A shift from In-Patient to Ambulatory Care
The healthcare system has been revolutionized because of the transition from in-patient to out-patient to ambulatory care.
Author: Dr. Shruti
Health System is defined as the organization and its resource and people target population to deliver the healthcare services to meet their health needs. That’s why it is called a healthcare system. It is comprised of many levels such as primary, secondary, tertiary and quaternary based on the complexities of diseases. The healthcare system has been revolutionized because of the transition from in-patient to out-patient to ambulatory care.
Ambulatory care is a vastly growing segment. It is one of the components of out-patient care. Out-patient has many segments such as-
- Emergency department
- Specialty clinics
- Imaging
- Primary care clinics
- Community health clinics
- Ambulatory centers
Ambulatory care is performing procedures on the patient without admitting them or same-day discharge which is much convenient to the patients. Many surveys and studies were done in the past have shown the benefits of this care and still, they are areas yet to be researched. This shift from IP to OP and ambulatory care settings has also boosted the revenue or the economy part. Several factors played an important role in this transition or shift.
First and foremost is the technology and innovation, due to advancements in the techniques many procedures can be done in these ambulatory care settings.
- Advancements in the technique of giving anesthesia and minimally invasive surgeries led to these centers being more convenient. The list of procedures is as follows-
- Cataract Surgery
- Lithotripsy
- Endoscopy
- Colonoscopy
- Sinus Surgery
- ACL (Anterior Cruciate Ligament) surgery
- Tonsillectomy
- Knee Replacements
- Laparoscopic Surgery
- Robotic Surgery
- Few cardiac surgeries such as catheterization, PCI (percutaneous coronary intervention), stent, and coronary angioplasties.
- Kidney treatment
- Adoption of mHealth – mHealth is mobile health. It is helping in remote monitoring of the patient with the help of various applications or portals where the patient’s vitals or anything the doctor wants to monitor can be monitored easily.
- Telemedicine – Telemedicine is a boom in today’s pandemic era where we can’t visit hospitals very often. It helps in monitoring the patient’s health virtually through video or tele call where a patient can connect with a doctor being at home. It helps in reducing the cost of travel, traveling time, OOPE (out-of-pocket expenditure of the patient and his family). It cuts down the major of distance by connecting any patient to any doctor PAN India or PAN World.
- Hybrid rooms – These are special rooms that are set up to perform multiple procedures under single anesthesia.
- EHR – It is electronic health records. It helps in maintaining records digitally with ease.
The second most important factor is cost. Costs of procedures are comparatively less or less expensive in nature due to less staff or resources, hybrid rooms, less duration of stay at the centers. It helps in reducing OOPE as well. Also in this pandemic era, where patients are much scared in visiting hospitals, this limits their duration of stay at the hospital.
The third factor is convenience. These centers are benefitting a local community by being accessible to them. Also due to no admission, the patient feels more satisfied and convenient in this pandemic. In short, these centers satisfy consumer demand by improving access, reducing cost, better experience due to less stay and efficient care.
The fourth important factor is incentives. A company like Medicare gives incentive in finding out these centers. Also, they are reimbursing the procedures done in ambulatory settings as well as telemedicine.
The fifth factor is opportunity to healthcare providers. They give incentives to doctors who carry out these procedures in ambulatory settings as it helps in reducing the spread of infection in this era.
The sixth factor is competition among hospitals. Competition among hospitals helps in strengthening ambulatory care as they compete to add services that are cost-efficient to attract more patients to their center.
The transition is pretty good for consumers as it lowers costs by improving access and giving complete satisfaction and convenience. Still, there is a need to strategize to avoid any issues. Previously, most revenue comes out from IP or in-patient care but now it has got shifted to OP or out-patient and ambulatory care. But these ambulatory care settings are not appropriate for complex procedures or patients with co-morbidities. Another challenge that comes up is the location which seems inconvenient to some which delay the acceptance of ambulatory care settings. Another challenge that comes up is sometimes patient’s demand to satisfy services free of cost, to make them understand, transparency is the rule which can be followed. They should tell patients transparently the cost in comparison to in-patient settings. In short, patients and providers have to be the decision-maker.
To establish these centers more efficiently, payers should discuss everything with healthcare providers so that everything can be under their guidance. Also, help these new centers to assure quality and safety which can help in promoting these centers also efficiently.
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