousands of dollars, by opting for outpatient procedures.