Inpatient or outpatient? Set consistent definitions so that costs are clear

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It seems as if it should be pretty easy to figure out whether a person being treated at a hospital is an inpatient or an outpatient. It seems logical, for example, that a person who’s been moved out of an emergency room and kept overnight in a hospital bed would be considered an inpatient.

But it’s a lot more complicated than that, like too many things in medical care. To compound the confusion, even the hospital doesn’t always know whether a patient’s treatment will be considered inpatient or not.

The technicality matters because the designation controls how much patients must put out for co-payments, testing and treatment, and it has implications on coverage for anyone who enters a skilled care or nursing home facility for follow-up care.

Pity the patients.

In an attempt to help them, state Rep. Stan Saylor, a York Republican, has introduced House Bill 1907, a consumer-friendly approach that would require hospitals to tell people whether they are being treated as admitted patients or are being cared for under what the medical community calls “observation.” He has enlisted cosponsors on both sides of the political aisle, including Democrat Dan Frankel of Squirrel Hill.

But what sounds like a solution won’t solve the whole problem. The determinations often are made by health insurance providers after the fact, leaving patients on the hook for costs they could not reasonably have expected at the time they were being treated. If they don’t pay, hospitals can end up on the short end, too.

The Hospital Council of Western Pennsylvania has a better idea: Establish a clear, consistent definition of what distinguishes an outpatient under observation from an admitted inpatient and make the rule apply to all insurers. Only then will patients, hospitals and health insurance providers be on the same page, and only then will patients know in advance how much their treatment may end up costing them.


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