Term
| OUTPATIENT SERVICES: Reasons for growth |
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Definition
- Changes in reimbursement constraining inpatient services and favoring outpatient services.
- Utilization controls—managed care
- Development of new technology.
- Social factors
CUDS |
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Term
| OUTPATIENT SERVICES: Reasons for growth - - Changes in reimbursement constraining inpatient services and favoring outpatient services. |
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Definition
• Few payment restrictions in outpatient services: surgeries, chemotherapy, dialysis—paid as fee-for-service
----Two main agents of change:
• Medicare—PPS reimbursement based on DRGs; fixed rate per admission; “quicker and sicker” discharges; coverage of home health
• Managed care—capitation |
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Term
| OUTPATIENT SERVICES: Reasons for growth - - Development of new technology. |
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Definition
| • Less invasive procedures enable quicker recuperation from surgery. Patients often do not need to be hospitalized for routine surgery |
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Term
| OUTPATIENT SERVICES: Reasons for growth - Utilization controls—managed care |
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Definition
• Prior authorization (precertification)
• Utilization review
• Quicker discharge
• Restrictions on utilization
PUQR |
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Term
| OUTPATIENT SERVICES: Reasons for growth - Social factors |
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Definition
| • Preference for obtaining services at home or in community-based settings—especially true for long-term care |
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Term
HOSPITAL OUTPATIENT DEPARTMENTS
Hospitals have been in a competitive position to develop outpatient services. Why? |
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Definition
1. Financial ability to adopt new technology
2. Excess (unutilized) capacity
3. Best equipped to provide emergency care
4. Physical ability to provide appropriate facilities (operating rooms, recuperation rooms)
FEBP |
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Term
HOSPITAL OUTPATIENT DEPARTMENTS
Hospitals have been in a competitive position to develop outpatient services. Advantages |
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Definition
• Continuum of services: “One-stop shopping” for managed care
• Significant contribution to profits
• Cross-referrals within a hospital’s own network
CSC |
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Term
OUTPATIENT CARE SETTINGS
• Private practice (shift from independent solo practice to group practice, institutional employment) - Advantages to physicians: |
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Definition
• Lower operating costs (startup, sharing of overhead, equipment, diagnostics)
• Greater opportunities to contract with managed care |
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Term
OUTPATIENT CARE SETTINGS
• Private practice (shift from independent solo practice to group practice, institutional employment) - Advantages to patients: |
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Definition
• Most routine services available at one place
• Hospital-based:
• Cross-referrals |
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Term
| Five main types of hospital outpatient services: |
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Definition
1. Clinical services—specialist consultations
2. Home health care
3. Emergency services for acute conditions
4. Women’s health centers
5. Surgical services
CHEWS |
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Term
| Five main types of hospital outpatient services: Emergency services for acute conditions |
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Definition
• Nonurgent, nonemergency—misuse of emergency departments, but used mainly by the uninsured as a substitute for primary care
• Emergent—require immediate attention
• Urgent—attention within a few hours |
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Term
| Five main types of hospital outpatient services: |
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Definition
• Freestanding facilities—walk-in clinics, urgi-centers, surgi-centers
• Greater proportion of women in the population
• Women are the major users of health care
• Mobile medical services—ambulance, EMT, and paramedics
• Diagnostic vans—X-ray, MRI Service vans, eye and dental care
• Unique healthcare needs that were previously ignored
MUD FGW |
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Term
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Definition
| Complements informal care provided at home by family members with professional services available in adult day care centers during the day. |
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Term
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Definition
| Refers to nontraditional approaches and includes the broad domain of all health care resources— other than those intrinsic to biomedicine—to which people have recourse. Examples include homeopathy, herbal formulas, use of other natural products as preventive and treatment agents, and acupuncture. |
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Term
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Definition
Refers to outpatient services. It includes
(1) care rendered to patients who come to physicians’ offices, outpatient departments of hospitals, and health centers to receive care;
(2) outpatient services intended to serve the surrounding community (community medicine); and
(3) certain services that are transported to the patient.
