chapter 9 Flashcards
ambulatory care
personal care service
NOT A BED PATIENT IN HOSPITAL OR OTHER INSTITUTION
on his or her own will by wheelchair, crutches, or gurney.
Covers all NON-hospital services
IT IS NOT the admission to a healthcare institution
Medical care not requiring
overnight hospitalization
synonyms of ambulatory care
-outpatient treatment, a clinic visit, and medical office visit.
These visits may involve routine, scheduled, urgent, or emergency situations.
what drives the American medical system?
99% of contacts between
providers and patients take place in an ambulatory setting
Approximately 1/5 of the non-institutionalized
civilian population in the United States had contact with providers of ambulatory care other than a physician during 2004. true or false?
false
1.4 or 25%
benefits
of utilizing non-physician clinicians such as physician
assistants (PAs)
include
- lowering overall costs,
-increasing accessibility of care
-improving the range
of consumer choice
Common Health Problems in Ambulatory Care
-Acute upper respiratory tract infections
* General medical exams
* Diabetes
* Asthma
* Rheumatism
* Allergic rhinitis
* Otitis media
* Sprains and strains
* Wound treatment
Primary Care Providers
-Physicians
* General practitioners
* Family medicine practitioners
* Midwives
* NPs
* PAs
* Pharmacists
Continuing volume shift from hospitals, 1980s–1990s
-advanced technology led to safety improvement
- lower costs
-patient satisfaction
- Payer incentives to decrease inpatient stays
-Consumer and physician preferences
-Physician/hospital competition
Reasons for popularity of ambulatory
care
-Use of sophisticated technology
- New diagnostic and treatment tools
-New payment system (DRGs)
-Increased reliance on outpatient care by MCOs
- Increased capacity of outpatient care facilities
- Improved access (Retail Clinics)
- Profitable and cost-efficient
- Use of allied health professionals is on the rise
Components of Ambulatory Care
-Private Medical Office Practice
* Other (non-physician) ambulatory care practitioners
* Ambulatory care services of hospitals
* Hospital emergency services
* Free-standing (non-hospital based) facilities
Early Physician Group Practice (3 or more)
-Mayo Clinic (in 1887)
(Same specialty or multispecialty groups)
- Mayo clinic group practice of salaried MDs in late
1800s; very controversial - 1932 Committee on the Costs of Medical Care*
recommended group practice as economically efficient; promoted insurance as a means to improve access
Group Practice Advantages
After hours and vacation coverage
Informal collegial consultation
Informal system of peer review
Shared office overhead expenses (personnel and
technology)
By 2012, almost 2/3 of physicians in group practices, ranging from 2–11 members
types of medical practices
solo vs group practices
Solo practice (private medical office practice)
-Family practice
* Internal medicine
* Pediatrics
* Obstetrics and gynecology
Predominant mode of ambulatory care: 929 million visits in 2012 (data most recently available)
-56% of visits to general internal medicine and family practice, pediatrics, Ob/gyn
-17% of visits to orthopedic surgeons, ophthalmology, dermatology, psychiatry
-27% of visits to an array of other physician specialists
1960s Transition from solo to group practices
-Social and lifestyle changes
-Increasing diagnostic and therapeutic information
-Medical specialization
-Medicare and other insurance complexities
-Office technology costs and overhead invited economies of scale
opportunities for sharing equipment and staff
Physicians private vs employment in hospitals
- In recent years, physicians choose employment by hospitals OVER private practice:
- American Hospital Association: Physicians employed by hospitals increased 32% since 2000.
- 2014 survey reported: 21% of all physicians in all specialties are employed by hospitals.
Hospital employment advantages: Freedom from:
* Reimbursement rate fluctuations
* Information technology requirements
* Malpractice insurance premiums * Work/life balance demands
