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
Hospital Advantages of Physician Employment
Gain market share for admissions (holding “privileges”) * Guaranteed use of diagnostic testing, other outpatient
s er v i c es
* Referrals to high-revenue specialty services
* Position with physician networks for health plan
negotiations, care coordination, quality monitoring, cost containment
EARLY public health dispensaries turned into
hospital clinics
very little freedom
uncompensation for care still remains
AHC
Academic health centers: teaching hospitals function more as group practices.
with the arrival of managed care we shift to
OUTPATIENT CARE
Hospital-Related Ambulatory Services
Hospitals establish ambulatory surgery centers
ER-1990s
sharp increase in ER visits in fewer hospitals
Emergency Services
Nonurgent care: minor, nonacute, nonsevere conditions.
Urgent care: medical attention required within a few hours
Emergent care (life threatening, needs immediate attention)
Emergi-centers (7X24) and urgi-centers (7X12)
Other Outpatient Care Programs
**Retail Clinics
-Public Health Agencies (communicable disease control, MCH, chronic diseases, general ambulatory care)
Neighborhood and community health centers (NHC Act-1965, for low income populations), now called CHCs
Indian Health Service programs (provided by PHS)
School Health Clinics
Prison Health Services
Voluntary agencies, free clinics (American Red Cross, Salvation army etc.)
Newer models of care: Integrated Ambulatory Care Models
- Accountable Care Organization (ACO)
often seek remedies for service fragmentation: piecework
reimbursement, no reimbursement for care coordination, ineffective/absent patient links among/between multiple service providers, service duplications, inadequate data on patient outcomes
Patient-Centered Medical Home (PCMH): a concept, not a “place
ACOs
* What’s an ACO? Accountable Care Organizations (ACOs) are groups of
doctors, hospitals, and other health care providers, who come together voluntarily to give coordinated high quality care to their Medicare patients.
PCMHs
* The Patient-Centered Medical Home (PCMH) is a care delivery model whereby patient treatment is coordinated through their primary care physician to ensure they receive the necessary care when and where they need it, in a manner they can understand.
RETAIL CLINICS
Walk in clinics
such as:
walgreen health clinics
rediclinic (rite aid)
walgreen health clinics
RediClinic (Rite Aid)
outline medical care, vaccinations, and health screenings. RediClinic aims to provide convenient and affordable healthcare services to individuals and families
