Inpatient, Outpatient, Primary Care, LTC Flashcards
What types of facilities are considered inpatient?
Hospitals and skilled nursing facilities (SNF)
What constitutes an inpatient service?
Any service that requires an overnight stay
If a person goes to the ER is not admitted to the hospital and kept overnight is it considered inpatient?
No
What is a hospital?
An institution with at least 6 beds
What is the primary function of a hospital?
Deliver diagnostic & therapeutic services for particular or general medical conditions
Does a hospital have to be liscensed?
Yes
What other staff/services are required to be considered a hospital?
Organized staff of physicians & nurses
Maintain medical records, provide pharmacy & food services
Continuous nursing supervised by a RN
Governing body & CEO
What were the first/precursors to modern day hospitals?
Almshouses/Pesthouses
Why did Almshouses & Pesthouses evolve into hospitals?
Due to:
- Evolution of the medical profession
- Scientific discoveries & technological progress
- Doctors needing a place to house patients
There was a transition from mainly government-run hospital institutions to __________.
community-owned
What are hospitals known for now?
Centers for high technology & medical research
What happened in the 1940s in regards to the expansion of hospitals?
Shortage of hospitals
Hill-Burton Act
What is the Hill-Burton Act?
Gave funds to cities to build hospitals.
Goal: 4.5 beds/1,000 population
Took 40 years to reach the goal, we have now exceeded
What happened in the 1950s in regards to the expansion of hospitals?
Rise in employer-based health insurance
What happened in the 1960s in regards to the expansion of hospitals?
Creation of Medicaid & Medicare
What happened in the 1970s in regards to the expansion of hospitals?
Many large hospitals & extended lengths of stay
Spiraling healthcare costs
What happened in the 1980s in regards to downsizing hospitals?
1983 - Social Security Amendments
What were the Social Security Amendments?
Required Medicare to switch from per diem to a PPS based on DRGs
Decreased lengths of stay
What happened in the 1990s in regards to the downsizing of hospitals?
Growth of managed care & outpatient services
- Shift from inpatient to outpatient helped to decrease costs
- Most MCOs and traditional insurers use DRGs
- Medical System
What is an inpatient day?
A person that is registered as a patient at midnight
What is the average length of stay?
Average number of nights the entire hospital patients are there (average 4.8 days)
Are newborns counted in the average length of stay?
No
How is capacity determined?
By the number of beds
What is a hospital census?
Profile of all patients that are in the hospital on a particular day (# of people, diagnoses, etc)
What is the hospital occupancy rate?
People currently in beds divided by the number of available beds
Average is 66%
Who is more likely to frequent hospitals, men or women?
Who is more likely to stay longer?
Women more likely to frequent
Men are more likely to stay longer
Who can go to a community hospital?
Are they publicly or privately owned?
What is the average length of stay?
What percentage of all hospitals are community hospitals?
Anyone can go
Can be publicly or privately owned
Less than 30 days
85%
What are examples of a non-community hospitals?
Military hospitals
Jails
Psychiatric centers
What is a public hospital?
Can a public hospital also be a community hospital? General hospital? specialty hospital?
Government owned
Yes! Community b/c it's open to anyone (ECMC) Restricted (VA) General (ECMC) Specialty (Buffalo Psychiatric Center)
What is a private, nonprofit hospital?
What percentage of all hospitals do they make up?
What other types of hospital can they be?
Owned and operated by community organizations
60%
General or specialty
What is a private, for profit hospital?
What other type of hospital can it be?
What is HCA?
Owned by individuals, partnerships, or corporations
General or specialty
HCA - Health Corporation of America
What is a general hospital?
Do they typically have long term or short term stays?
Provide a broad range of services for a variety of conditions
Short term stays
What are specialty hospitals?
Provide services for specific illnesses
Rehabilitation hospitals, cancer hospitals, psychiatric hospitals, children’s hospitals
What is a rural hospital?
What are some of the problems they frequently experience?
What populations do they treat most?
Located in the country
Frequently in financial difficulty - frequent closures
Generally treat larger percentage of poor and elderly
What is a teaching hospital?
Offers one or more graduate residency programs approved by the AMA
Most are affiliated with a major university and have a research/teaching mission
What is an osteopathic hospital?
How many are there in the US?
Offers full medical care, but has a more holistic focus
About 200 in the US
What are the licensure requirements for a hospital?
Must be licensed by the state in order to operate
Must meet minimum standards by the state health department
Compliance with building codes, fire safety, climate control, space allocation, & sanitation
What is a hospital certification?
Gives the hospital the authority to participate in Medicare and Medicaid
Must meet standards (Conditions of Participation) set by the US DHHS
Is a hospital accreditation required?
What organizations can accreditate?
Not require, but most are.
Joint Commission (JCAHO) - if JCAHO accredited, they are automatically able to participate in Medicare & Medicaid
CARF (Commission on Accreditation of Rehabilitation Facilities) - not mandated, but a good sign of quality
How is the hospital organized?
What does this mean?
Tripartite Structure
Triangle: Board of Trustees at the top, CEO and Chief of Staff are the base
The CEO is in charge of the administration: Senior VP, VP, Department heads, Supervisors
The Chief of Staff/Medical Director is in charge of the medical staff: Service chiefs and committee chairs
Where do OTs fall in a hospital organization?
Administration (documentation, productivity efficiency, trainings) AND Medical staff (treating patients)
Who is usually the Chief of staff?
An MD
What is beneficience?
What is nonmaleficience?
Do good!
Do no harm
What is an outpatient service?
What is another term for outpatient?
Any services that do not require an outpatient stay
Ambulatory care (because you can ‘walk’ out)
Why is primary care called the “point of entry”?
Because primary care is the first contact with the healthcare system
What is gatekeeping?
