Hospital patients in outpatient settings are sicker, poorer

Medicare patients who receive hospital outpatient care are more likely to be poorer and have more severe chronic conditions compared to those treated in an independent physician office, according to a study commissioned by the American Hospital Association. Findings were also similar among Medicare cancer patients, according to the study.

Medicare patients, including cancer patients, who were seen in a hospital outpatient department (HOPD) were more likely to be from lower-income areas, under 65, burdened with more severe chronic conditions, previously hospitalized, dually eligible for Medicare and Medicaid, and previously cared for in an emergency department.

Medicare currently reimburses different sites of care for the same service depending on where a patient received care.

According to AHA, the findings underscore why some newly proposed rules could put patients at risk by reimbursing hospitals the same amount as physician offices.

“America’s hospitals and health systems are proud to provide care and emergency services 24/7 to all who come through the door regardless of their ability to pay,” AHA President and CEO Rick Pollack said in a statement. “But as this study clearly shows, the needs of the patients hospital outpatient departments care for each day are different from those who choose to be seen at an independent physician office. Proposals that treat them the same ignore the very different clinical and regulatory demands hospitals face and could threaten access to care.” 

The study, which was conducted by KNG Health Consulting for the AHA, looked at Medicare inpatient, outpatient, and carrier standard analytical files and denominator files from 2010 to 2016 to analyze how patients between settings differ in demographics and socioeconomic status, severity of comorbid conditions and prior healthcare utilization.

Overall, Medicare patients served in HOPD settings required a greater level of care as a result of their higher complexity.