Hospital Outpatient Departments Treat Sicker, Poorer Patients

Hospital outpatient departments (HOPDs) treat sicker and poorer patients than do physician offices, according to a new study. Prepared for the American Hospital Association, the study aimed to determine whether there were differences in patient demographics or care between HOPDs and physician offices. Compared with patients treated in physician offices, those treated in HOPDs are:

• 2.5 times more likely to be on Medicaid, to self-pay or to rely on charity. In HOPDs, 37 percent of patients are on Medicaid, self-pay or rely on charity compared with 14 percent in physician offices.

• 1.8 times more likely to be eligible for both Medicare and Medicaid. Dual-eligible patients are among the sickest and poorest individuals, and their care often is fragmented. In HOPDs, 2.5 percent of patients are dual eligible compared with 1.4 percent in physician offices.

• 1.8 times more likely to live in high-poverty areas (nonmetro areas with a poverty rate of 20 percent or more). In HOPDs, 22 percent of patients live in high-poverty areas compared with 12 percent in physician offices.

The study’s assessment of patient severity and complexity found that patients in HOPDs have:

• more severe chronic conditions than those in physician offices

• higher prior emergency department and prior acute care use

Finally, the study found that the delivery of care varies between HOPDs and physician offices. Care provided to patients in HOPDs:

• is more likely to involve a nurse in addition to a physician

• includes more services ordered or provided and involves more health education. www.aha.org