The PCP regulates visits to specialists
What is ‘coordination of care’?
The PCP coordinates health care among specialists
Acts as a case manager
Why is primary care considered ‘essential care’?
Because everyone needs it, but not everyone has access to it
Preventative care
What is ‘Integrated Care’?
Comprehensive, coordinated services
What is the balance of accountability between the client & the clinician?
Clients and clinicians are accountable to each other. Clients are expected to show up to appointments, follow through with instructions, compliance, etc.
Clinicians are expected to provide accurate information, keep the patients best interests in mind
The stronger the use of primary care, the lower the…(4 things)
Rate of hospitalization
Cost of healthcare
Rate of morbidity & mortality
PCPs are not evenly distributed in the US. Where is there less availability?
Inner cities & rural areas
What are some examples of freestanding facilities?
Walk-in clinics Urgent care centers Surgical centers Dental clinics Optometric clinics Rehabilitation Clinics
What is the benefit of mobile facilities?
What types of services are available?
Can reach small towns, rural areas, malls
Diagnostic, medical, & screening services
What is telephone triage?
Can call and talk to an expert (24 hour nursing lines)
What types of services are provided by home health?
Nursing, aides, therapists
What services at provided by Public Health Services?
Clinics for well baby care, STDs, family planning
Why were community health centers & free clinics created?
To reach medically underserved populations - provide a safety net for those with limited or no insurance
What is included in Complementary & Alternative clinics?
Chiropractic Clinics
How have the following factors influenced the growth in outpatient services?
Reimbursement
Technology
Utilization Control
Social Factors
Reimbursement:
DRGs have shifted services from inpatient to outpatient
Quicker discharge from hospitals under PPS
Technology:
Shorter-acting anesthesia, less invasive procedures, fewer overnight stays
Utilization Control:
Insurers discourage inpatient stays whenever possible (through utilization review methods)
Social Factors:
Patients prefer to be at home
What is the goal of LTC?
Promote maximum possible functional independence
What are some characteristics of LTC? (6)
- Includes a variety of health care services
- Services must be well coordinated
- Services are individualized
- Services needed for an extended period
- Holistic approach
- Quality of life must be maximized
What are the (4) objectives of community based LTC services?
- Deliver LTC in the most economical & LRE
- Supplement informal caregiving when more advanced skills are needed
- Provide respite to family members
- Delay or prevent institutionalization
Who provides home health care?
What types of services?
The individual must be ________ to receive services.
Hospital home health division, private home health agency
Nursing & rehabilitation services
Homebound
What is adult day care?
Run during business hours
Place for adults to go to receive supervision, food, social activities, therapeutic services
What is adult foster care?
Small, family run homes for adults who need supervision & assistance with ADLs
Provide room, board, personal care
What are home delivered and congregate meals?
Meals on wheels
Meals at senior centers
Sponsored by the Elderly Nutrition Program
What is the focus of senior centers?
Socialization & activity
What are homemaker & handyman services?
Organized services for seniors or disabled people - household chores, yard work, shopping, home repairs
Generally volunteer staffed
What are PERS?
Personal Emergency Response System
Electronic device that enables people to call for help in an emergency (person carries it around)
What does case management seek to do?
Link, manage, and coordinate services to meet the changing needs of elderly clients
What are institutional LTCs?
Used for individuals whose needs cannot be met in community-based settings.
Includes a range of facilities from retirement facilities to specialized care facilities
What types of facilities are considered retirement homes?
Personal care homes?
Nursing homes?
Retirement - Independent living facilities
Personal Care - Residential (personal care) facilities, Assisted living
Nursing homes - SNFs, Subacute care, Specialized care facilities
What are retirement facilities?
Do not deliver nursing services
Provide security, independence, active lifestyle
May provide 1 meal/day
What are personal care facilities?
Nonmedical custodial care
Provide routine assistance with certain ADLs
What are assisted living facilities?
Fastest growing form of LTC
Provides personal care services for ADLs, 24 hour supervision, social activities, some nursing services
What do SNFs provide?
Medically oriented care (nursing, therapy, ADL assistance)
What is a subacute care facility?
Provide medically oriented care that is not long term in nature (20-90 days)
Examples: recovery & rehab after hip surgery
What is a specialized care facility?
Some SNFs have specialized units for patients with specific needs
Ex. head injury unit, ventilator dependency unit, alzheimers unit
What are the licensure & accreditation requirements for nursing homes?
Licensure - must be licensed by the state & meed minimum standards by the state health dept.
Accreditation - not required, but many do seek it (joint commission)
How is a certified nursing home differ from one that isn’t certified?
The certified on can participate in medicare & medicaid
The certification identifies different types of nursing facilities
Will medicare or medicaid pay for the following facilities?
- SNF
- Nursing Facility
- ICF/MR
What are their stipulations?
SNF - Medicare pays first 20 days (fully)
Up to 100 days (partially)
**ONLY if person was hospitalized at least 3 days prior to SNF admission
Nursing Facility - Medicaid, indefinite length of stay
ICF/MR - Facility for individuals with developmental disabilities who cannot live in the community; mainly medicaid
Are nursing homes private/for-profit, private/not for profit, or public?
Examples?
Who pays for nursing home stays?
Can be any:
Private/for profit (ex. elderwood)
Private/not for profit (ex. brothers or mercy)
Public (ex. erie county home)
Medicaid is the largest payer
Medicare pays for eligible beneficiaries under part A, but for short duration
What is respite care?
Gives informal caregivers time off, while still meeting the person’s needs
Ex. adult day care, home health
What is restorative care?
Helps patients reach their maximum physical/mental functioning
Includes rehabilitation & therapy
What is hospice care?
Comprehensive services for those with terminal illness
Emphasis on pain management, symptom management, psychosocial & spiritual support
