MMHA 6050 Week 3 Hospital and Ambulatory Comparison Example

Hospital and Ambulatory Care Compared on Access, Cost and Quality, With the Criteria Defined First

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Walden University

MMHA 6050: Delivery of Healthcare

Instructor Name

Month Day, Year

Hospital and Ambulatory Care Compared on Access, Cost and Quality, With the Criteria Defined First

Criteria

This paper compares inpatient hospital care and ambulatory care on three criteria, defined before either sector is discussed so that each judgment can be traced to a standard. Access means whether people can obtain care when they need it, measured by hours of availability, geographic reach and whether a person can be seen without an appointment or referral. Cost means spending per comparable episode of care, the total paid by insurers and patients for treating the same condition. Quality means outcomes and safety for comparable patients, measured by indicators such as complications, appropriate treatment and preventive services delivered. A sector that scores well on one criterion may score poorly on another, and the comparison keeps them separate.

The Two Sectors

The inpatient hospital is defined by overnight care and intensive resources: operating rooms, intensive care units, round-the-clock nursing and the specialists and equipment needed for serious illness and major surgery. Ambulatory care covers everything delivered without an overnight stay, from physician offices and hospital outpatient departments to surgery centers, urgent care and retail clinics (Shi & Singh, 2022). The two overlap at the edges: an emergency department is part of a hospital but treats most patients without admitting them, and many surgeries once done as inpatient stays are now done in outpatient settings.

Access

On access, the two sectors differ in kind. Hospitals offer the widest hours, since emergency departments are open around the clock, and the broadest capability, since they can treat almost anything. But geographic reach is limited where hospitals have closed, and access to an emergency department is not access to ongoing care. Ambulatory care offers broader geographic reach, with many more sites, and convenience for routine needs, especially where urgent care and retail clinics offer evening and weekend hours without appointments. Its limits are capability, since an ambulatory site cannot manage serious illness, and, for physician offices, appointment availability. For the needs most people have most of the time, ambulatory care offers better access; for serious illness, only hospitals offer access at all.

Cost

On cost per comparable episode, ambulatory settings are generally lower. A study of three common illnesses found that care for episodes beginning at retail clinics cost $110 on average, compared with $166 at physician offices, $156 at urgent care centers and $570 at emergency departments (Mehrotra et al., 2009). For surgery, Munnich and Parente estimated that the same procedures ran roughly half an hour shorter in surgery centers than in hospital settings, lowering cost and freeing capacity (Munnich & Parente, 2014). The cost advantage reflects lower overhead, since ambulatory sites do not carry the fixed costs of round-the-clock emergency and intensive care. But the comparison holds only for comparable episodes: patients with serious illness cannot be treated more cheaply in an ambulatory setting because they cannot be treated there at all.

Quality

On quality, the evidence is more mixed and depends on what is measured. In the retail clinic study, aggregate quality scores were similar across retail clinics, physician offices and urgent care, and lower in emergency departments, for the same three illnesses (Mehrotra et al., 2009). For conditions that need inpatient care, hospitals are the only setting where quality can be measured at all. The Institute of Medicine's six aims for quality apply in both sectors (Institute of Medicine, 2001), but each sector faces different risks: hospitals carry the risks of complex procedures and infections, while ambulatory care carries the risks of missed follow-up and fragmented information. Neither sector is simply higher quality; each is higher quality for the work it is equipped to do, and the most common quality failure is a mismatch, such as a minor illness treated in an emergency department or a deteriorating patient kept in an office setting too long.

Migration Between the Sectors

The boundary between the sectors keeps moving toward ambulatory care. Procedures that once required admission, such as many joint replacements and cataract surgeries, are now routinely done in outpatient settings. Three forces drive the shift: clinical advances in anesthesia and minimally invasive surgery, which shorten recovery; payment, since payers pay less for the same procedure in lower-cost settings; and patient preference for avoiding hospital stays. Migration means that comparisons between the sectors must be updated, because the case mix of each changes as simpler cases leave the hospital, leaving it with sicker patients and higher average costs per case.

Access Within Ambulatory Care

Ambulatory care is not one access point but several, and they differ in who they serve well. Physician offices offer continuity, the same clinician over time, but often require appointments days or weeks ahead. Community health centers see patients whether or not they can pay, extending access to uninsured and Medicaid patients who may struggle to find other practices. Urgent care and retail clinics offer walk-in access in the evening and on weekends, but little continuity and a narrow scope. Telehealth adds access without travel; one study found that most direct-to-consumer telehealth visits for respiratory illness represented new use rather than replacing other visits (Ashwood et al., 2017), which suggests it reaches people who would otherwise have gone without care, though it also adds to spending. A patient's access to ambulatory care therefore depends on which ambulatory setting is available to them, and on their insurance.

Summary Judgment

On access, ambulatory care is better for common needs and hospitals are essential for serious ones. On cost per comparable episode, ambulatory care is generally lower, with evidence from both common illnesses and surgery. On quality, the evidence does not favor either sector overall, and the comparison depends on matching the setting to the patient's needs. The practical conclusion for a health administrator is not that one sector is better overall, since the evidence does not support that, but that care should be delivered in the least intensive setting that can provide it safely, and that the seams between the sectors, where patients move from one to the other, deserve as much management attention as either sector alone.

References

Ashwood, J. S., Mehrotra, A., Cowling, D., & Uscher-Pines, L. (2017). Direct-to-consumer telehealth may increase access to care but does not decrease spending. Health Affairs, 36(3), 485-491. https://doi.org/10.1377/hlthaff.2016.1130

Institute of Medicine. (2001). Crossing the quality chasm: A new health system for the 21st century. National Academies Press.

Mehrotra, A., Liu, H., Adams, J. L., Wang, M. C., Lave, J. R., Thygeson, N. M., Solberg, L. I., & McGlynn, E. A. (2009). Comparing costs and quality of care at retail clinics with that of other medical settings for 3 common illnesses. Annals of Internal Medicine, 151(5), 321-328. https://doi.org/10.7326/0003-4819-151-5-200909010-00006

Munnich, E. L., & Parente, S. T. (2014). Procedures take less time at ambulatory surgery centers, keeping costs down and ability to meet demand up. Health Affairs, 33(5), 764-769. https://doi.org/10.1377/hlthaff.2013.1281

Shi, L., & Singh, D. A. (2022). Delivering health care in America: A systems approach (8th ed.). Jones & Bartlett Learning.