Chapter 8

Question 1

Historical Perspective

Answer 1

Scientific Method for Medical Education

Health insurance as means to access

Hill-Burton Act to build hospitals

Chronic diseases instead of infectious disease

Question 2

The Flexner Report

Answer 2

-first factor to impose a structural change on hospitals

-Flexner conducted a survey on all med schools

-his evaluations assessed admission requirements, curricula, and financial basis, and projected need of physicians and med schools based on population size.

FINDINGS: reducing med schools from 150 to 31, changing admission to a minimum of a bachelors degree, and using scientific method for basis of med education.

Question 3

Scientific method and education

Answer 3

AMA- American Medical Association adopted Flexner Report ideas, medical education was transformed into a system based on scientific method.

Scientific method: Based on diagnosis and treatment of disease on hypothesis formulation, experimentation and conclusions. as med edu relied on scientific principles it lead to reliance on technology for treatment disease and diagnosis.

Question 4

Hill Burton Act

Answer 4

-The Hospital Survey and Construction Act of 1946 (also known as the Hill-Burton Act) is credited with expanding the infrastructure of the healthcare delivery system by cre-ating federal funding sources to build new hospitals, expand and renovate facilities, increase bed capacity, and add emerging technology.

-support building hospitals in rural areas and small cities.

-intensive care units and emergency departs were created

Question 5

Infectious to Chronic

Answer 5

20th century most prevalent was infectious diseases and SINGULAR CARE.

With the advent of preventive measures (such as immunizations and antimicrobial agents) and improvement in the water supply and general sanitation, morbidity resulting from infections has declined in recent decades.

As a result, chronic diseases are now the most prevalent types of disease. Thus, hospitalizations are NO LONGER singular events. Treatment for chronic diseases requires more than hospital care; it requires a continuum of care including ambulatory, acute, and long-term care.

Question 6

reactions to reimbursement methods

Answer 6

1. inpatient prospective payment system:

-move some surgeries to to outpatient setting
-only covers acute phase

2. Value based purchasing
   -measure prescribed process of care
   -outcomes measured(mortality post hospitalization)
   -value- based purchasing program is developed, hospitals will be paid based on performance on quality measures

Question 7

Diagnosis Related Groups (DRGs)- Prospective payment

Answer 7

it was a payment mechanism for hospitalization of PART A medicare.
it was used as a method to control increases in Medicare spending, it created incentives for hospitals to discharge QUICKER AND fewer procedures
Efficiency, utilization review, and evaluation of diagnostic procedures for appropriateness became important—if not vital—for hospitals to survive.

result of DRG: decrease lengths of stay, reimbursed the acute phase of illness or surgery. leading to higher acuity of inpatients. less mix of nursing and medical care, and less financial support for uncompensated hospital care

Question 8

Retrospective FEE for SERVICE

Answer 8

Incentive for providers to keep more patients in the hospital and more procedures

Question 9

hospital characteristics

Answer 9

1.length of stay (acute aka short term) vs long term care) LTC-30+ days, Short term less than 30 days

2. type of service ( general or speciality)
   -general: medical, general, surgical
   -specialty: concentrate on one disease process, like psychiatric or cancer, or focus on one population children vs veterans
3. ownership (federal vs nonfederal). nonfederal are operated by state, city of county government, usually general hospitals. state governments are responsible for speciality care (disabilities and mental care). federal are for military or veterans
4. nongovernmental : not for profit (non profit) and investor owned (for profit)
5. community hospitals: nongovernmental hospitals
6. teaching hospitals: clinical training sites for physicians

7.multihospital chains

Question 10

nongovernment (nonprofit and investor owned aka profit)

Answer 10

A nonprofit organization reinvests its excess revenues in the organization, usually in the form of capital, new equipment, remodeling, or new buildings. A for-profit organization uses its excess revenues in a similar manner; however, a portion of the excess is paid to the organization’s investors in the form of a dividend.

nonprofit is run by religious orgs or community hospitals

Question 11

community hospitals

Answer 11

Community hospitals, include all nonfederal hospitals, short-term general, and specialty hospitals that are available to the public (can be nonprofit)

