Prioritizing outpatients over inpatients for procedures

It is a fairly common practice to prioritize outpatients over inpatients in hospitals where procedures are performed. The justification is fairly simplistic. After all, an outpatient has been inconvenienced by requiring them to come to the hospital for the procedure. Perhaps they have taken a day off from work. It is extremely infuriating if an outpatient is told, after waiting a good portion of the day, to come back the next day or another time for their non emergent procedure. Patient satisfaction scores take a huge hit if this is a routine occurrence.

As the number of ACO attributed lives increases and hospitals are looking into accepting risk based contracts, does this logic still hold?

By prioritizing an outpatient over an inpatient, especially those in an ICU, you run the risk of increasing length of stay. This translates to $4,000 - $10,000 of increased cost per day. Aren't you better off compensating an outpatient for their inconvenience? A $1,000 or $1,500 check will go a long way towards minimizing the negative perceptions of the outpatient. Instead of trying to optimize locally for a center that performs procedures, it is time to think about downstream impacts and optimize globally at the system level.