Textbook Chapter 9 - Ambulatory Care Flashcards
ambulatory care services have rapidly evolved since ____
1980
_______ has spirited the change away from inpatient side of hospitals to less costly services in outpatient settings
MANAGED CARE
AMBULATORY CARE compromises what kind of services?
healthcare services delivered on an OUTPATIENT basis and do not require overnight hospitalization
the change in focus from inpatient to outpatient care was highlighted by the development of managed care and what law?
the medicare prospective payment system for inpatient hospitalizations
-gave hospitals incentives to not provide excessive services, and to make stays as short as possible. get them out “faster and sicker” – encouraged development of ambulatory care
what are the primary diagnosis groups seen in an ambulatory care setting?
3 of the top 5 are chronic illnesses – hypertension, joint problems, diabetes
what are the major disease categories seen in ambulatory care
diseases of the respiratory, circulatory, and nervous system
what is the most common physician specilaity area in ambulatory care
primary care (family practice, internal medicine, etc)
primary care providers include…
physicians
midwives
nurse practicioners
physician assistants
Of the 4 types of PCPs mentioned, which 2 perform about 3/4 of services that physicians provide in adult practice?
NPs and PAs
name the 2 major types of medical practices
which is predominant?
- private practice physicians on a FFS basis
- ambulatory care – has identity INDEPENDENT of its physicians. includes HMOs and PPOs (managed care)
private practice physicians are predominant, but ambulatory care has been experiencing dramatic growth
explain solo practice
very appealing for most physicians — you’re self employed.
but #s have been dropping due bc of managed care pressures
physician provides care for the patient even in the hospital
explain group practice
affiliation of 3 or more providers (usually physicians) who share income, expenses, facilities, equipment, medical records, etc and who provide services through a formal organization
what was the 1st successful nonindustrial group practice
Mayo Clinic in Rochester, MN
define managed care
the use of a planned and coordinated approach to providing health, with the goal of delivering quality care at the lowest cost, with emphasis on PREVENTATIVE CARE
TRUE OR FALSE
the defining feature of managed care is the use of provider networks
true
with HMOs, how is a provider paid?
prospective payment – per member per month
paid the same regardless of if that member received services and how much they cost