Question 12

non-community hospitals

Answer 12

not open to the general public, they are federal hospitals for military personnel and veteran affairs (VA)

Question 13

What makes it a teaching hospital? *physician based

Answer 13

The designation of teaching hospital refers to the teaching and practice of medicine . Although a hospital may serve as a clinical training site for students in pharmacy, nursing, clinical laboratory, and any of the other allied health professions, it is not considered a teaching hospital unless it serves as a clinical training site for physicians.

teaching hospitals can be community (nonfederal), general, nonprofit or it can be a federal and general.

Question 14

multihospital chains

Answer 14

national in scope, with hospitals being located in one or more geographic areas of the country. they have an advantage when competing for managed care contracts for business located in more than one state.

ex. Hospital corporation of America

Question 15

Hopsital mangement 3 parts

Answer 15

1. board of trustees
2. hospital administration
3. medical staff

Question 16

board of directors (trustees)

Answer 16

primary source of authority are board of directors in “for-profit hospitals” or board of trustees in “nonprofit hospitals”

The board is composed of members of the community who often have knowledge and skills specific to healthcare delivery. Its purpose is to determine the mission and goals of the hospital and to develop policies

Question 17

hospital administration (or chief executive officer)

Answer 17

responsibility is daily operations .

they are either a physician or individual with advanced degrees in health admin or business.

they implement the polices created by the board of trustees

Question 18

medical staff

Answer 18

composed of staff physicians and community based physicians, who have staff privileges to admit and treat patients in hospitals

Question 19

Accreditation

Answer 19

The Joint Commission: is a national organization founded by AMA in 1951. Its purpose is to set standards and to subsequently accredit hospitals based on those standards. it can accredit more than hospitals and goes to behavioral health facilities, LTC, ambulatory, etc.

Joint Commission accreditation is based on voluntary compliance with the standards. However, that accreditation has become critical for fulfilling state licensure requirements and is essential for receiving reimbursement in the Medicare and Medicaid programs.

The Joint Commission’s mission is to improve the quality of health care in the United States. Joint Commission changed the focus of its standards to include clinical processes and outcomes of care.

Accreditation is earned after an evaluation of the organization’s compliance with appropriate standards based upon an unannounced on-site inspection
standards

-AMA: american medical association
-AHA: american hospital association
-ACP: american college of physicians
-ACS: american college of surgeons (developed the first hospital standards 1918)
-ADA: american dental association

Question 20

Pharmacists role

Answer 20

1. director of pharmacy
2. staff and clinical pharmacists
3. technical and support staff

Question 21

Director of pharmacy

Answer 21

pharmacy has one of the most complex jobs within the hospital The director of pharmacy must satisfy a variety of leadership and management responsibilities, including overseeing both personnel and department budget issues.

main issue: drug budgeting

Director justifies and develops job descriptions for new pharmacy positions and generally manages the
recruitment and interview process. (failure of drug budgeting can result in less jobs offered)

they set quality standards for department, like med safety, policies and procedures, new programs, and compliance with the Joint commission or any accreditation

Question 22

Staff and clinical pharmacists

Answer 22

Staff pharmacists are generally more involved with routine pharmacy operations (e.g., order entry/verification, checking medication carts, sterile prod- uct preparation), and they supervise the activities of the technicians and other support staff who help with these activities.

Clinical pharmacists are generally more involved with patient-care-related activities, including rounding with medical teams, obtaining medication histories, providing discharge counseling, managing adverse drug reaction programs, and responding to drug information inquiries.

clinical pharmacists have higher reports of satisfaction due to more clinical practices.

Question 23

Technicians

Answer 23

The technical personnel of a hospital pharmacy department comprise pharmacy technicians.

Under the supervision of the pharmacist, technicians perform many of the distribution functions within the pharmacy department such as filling unit-dose cassettes, preparing intravenous admixtures, and monitoring and restocking inventory within the pharmacy and on the nursing stations