How hospitals work: when you are admitted

Outpatient and Inpatient Services

Hospitals today provide both outpatient and inpatient services. 

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 Surgical Inpatient Services include:

• Total knee or hip replacement
• Spine surgery
• Tumor removal
• Emergency surgery (appendectomy for appendicitis, trauma from motor vehicle accident)

Some examples of Non-Surgical Inpatient Services include:

• Heart attack (the medical term of which is a myocardial infarction or MI for short)
• Stroke
• Pneumonia
• 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

Additionally, 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.  

Admitting

There are four 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, the term ‘elective’ in this context refers to 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. an 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 symptom (e.g., pain, difficulty breathing, bleeding). 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).

With Alight’s healthcare navigation services, our Health Pro consultants can assist you in reviewing your bills after a hospital stay to make sure you are charged correctly.