Outpatient Services

Learning About Outpatient Services

What are outpatient services?

Outpatient services are medical procedures, surgeries, or tests that are done in a qualified medical center without the need for an overnight stay. For many of us, this means less time away from work and other commitments, as numerous procedures and tests can now be completed in just a few hours instead of having to spend days in a hospital. There are now a wide range of outpatient services offered, including those that focus on:

• Wellness and prevention. These services may include counseling, childbirth education and delivery, diabetes education, and nutritional counseling that often includes weight loss programs.
• Diagnosis. These are services such as imaging (for example, MRIs or CT scans) and laboratory testing (such as blood tests).
• Treatment. Types of outpatient treatment vary but can include services such as outpatient surgery, cardiac catheterization, and pain management treatments such as epidural steroid injections and acupuncture.
• Rehabilitation. These services may include physical therapy, occupational therapy, drug or alcohol rehabilitation, cardiac rehabilitation, and home care services.

What are the benefits of choosing outpatient services?

Generally, outpatient services can be cost-effective since you are not staying overnight and are not billed for separate hospitalization charges. The staff at outpatient facilities are often highly experienced in the type of service provided, because the centers usually specialize in just one type of treatment or procedure. Outpatient services can be convenient because all the care you need is often provided in one location.

Who uses outpatient services?

If the type of service is available, anyone who needs a medical procedure can choose an outpatient service center rather than a hospital. However, not all medical procedures can nor should be performed at outpatient service centers. For example, open-heart surgeries and brain surgeries are still performed in bigger hospitals, where a large number of emergency services are available should they be needed.

How do I know if the center is reputable?

The best way to find the highest-quality service is to investigate the outpatient center before the scheduled procedure. Many health and government agencies rate or report on the quality of outpatient service centers.

Keep in mind that your health insurance plan may only cover a specific outpatient facility; if so, your choice of centers may be limited to those covered by your plan.

Frequently Asked Questions

Types of Outpatient Services

Increasingly, more medical procedures are being offered in qualified outpatient service centers. A recent study indicated that almost 88 million people per year in the United States alone sought care in outpatient facilities.¹

Outpatient services are offered in numerous settings. For instance, medical schools often provide various types of outpatient services, such as pain clinics or rehabilitation centers. Other types of outpatient facilities include:

• Medical group practices.
• Outpatient clinics at hospitals or other medical facilities.
• Surgery centers.
• Imaging centers.
• Cardiac catheterization centers.
• Mental or behavioral health centers, which may provide substance abuse treatment services and mental health services for adults or adolescents.
• Laboratory centers.
• Gastrointestinal centers, which may provide screening or other services such as colonoscopy and endoscopy.
• Durable medical equipment rental facilities.

Many outpatient service centers specialize in a specific area of medicine, such as orthopedics (bones) or cardiology (heart). These centers, like many hospitals, have advanced equipment and highly trained staff.

Important Considerations

There are numerous benefits to outpatient services, depending on the type of medical procedure you need and your personal preference.

• Outpatient services can be cost-effective. Often, the procedure that you need may be less expensive at an outpatient service center than at a hospital, especially since you are not billed for separate hospital services. Outpatient service centers do not require an overnight stay, which can reduce costs.
• The staff usually has a great deal of experience that is focused on the procedure you need. Since outpatient service centers usually specialize in one type of treatment or procedure, the staff is highly experienced in the type of service offered. The equipment and techniques used may also be the most advanced.
• Outpatient services may be more convenient for you. All of the care that you need before, during, and after the procedure, surgery, or test may be conveniently provided in one place.

When choosing an outpatient facility, consider:

