Term
| Where are most people employed in the health care industry? |
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Definition
| Most people (35%) are employed in hospitals, even though hospitals only make up 1% of health care establishments. |
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Term
| Trend in health care employment? |
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Definition
It has been rising steadily.
7 of the 20 fastest growing occupations are HC related.
It will generate more new jobs from 2006-2016 than any other industry. |
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Term
| In what size groups do most physicians practice? |
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Definition
| Most physicians practice in groups of 1-2. Most visits occur in practices of 4 or fewer physicians. |
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Term
| Why has there been a shift from inpatient to outpatient care? |
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Definition
- Reimbursement methods (FFS to prospective, more volume means more money)
- Technological factors (better technology, more care can be done as outpatient)
- Utilization Control
- Social factors (want to get ppl. out of hospitals and back home faster, deinstitutionalization) |
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Term
| Why have specialty hospitals developed? |
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Definition
- High reimbursements for certain procedures
- Physicians' desire for greater control over management decisions affecting productivity and quality
- Specialists' desire to increase their incomes in the face of reduced reimbursement for professional services
- Notion of "focused factories" |
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Term
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Definition
- The amount of ppl dying in acute care hospitals is decreasing
- MORE ppl. are dying in nursing homes and at home |
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Term
| Trend in inpatient vs. outpatient ? |
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Definition
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Term
| Trend in provider consolidation? |
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Definition
- More consolidation of hospitals and physician groups
- In response to higher costs (such as EMR), MC, payment systems |
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Term
| Trend in specialized and ancillary facilities? |
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Definition
| - increase in specialized and ancillary facilities |
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Term
| Trend in number of comm. hospital beds? |
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Definition
| - Number of community hospitals beds is declining over time |
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Term
| Trend in length of stay, number of hospitals, number of beds? |
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Definition
- Average length of stay is decreasing
- Average number of hospitals is decreasing
- Average number of beds is decreasing |
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Term
| Trend in number of ER dpmnts? |
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Definition
| - Number of ER departments is decreasing, but ER visits are increasing |
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Term
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Definition
- Increase in overall number of nurses, BUT also increase in OLDER nurses
- What happens when they age out? |
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Term
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Definition
- Longer life expectancy w/ more PC physicians
- Lower costs
- Less avoidable hospitalizations |
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Term
| Trend in length of hospitalization for childbirth? |
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Definition
| - LOS is getting shorter for childbirth |
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Term
| Trends in inpatient visits? |
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Definition
- More people being admitted, but their LOS is shorter.
- Ex: childbirth |
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Term
| Trend in number of surgeries in free-standing facilities? |
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Definition
| - Increase in number of surgeries in free-standing facilities, less in hospitals. |
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Term
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Definition
| - HUGE amount of paperwork in ED, one hour of paperwork per hour of patient care |
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Term
| Trend in outpatient vs. inpatient surgery? |
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Definition
| - Outpatient surgery increasing, inpatient surgery decreasing. |
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Term
| Trends in hospitals volume? Why? |
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Definition
- More ppl. using hospital services
- BECAUSE of population growth and increased use rates (backlash: easing of MC restrictions on access, aging pop, technology) |
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Term
| Trend in number of nursing home beds? |
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Definition
- number of nursing home beds has declined slightly, BUT
- number of elderly is growing faster than number of elderly in nursing homes |
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Term
| Trends in length of physician visits? |
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Definition
- Physician visits are getting longer, EVEN THOUGH physicians are still reporting that they don't have adequate time with patients
- Physicians are feeling more constrained b/c patient care has gotten more complex, more chronic conditions. |
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Term
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Definition
- Mainly non-referral, old patients
- 75+ years old
- Slightly more women than men
- Half of patients have one or more chronic condition
- Only 35% of visits are for a new problem |
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Term
| Trends in physician income? |
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Definition
- 5.5 times the income of all other full time workers, but it is not increasing as much as their incomes
- Salary varies a lot by specialty
- Physician NOMINAL income is increasing, but REAL income (adjusted for inflation) has stayed the same or even decreased a little bit |
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Term
| Distribution of primary care vs. specialists? |
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Definition
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Term
| Most common treatment from ambulatory visits? trends? |
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Definition
- Pharmacotherapy (drugs)
- Physicians are prescribing more medications per visit |
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Term
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Definition
- medical tech. has prolonged life for previously fatal conditions
- Growth of the older population
- Increased longevity of the older population
- PPS for in-patient care reduced length of hospital stay, promoting post-acute care
- Desire to keep people out of hospitals
- Desire to keep people out of nursing homes (home care) |
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Term
| Rural vs. urban physicians? |
