Instructions

Reply prompt: Respond to the two discussion questions from classmates who reached a different conclusion than you did. Identify the points of difference in your analyses and explain how your sources and analysis led you to your conclusion. Replies must be at least 450 words each discussion reply. Each reply must reference at least 3 scholarly sources and follow current APA format (including both in-text citations and a reference list). You must also support each reply with thoughtful analysis (considering assumptions, analyzing implications, and comparing/contrasting concepts and include thorough biblical worldview integration.

Discussion Question #1

What is Outpatient?

The term Outpatient Service refers to any health care services that do not require an overnight stay in an institution of health care delivery (Shi & Singh 2017). Services that include outpatient care are: wellness and prevention such as rehabilitation for patients with previous heart surgery or high blood pressure, physical therapy, diagnosis and x-rays, minor surgeries, and treatment such as chemotherapy for patients with cancer. In some cases, physicians send their patients to an Outpatient setting for lab tests such as blood work and urine test. Some employers send their job candidates to an outpatient setting for drug tests for employment. The shift toward outpatient care is expected to continue (Shi & Singh 2017). The growth of non-hospital-based outpatient services has intensified competition for outpatient medical services between hospitals and community-based providers (Shi & Singh 2017). Competition includes medical services such as urgent care clinics, home health care and outpatient surgery. I remember learning about outpatient care at a very young age. When I was admitted into surgery, I thought I was going to stay overnight but the procedure I had done was only two small incisions. I received further instructions on how to manage myself at home until I was completely healed. As for inpatient stay, I stayed overnight when I delivered a baby. Overnight stay while under inpatient care requires close monitoring so that physicians can monitor the progression of the health status of the patient. 

Key Factors

Several key changes have been instrumental in shifting the balance between inpatient and outpatient services (Shi & Singh 2017). These four factors are utilization control factors, social factors, reimbursement, and technological factors. New technology and equipment that were used in inpatient services have been effective in treatment procedures and diagnostics. Shorter acting anesthetics and the proliferation of minimally invasive technologies have made surgical procedures less traumatic and require much shorter recovery times (Shi & Singh 2017). Reimbursement factors are effective in outpatient vs inpatient care because inpatient care are more costly than outpatient health care services. Stay for patients are minimized. Social factors include patient’s preference to receive health care service in home and at community based settings (Shi 2017).  Lastly, utilization control factors are used by medical physicians close monitoring of patients during hospitalization.

Shi, L., & Singh, D. A., (2017). Essentials of the U.S. Health Care System. (4th ed.). Burlington, MA. Jones & Barlett.

Discussion Question #2

In the past outpatient care was when a physician would make a home visit to treat patients.  Now, outpatient care includes more than just primary care, there are a variety of new services that are included in outpatient care. Outpatient care can be interchanged with ambulatory, and it can be defined as “diagnostic and therapeutic services and treatments provided to the walking patient (Shi & Singh, 2017).  The services that are provided are mobile diagnostic units and home health care is taken to the patient rather than the patient coming into the hospital or clinic. The term outpatient care refers to any health services that do not require an overnight stay in an institution of health care delivery ((Shi & Singh, 2017).  Outpatient care performs almost 53 million ambulatory procedures annually (Hollingsworth, 2014). One of the biggest expenditures in the United States is surgical care. Surgical care also represents a major source of morbidity and mortality in the United States (Hollingsworth, 2014).  The payment of outpatient care has been impacted due to the reforms under the Affordable Care Act, these reforms have been made to enhance the quality and reduce the costs of surgical care, for inpatient surgery they are able to bundle the care into a package and can encompass inpatient surgical care. By bundling the care together, the hospital is able to bill the insurance in a timely manner and ensures that the patient is receiving the care that they need to recover. By bundling the care, it can also alleviate the stress of worrying if their insurance will cover the cost of outpatient care.

There are a few factors that have been instrumental in shifting the balance between inpatient and outpatient services.  These factors include reimbursement, technological factors, utilization control factors, and social factors (Shi & Singh, 2017).  Containing outpatient healthcare spending has created a shifting influence from outpatient to inpatient care.  Controlling the cost of outpatient, and insuring that the care will be reimbursed by the insurance company, Medicare or Medicaid.  The Centers for Medicare and Medicaid Services replaces the previous system of cost-based reimbursement of outpatient services to the new system of called Outpatient Prospective Payment System (OPPS) in 2000 (He&Mellor, 2013). OPPS allows hospital outpatient services into an ambulatory payment classification that is based on clinical and cost similarity and sets a common payment classification based on clinical cost similarity and sets a standard payment rate for services in a clinic with an ambulatory payment classification. Ensuring that patients are able to get the best care they can, and that those clinics receive their payments.

            It is important for hospital administrators to administrators to utilize outpatient care, because it can free up resources in the hospital and send their ambulatory patients to specialized physicians within their network or who are used on a regular basis. With the shift to outpatient care, administrators can utilize this by helping keep their patients happy by allowing them to stay in their homes and that gives them a “strong sense of independence and control over their lives (Shi & Singh, 2017).”  Giving patients the ability to not have to travel long distances or be away from their home, can help speed their recovery because there is less stress for them to attain the care they need. By using outpatient care, administrators are able to utilize specialized care that may not be provided at the hospital. Outpatient care, utilized correctly, will improve patient care overall. Ensuring that patients can receive their care and not have to stay at a hospital for extended periods of time, can help them recover faster and create less stress for the patient.    

Reference

Hollingsworth, J & Birkmeyer, J. & Zaojun, Y. & Miller, D. (2014). Specialty-Specific Trends in            the Prevalence and Distrution of Outpatient Surgery. Surgical Innovation. 21(6), 560-            565.http://journals.sagepub.com.ezproxy.liberty.edu/doi/full/10.1177/1553350613520515            #articleCitationDownloadContainer

He, D. & Mellor, J. (2013). Do Changes in Hospital outpatient Payments affect the setting of       care? Health Services Research. 48(5) pp   1593. http://dx.doi.org.ezproxy.liberty.edu/10.1111/1475-6773.12069

Shi, L., & Singh, D. (2017). Essentials of   the U.S. Health Care System (Fourth ed.).Burlington,             MA: Jones & Bartlett Learning.