• The reputation and quality of the center. What do you know about the care offered by the facility? Learning about the particular center before the procedure may prevent you from receiving poor care. For more information about determining the quality of an outpatient facility, see the Quality of Outpatient Services section on this topic.
• The center's ability to access emergency equipment. Does the center have all of the possible equipment and knowledge it needs to treat you in case of an emergency during your procedure, test, or surgery—such as unexpected problems with anesthesia during surgery or your newborn needing unexpected intensive care after delivery? If you have additional health conditions, you may be at higher risk for needing emergency care.
• The center's level of follow-up care. Do you know if the center offers follow-up care or has designated someone to care for you after the procedure, surgery, or test? Will you receive clear, written instructions on how to care for yourself after your visit? Follow-up care can be an important part of appropriate health care.
• The center's location. Is the facility close enough that if you need to return for additional care, you can get there without too much inconvenience? Is there a center located closer to you that offers the same service?
• The type of communication that will be available to your health professional. Will the facility send all test results and reports to your doctor? If a center does not communicate well, it will be a struggle to get helpful information to your doctor. Talk with your doctor and others who have used the center to determine whether the staff will communicate well with you and your doctor.
• Your insurance coverage. Does your health plan provide coverage for the particular outpatient service center? It is possible that your health care coverage will dictate where you can obtain care. Check with your provider to understand your options. If the center is not covered, you risk having to pay for the services.

Quality of Outpatient Services

While most outpatient service centers are accredited and approved for the types of treatment offered, not all centers provide care that is right for you. It is important to determine whether the provider you're considering is reputable and qualified. The following government and health agencies can help you learn about the quality of outpatient service centers:

• Quality Check, which is a service of the Joint Commission on Accreditation of Healthcare Organizations. You can contact this organization by phone at (630) 792-5800 or online at www.jcaho.org.
• Your state's board of medicine. Every state in the United States has a state board of medicine that regulates complaints against medical facilities and health professionals. Although this agency will not reveal the details about any facility or individual, you can find out if there have been complaints filed against a facility or health professional. You can locate your state board of medicine through the local telephone directory or by going online and searching for "Board of Medicine" for your particular state.
• The Commission on Office Laboratory Accreditation for Immunohematology, which oversees the accreditation for laboratories and testing centers. Information from this agency can be obtained through their Web site at www.cola.org.
• The American Osteopathic Association, an agency that monitors approval of professional services by osteopathic physicians. You can find this agency through your local telephone directory, online at www.osteopathic.org, or by contacting the Centers for Disease Control and Prevention (CDC) at www.cdc.gov.
• Your HMO, PPO, or insurance carrier, which may also be able to provide information about outpatient service centers because many keep quality indicator records for health professionals and facilities in your local area.

Finding the Right Provider

It is important to check with your HMO, PPO, or health insurance provider to determine whether outpatient services are covered. Your particular health plan coverage may limit your choice of services.

Selecting a quality outpatient center prior to having a medical procedure is the best way to ensure that you'll receive excellent care. Friends and family who have used outpatient services may tell you about their personal experiences. Often, your health professional will know about the quality of outpatient services in your area. You may want to begin your search by discussing your options with your health professional. Next, verify which outpatient services are covered by your insurance company. The following questions may help you find the outpatient service center that best fits your needs:

• Does the facility accept your health insurance, HMO, or PPO coverage? Does your insurance cover all of the costs you expect to be charged?
• Is the outpatient service center conveniently located or within a reasonable distance of your home or work?
• Is more than one facility in your area qualified to provide the service you need?
• Will the facility communicate well with your doctor and provide needed information in a timely manner? Can your doctor verify the accuracy of any tests taken?
• Is the outpatient service center accredited by a national medical board or other recognized agency? You can obtain this information by calling your state medical board or the Joint Commission on Accreditation of Healthcare Organizations. For more information, see the Quality of Outpatient Services section of this topic.
• Is the facility clean, organized, comfortable, and private? You'll need to visit the facility for this information. You may want to ask the facility or others who have used the facility if the recovery room is well-staffed. Is there a waiting room for your family?
• Is information readily available to you? Will you receive instructions before, during, and after a procedure or test?
• Are brochures or literature available that explain the outpatient center's services and fees? Does the facility provide information on financial assistance?
• Do you have other health conditions that should be considered? Can the facility accommodate treating your other conditions if needed? Does your doctor think there is a risk that you may need specialized attention or emergency services during the procedure?
• Can you obtain all the care you need at the facility? Will the center provide all the medications or other treatment needed? Will you have to go somewhere else for follow-up care?
• What kind of experience does the staff have? How long has the outpatient service center been operating? What are the specialties of the health professionals providing the care? Are they board-certified in their specialty areas?

You may have additional questions based on your own health issues and the type of procedure or test you need. Asking questions, listening to the recommendation of your health professional and those you trust, and visiting the facility can provide the information you need to make the best decision for your health care.

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