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Definition
- Average physician income in urban areas higher than rural areas, BUT rural income higher when adjusted for the cost of living
- More physicians overall in urban areas, also more specialists leads to problems in access to care in rural areas |
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Term
| Physicians and MC contracts? |
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Definition
| - Most physicians have at least one MC contract |
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Term
| Physicians and capitation? |
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Definition
- Smaller proportion of physicians have capitated contracts than MC contracts
- More primary care physicians have capitated contracts than specialists |
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Term
| Trends in malpractice crisis? |
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Definition
- sharp increase in premiums for medical malpractice and liability insurance
- rising premiums traced largely to increases in claims severity |
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Term
| Impact of malpractice crisis |
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Definition
- leading to defensive medicine
- hospitals have stopped performing high risk procedures, sending patients to ER
- EMR's seen as essential to improve quality of care |
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Term
| What becomes electronic with EMR's? |
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Definition
- demographics
- physician clinical notes
- test results
- computerized drug orders
- computerized test orders
- public health reporting |
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Term
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Definition
| - the larger the practice, more likely to use EMR (expensive) |
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Term
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Definition
- Physicians are using the facilities but aren't tied to the hospital
- are not employees of the hospital, but can admit patients to the hospital
- Exchange:
- Physicians occasionally take ED "on call"
- Serve on quality and utilization review committees
- NO competition between hospital and physician |
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Term
| Hospital-owned physician practice model |
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Definition
- Opposite to staff model
- Vertical integration
- hospitals buy physician practices (primarily primary care)
- Advantages: improves quality, manages cost care, reduced LOS, increased negotiating leverage with health plans
- Disadvantages: can be expensive to buy physicians, creates two bureaucratic costs, internal politics, indiv. incentives |
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Term
| Challenges for physicians |
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Definition
- Primary care vs. specialty care
- Practicing w/ financial risk
- MC contracts, accepting capitation or not
- Individualized quality reporting and provider profiling
- Maintaining clinical and employment control
- Hospital practice or only ambulatory?
- Managing physician extenders |
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Term
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Definition
- Ambulatory: lower overhead, no need for extensive tech, less wait time=higher patient satisfaction
- Hospitals: must maintain tech and expensive services, so higher overhead |
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Term
| Patient-Centered Medical Home (PCMH) |
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Definition
- A physician practice committed to organizing and coordination care based on patients' needs and priorities, communicating directly with patients and their families, and integrating care across settings and practitioners
- A new idea on the horizon... |
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Term
| 4 Sectors of Mental Health |
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Definition
1. Specialty Mental Health Sector: "specialized professionals"- psychologists, psychiatrists, etc.
2. General Medical/Primary Care Sector: Family physicians, nurse practitioners, internists, etc.
3. Human Services Sector: Social welfare, criminal justice, educational and religious services
4. Voluntary Support Sector: Self help groups and organizations devoted to education, communication, and support (AA, Al-Anon, etc.) |
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Term
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Definition
| - mental illness AND substance abuse |
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Term
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Definition
| - less coverage for mental health and substance abuse services than for physical health |
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Term
| Mental Health Parity Act 1996 |
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Definition
- no "bite", same annual and lifetime limits, but did not affect service limits or cost sharing
- Benefit: end stigma, create greater access for ppl needing mental health and addiction treatment |
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Term
| Mental Health Parity and Addiction Equity Act of 2008 |
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Definition
- offers both medical/surgical and mental health benefits
- affected financial reqs, treatment limits
- must disclose criteria for determining medical necessity, must say why claim was denied
- must cover substance abuse treatment
- this act DID bring about actual parity |
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Term
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Definition
- Mostly public, 58%
- Medicaid largest payer, states provide most $$ |
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Term
| Trend in Mental Health Spending ? |
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Definition
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Term
| Mental Health Top Expenses? |
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Definition
- #1 expense: prescription drugs, fastest growth
- #2 expense: physicians esp. specialty providers |
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Term
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Definition
- Short stay less than 30 days
- Long stay more than 30 days |
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Term
| Why are hospitals under pressure? |
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Definition
- FFS reimbursement
- Continued building of new hospitals (post WWII stimulated by Hill-Burton Act)
- High overhead
- Charity Care
- Surplus of Beds
- Health care as increasing percentage of GDP
- MC forced cuts in reimbursement via PPS |
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Term
| Ways Hospitals Can Survive |
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Definition
- Horizontal Integration (form multi-hospital associations)
- Vertical Integration (diversification of product line, develop new service)
- Closing ER's for hours or weekends |
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Term
| Why Create Integrated Delivery System? |
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Definition
- to negotiate better prices
- to gain and not lose a patient base
- to achieve economies of scale |
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Term
| General Hospital's Responses to Specialty Hospitals |
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Definition
Losing profitable patients, so...
