Exam 2 Flashcards
What is ambulatory care?
Healthcare services not requiring overnight hospitalization. Synonymous with outpatient care.
What are HPSAs?
Health Professional Shortage Areas
How many HPSAs are in Georgia?
232
What is primary care defined?
“Accessible, comprehensive, coordinated, and continual care delivered by accountable providers of personal health services.”
Which specialists are under the primary care umbrella?
Family Physicians, Internists, Pediatricians
What is the value of primary care?
Lower costs, better outcomes
Lower mortality, lower premature death (especially from asthma, cardiovascular disease, and pneumonia)
Increased age appropriate prevention
Reduced use of Emergency Department / hospital
What is a PCMH?
Patient Centered Medical Home
What are current issues with primary care?
Not enough physicians (it doesn’t pay as well as specialties) - only 5% of residencies match to primary care
Payment system reimburses procedures higher than face to face interaction
What are ACOs?
Accountable Care Organizations
Provider led organizations whose mission is to manage the full continuum of care and be accountable for the overall quality and costs for a defined population.
What are the primary principles of ACOs?
Local accountability for continuum of care
Pay for value
Transparent measures of system performance
Systems alignment (aligning pay with outcomes)
Incentivize better care at lower costs
What are the primary principles of PCMHs?
Introduced by American Academy of Pediatrics in 1967
Proactive, preventative, coordinated, and patient centered model (with physician directed teams)
Payment reform, enhanced access
What is the relation between ACOs and the ACA?
The ACA funded CMS ACO pilots starting in 2012
What are challenges for ACOs?
Incentives are aligned with cost savings which runs the risk of ACOs avoiding underserved populations (such as low income, minority, and disabled)
What are Community Health Centers?
An integral part of the health care safety net
Many are certified PCMHs
More than 10,000 clinical sites
Serving over 27,000 patients (most of which are low income & racial minority)
Does the US have a shortage of doctors?
Many experts state that we have enough doctors but we have unequal distribution / shortages in certain areas (specialties, demographics, and geographics)
How can we get more primary care doctors / doctors in rural areas?
Accept more students from rural areas (e.g. Mercer rural student scholarship)
More mobile avenues for primary care
Financial incentive for medical school completion
Medical school schoalrships
Requirement for placements in rural and /or low SES settings to become licensed
Fast track foreign trained physicians to work in an area with their race / ethnicity
Where do patients go when community health centers shut down?
Public hospitals (usually overwhelming them)
Describe the breakdown of Primary Care Physicians by practice size.
Describe the breakdown of US Healthcare spending.
What was the Hill Burton Act (1946)?
Hospital Survey and Construction Act
Provided federal grants to states for construction of new community hospitals
Required hospitals to provide a certain amount of charity care
Permitted hospitals to separate patients based on “separate but equal”
Conservation response to Truman’s comprehensive national insurance plan
Only codified instance of racial segregation in healthcare
What were the early versions of hospitals and when did the institution of hospitals arise?
Almshouses / poorhouses (1800s)
Hospitals become official institutions in the 1900s and all started as nonprofit
The Joint Commission (for accreditation) of 1950 helped begin the progression of for profit hospitals
What are the different types of hospitals?
Public (13%) including the VA system
Non-profit (60%)
For profit (13%)
How are different types of hospitals funded?
Public - by local taxes and CMS, Disproportionate Share Payments (DSP)
Non-profit - must demonstrate benefit to the IRS and via a Health Needs assessment for tax exemptions, government grants, and philanthropy
For profit - investors (e.g. Tenet, Hospital Corporation of America)
Hospitals get more funds for being Teaching Hospitals
What are Disproportionate Share Payments / Adjustments?
A payment adjustment under Medicare’s PPS for Medicaid utilization at hospitals that serve a relatively large volume of low-income patients, pregnant patients or other patients under the Medicaid program.
When did Medicare develop Diagnostic Related Groups (DRGs) and how did they affect hospitals?
1983; this changed reimbursement to hospitals based on patients’ admitting diagnoses. This led to increased care and discharge management (payment was set based on diagnosis, not length of care which incentivized quicker discharge and led to fewer hospital beds)
What were factors that led to reduced numbers of hospital beds?
Diagnostic Related Group reimbursements (and similar funding changes in private insurance plans)
Moving procedures and surgeries out of hospitals
Developing hospitals into larger systems (like Wellstar and Emory)
“Certificate of Need” in Georgia (needed to build new hospital or provide more beds)
What are Rural / Critical Access Hospitals?
Similar to public hospitals but are often required to provide 24 hour emergency services (this rule was waived in Georgia) to justify funding. They are paid similarly to public hospitals but can also get cost-plus reimbursement due to increased costs of maintaining high level of services to a small population.
Why have DSPs lowered?
Assumptions that all states would expand Medicaid (which did not happen).
What is Health Care Quality defined?
The degree to which health services for individuals and populations increase the likelihood of desired health outcomes and are consistent with current professional knowledge.
What are the three major issues with quality in healthcare?
Overuse
Underuse
Misuse
What is the Institute of Medicine Framework of Quality in Medicine?
Patient experience
Functioning of Microsystems
Functioning of organizations that house microsystems
Environment of policy, payment, regulation, accreditation, etc.
What are the 6 IOM Aims for Healthcare Improvement?
Safe
Effective
Patient Centered
Timely
Efficient
Equitable
What is the Triple Aim of Improving Healthcare?
Improving Patient Experience of Care
Improving the Health of Populations
Reducing per capita cost of healthcare
What are the three aims of improving healthcare?
Better Care
Healthy People / Healthy Communities
Affordable Care
What are the three long term goals of making care safer?
Reducing preventable hospitalizations
Reducing adverse health care associated conditions
Reducing harm from inappropriate or unnecessary care