COC |
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Term
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Definition
| Provides coordination and referral among a variety of healthcare services. The objective is to find the most appropriate setting to meet a patient’s healthcare needs. |
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Term
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Definition
| Public health programs specifically designed to address certain categories of disease or serve specific categories of persons. |
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Term
| Community health center (CHC) |
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Definition
| Local, non-profit, community-owned health care providers serving low-income and medically-underserved communities. |
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Term
| Community-oriented primary care (COPC) |
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Definition
| Incorporates the elements of good primary care delivery and adds to this a population-based approach to identifying and addressing community health problems. |
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Term
| Complementary and alternative medicine (CAM) |
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Definition
| the broad domain of all health care resources other than those intrinsic to biomedicine to which people have recourse (e.g., homeopathy, herbal formulas, use of other natural products as preventive and treatment agents, acupuncture, meditation, yoga exercises, biofeedback, and spiritual guidance or prayer) |
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Term
| Durable medical equipment (DME) |
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Definition
| Includes certain medical supplies and equipment, such as ostomy supplies, hospital beds, oxygen tanks, walkers, and wheelchairs. |
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Term
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Definition
| Require immediate medical attention; time delay is harmful to patient; and the disorder is acute and potentially threatening to life or function. |
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Term
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Definition
| A general ambulatory care center serving primarily the poor and the homeless who may live next to affluent neighborhoods. Free clinics are staffed predominantly by trained volunteers, and care is given free or at a nominal charge. |
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Term
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Definition
| The care coordination role of a primary care practitioner. It implies that patients do not visit specialists without referral from the primary care physician, who functions as the gatekeeper. It is not designed to be a controlling mechanism to deny people necessary care. It is designed to protect patients from unnecessary procedures and overtreatment. |
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Term
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Definition
| Includes various types of services that are brought to the patients in their own homes. Such patients are generally unable to leave their homes safely to get the care they need. |
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Term
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Definition
| Refers to a cluster of comprehensive services that address the special needs of dying persons and their families. It blends medical, spiritual, legal, financial, and family-support services. Services are taken to patients and their families wherever they happen to be located. |
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Term
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Definition
| Illness or injury is any complication that is caused by the process of health care. |
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Term
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Definition
| A designation determined by the federal government. It indicates a dearth of primary care providers and delivery settings, as well as poor health indicators of the populace. The majority of this population group are Medicaid recipients. |
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Term
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Definition
| Do not require the resources of an emergency service, and disorder is nonacute or minor in severity. |
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Term
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Definition
| Include any healthcare services that are not provided on the basis of an overnight stay in which room and board costs are incurred. The term is synonymous with “ambulatory care.” |
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Term
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Definition
| Provides telephone access to bring expert opinion and advice to the patient, especially during the hours when physicians’ offices are generally closed. |
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Term
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Definition
| Essential health care that constitutes the first level of contact by a patient with the health delivery system and the first element of a continuing healthcare process. |
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Term
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Definition
| Includes routine hospitalization, routine surgery, and specialized outpatient care, such as consultation with specialists. Compared to primary care, these services are usually short-term in nature and more complex, involving advanced diagnostic and therapeutic procedures. |
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Term
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Definition
| Freestanding ambulatory surgery centers independent of hospitals. They usually provide a full range of services for the types of surgery that can be performed on an outpatient basis and that do not require overnight hospitalization. |
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Term
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Definition
| Refers to a telephone call-in system staffed by specially trained nurses who receive patients’ calls. Using a computer system, they can access a patient’s medical history and view the most recent radiology and laboratory test results. The nurses use standardized protocols to guide them in dealing with the patient’s problem and consult with primary care physicians when necessary. If necessary, the staff can direct patients to appropriate medical services such as an ED or a physician’s office. |
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Term
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Definition
| Constitutes the most complex level of care. Typically, tertiary care is institution-based, highly specialized, and highly technological. Examples include burn treatment, transplantation, and coronary artery bypass surgery. |
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Term
HOSPITAL
Legal description: |
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Definition
• Provides diagnosis and treatment
• Licensed by state
• Organized physician staff
• Nursing care under the supervision of RNs
• Minimum 6 beds
PLONM |
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Term
