Introduction & Hospitals 101 Flashcards
What are the key players in the healthcare industry?
- Providers
- Patients
- Pharmaceutical/Biotech Companies
- Employers
- Payors
What role does a patient serve?
see doctors (providers) and pay for medical services
What is considered a provider?
Does not only include doctors, also includes APPs, nurses, and
facilities
List ways in which providers drive demand in a hospital.
- Referrals, recommendations, prescriptions (specialist, tests,
treatments) - Patient education and counseling (specific services)
- Practice patterns and new technologies (innovations)
- Physician- induced demand (financial incentives)
- Preventive care, chronic disease management
Physician are the drivers for the service but…
they do not pay for the service
List other demand drivers.
- Population demographics
- Chronic diseases
- Public health trends
- Healthcare awareness
- Insurance coverage
- Economic factors
List supply drivers
- Healthcare workforce
- Medical facilities and equipment
- Pharmaceuticals and medical supplies
- Regulatory Environment
- Technological Advancements
- Healthcare Funding
Payors role in healthcare
pay for services that the consumer (aka patient) receive
What are the 2 types of payors in healthcare?
- private insurance
- government funded insurance
How or by who does the pharma/biotech company get paid?
- by the provider
- by the payor
- by the patient (in the case of self insured)
What is the reason employers began offering health benefits?
to fill job openings when federally imposed wage controls prohibited employers from raising wages to attract workers during WWII
By 1958
57% of Americans had insurance
Tension between providers and pharma/biotech companies
get providers to recommend or prescribe medications/products
through sales efforts
Tension between pharma/biotech companies and payors
they negotiate with payors to add new drugs/products to approved
list of treatments (note: if drug/product is not covered by insurance, it’s unlikely to be prescribed)
Tension between payors and providers
negotiate lower fees with providers
Tension between payors and employers
search for the lowest premiums
Tension between payors and patients
payors avoid insuring high risk patients
Tension between employers and patients
employers minimize healthcare benefits
Providers make… and have…
…more money when they provide more healthcare services
…legal obligation to provide the best care possible
Relationship between patients and providers
insured patients will follow the providers recommendation since it
is the insurance company that pays
Identify the two big problems in healthcare.
- high costs
- too many uninsured patients
Identify goals of affordable care act
- make affordable health insurance to more people through tax
credits for household between 100% and 400% of the federal
poverty level - Expand the Medicaid program to cover all adults with income
below 138% of the federal poverty level - Support innovative medical delivery methods designed to lower
cost of healthcare generally
Those who do not qualify for Medicaid…
can purchase subsidized health insurance through the Health
Insurance Marketplace (exchange)
Identify types of providers
- Facility Providers
- Professional Providers
What are facility providers?
hospitals, skilled nursing facilities, assisted living facilities, home
health agencies, ambulatory surgery centers
What are professional providers
physicians, pharmacists, nurses, advanced practice providers
(APPs), and allied health professionals (physical therapists, social
workers, etc)
What are the types of physician rendering services
- Primary Care
- Specialists
Primary care physicians are trained as…
family practice, general practice, general internal medicine, and
pediatrics
Primary care physicians treat…
common conditions or injuries, and often provider preventive
healthcare screenings
Primary care physicians role
coordinator of a patient’s care, assessing a patient’s condition (an
treating if simple) or referring a patient to a specialist physician
Specialist focus their work based on…
in-depth training in different diseases, body systems or types of
healthcare service
Examples of specialist physicians
anesthesiology, radiology, pathology, cardiology, obstetrics/gynecology, ophthalmology, orthopedics, psychiatry, general surgery,
oncology, neurology, or hospital medicine
What is a hospital based physician?
the specialties of radiology, anesthesiology, pathology, surgery,
obstetrics and gynecology, etc. - along with emergency room
physicians and hospitalists are commonly referred to as
True or False: “hospitalist” and “hospital-based” are the same
thing
False; while hospitalists are hospital-based physicians, “Hospitalist” and “Hospital-based” are not synonyms
What is hospital medicine?
a medical specialty dedicated to the delivery of comprehensive
medical care to hospitalized patients
Each provider rendering care to a patient…
bills for services related to the patient (example: PCP, PT, Radiologist, Surgeon, Pathologist, Hospital, etc)
List the types of hospital personnel a patient might interact with.
- Scheduling
- Registration
- Financial Counselors
- Physician, Resident Fellow
- Advances Practice Practitioner (APP)
- Nurses and Nurse Aids
- Lab techs or Phlebotomists
- Radiology techs
- Patient Transport
- Cafeteria Staff and Dieticians
- Housekeeping
- Respiratory Therapists
- Physical and Speech Therapists
Map of Patient Journey