HOSPITAL
Other applications used today |
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Definition
• Medical Center—offers a wide array of specialized services
• Health System—covers a large geographic area with a variety of facilities such as satellite |
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Term
| EVOLUTION OF HOSPITALS Five stages: |
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Definition
1. Hospitals built specifically to care for the sick
2. Institutions of social welfare
3. Institutions of medical practice
4. Institutions of medical training
5. Institutions of health service consolidation
HIIII |
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Term
EVOLUTION OF HOSPITALS Five stages:
Hospitals built specifically to care for the sick |
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Definition
• Subsequently, hospitals built to serve the general public were voluntary (nongovernment), financed by rich philanthropists
• Hospitals opened in Philadelphia, New York, and Boston were the most prominent
• Europe—started by religious orders, later converted to public
• Many of the early hospitals were unsanitary, unventilated, had unskilled staff, and were dreaded as “houses of death”
• Initially, an extension of the above public institutions, although almshouses often continued to exist side by side
• Control in the hands of the boards
SHEMIC |
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Term
EVOLUTION OF HOSPITALS Five stages:
Institutions of social welfare |
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Definition
• charity function
• almshouses and pesthouses
• public (government) institutions
• more a custodial or isolation function—rudimentary medical function
CAPM |
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Term
EVOLUTION OF HOSPITALS Five stages:
Institutions of medical practice |
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Definition
• Science and technology—anesthesia, germ theory of disease (antiseptic, sterilization), X-ray
• Physicians started many of the first proprietary hospitals, generally required financing from private donors
• Inpatient treatment began to be restricted to the acute phase of illness |
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Term
EVOLUTION OF HOSPITALS Five stages:
Institutions of medical training |
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Definition
• Hospital experience became necessary for physicians
• Affiliations between medical schools and teaching hospitals
• Research—variety of cases with similar medical conditions were found in one place
• Many training programs for nurses were hospital-based
HARM |
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Term
EVOLUTION OF HOSPITALS Five stages:
Institutions of health service consolidation
HIIII |
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Definition
| • Diversification into nonacute services—outpatient departments, physician clinics, home health, longterm care, etc |
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Term
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Definition
- Community hospital
- General hospital
- Specialty hospital |
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Term
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Definition
• Nonfederal, short-stay (< 30 days, acute)
• Services available to the general public
• Examples of noncommunity hospitals—federal, longterm, university hospitals or prison (FLUP) |
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Term
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Definition
| • Provides a variety of services to meet the general medical needs of the community such as general and specialized medicine, general and specialized surgery, obstetrics, etc. |
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Term
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Definition
| • Admits only certain types of patients (women, children) or only patients with certain types of conditions (TB, psychiatric, rehabilitation, cardiac care) |
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Term
| Hospitals can be distinguished by:- Ownership |
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Definition
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Term
| Hospitals can be distinguished by:- Affiliation |
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Definition
| Independent, Multi-unit hospital chains (hospital systems) |
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Term
| Advantages of belonging to a chain (Hospital System) |
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Definition
• Reduced administrative overhead
• Ability to provide a wide spectrum of services
• Ability to reach a variety of markets
• Access to capital
• Access to management resources, expertise |
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Term
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Definition
Teaching hospital—have AMA-approved residency programs for physicians
Osteopathic hospital—community general hospitals operated according to osteopathic principles
Nonprofit hospitals—main characteristics, three major distinguishing features:
- Exist primarily for some public good; social function— community health, charity care, teaching, research
- Profits are not distributed to any individuals (they do not have shareholders)
- Exempt from income, sales, and property taxes— receive a subsidy from taxpayers. Do they deliver benefits to society that equal or exceed the tax subsidies?
TON |
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Term
LICENSURE, CERTIFICATION, ACCREDITATION:
Licensure |
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Definition
state function, mandatory
Condition - compliance with state laws, building codes, fire safety, sanitation standards |
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Term
LICENSURE, CERTIFICATION, ACCREDITATION:
Certification |
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Definition
federal function, eligibility for participation in Medicaid and Medicare
Condition - satisfy the conditions of participation; compliance with standards |
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Term
| LICENSURE, CERTIFICATION, ACCREDITATION: |
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Definition
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Term
LICENSURE, CERTIFICATION, ACCREDITATION:
Accreditation |
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Definition
private function (JCAHO), voluntary
Condition - satisfy Joint Commission standards |
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Term
| LICENSURE, CERTIFICATION, ACCREDITATION: |
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Definition
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Term
| Hospital: ETHICS PRINCIPLES |
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Definition
• Respect for others
• Autonomy
• Truth-telling
• Confidentiality
• Fidelity
• Beneficence
• Nonmaleficence - “given an existing problem”
• Justice
RAFTN CBJ |
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Term
| Hospital: LEGAL RIGHTS, PATIENT BILL OF RIGHTS |
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Definition
• Do not resuscitate orders
• Informed consent
• Advance directives
• Living will
• Durable power of attorney
DIAL-D |
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