- built own specialty facilities
- formed joint ventures w/ physicians (vertical integration)
- tried to deny admitting privileges to physician's who have ownership interest |
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Term
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Definition
| - Predominately low-income, on Medicaid or uninsured, and disproportionately minority |
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Term
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Definition
- Primary sources of revenue are Medicaid and SCHIP
- payers distributed differently |
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Term
| Physicians and charity care? |
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Definition
| - proportion of physicians providing charity care has declined over time, due to physician incomes not keeping up w/ inflation, income growth |
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Term
| Why have hospitalists taken off? |
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Definition
- Hospitals' desire to reduce length of stay and per admission costs
- Reimbursement pressures on physicians, esp. on primary care physicians
- Advantages: attracts interests of high-revenue admitters, facilitate flow
- Disadvantages: no long-term relationship, less opportunity for hospitals and community physicians to interact |
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Term
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Definition
- stigma of abuse, public perception of poor quality
- availability and access to services
- crazy funding, not covered by Medicare, small percent covered by Medicaid
- personnel training and compensation,
- high turnover and continuity of care
- regulation and enforcement
- poor family and client awareness of services
- services are often needed in moment of crisis, decisions have to be made quickly with little info. or capacity to absorb it |
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Term
| Quality- who is most disadvantaged? |
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Definition
| - waiting time highest, go to ER for avoidable conditions if minority, below avg. income, and uninsured |
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Term
| US Quality in relation to others |
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Definition
| - US has worst rates among developed countries despite double the spending |
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Term
| Organizations overseeing quality? |
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Definition
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Term
| Medicare spending and mortality rate |
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Definition
- Graph should be linear, higher spending should correlate to lower mortality rate, but it DOESN'T
- larger w/ bigger cities have more HC resources, higher utilization but not better results
- US does not have clear relationship between cost and quality, higher spending, worse results |
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Term
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Definition
- Structure: access, equipment, providers, teams, community
- Process: medication, procedures, tests, symptoms, and interaction
- Outcome: clinical status, function, satisfaction, quality of life, mortality |
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Term
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Definition
| - Process of directing an ongoing course of treatment to assure that it occurs in the most appropriate setting and the best form of service is selected. Often produces alternatives to institutional care that result in better patient outcomes as well as lower costs. |
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Term
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Definition
| Hospitals that specialize in treating particular illnesses, or performing particular treatments, such as cancer or organ transplants. |
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Term
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Definition
| Medical services that are first contact, community-based, longitudinal, comprehensive, coordinated, and integrated. |
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Term
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Definition
| State regulation that says you must demonstrate that capital expansions are "necessary." Not all states require it and regulations vary. |
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Term
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Definition
| - A way for hospitals to survive, where they can integrate with other hospitals and form multi-hospital associations or "chains" in order to achieve economies of scale. |
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Term
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Definition
| - A way for hospitals to survive, involving diversification of product line, such as adding physicians groups or post-acute care. |
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Term
| Pre-Admission Certification |
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Definition
| - Determines whether a hospital should admit a patient and whether services can be provided on an outpatient basis; its goal is to eliminate unnecessary nonemergency procedures. |
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Term
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Definition
| - Also known as outpatient care, medical, surgical or diagnostic services provided in a nonhospital setting that do not require an overnight stay. |
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Term
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Definition
| Reimbursement for dental services and supplies, including preventive care. Benefits may be provided through a plan integrated with other medical insurance coverage, or a plan may be written separately from other coverage (non-integrated). |
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Term
| Diagnostic X-Ray and Laboratory Examinations |
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Definition
| Reimbursement for outpatient diagnostic and laboratory examinations. |
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Term
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Definition
| Services given at home to aged, disabled, sick, or convalescent individuals not needing institutional care. The most common types of home care are visiting nurse services and speech, physical, occupational, and rehabilitation therapy. These services are provided by home health agencies, hospitals, or other community organizations. |
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Term
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Definition
- A cluster of comprehensive services for the dying that is "method" of care. It is team oriented and individualized to the patient and family, and includes medical care, pain management, and emotional and spiritual support (for patient AND family).
OR
-Care for the terminally ill and their families, in the home or a nonhospital setting, that emphasizes alleviating pain rather than a medical cure. |
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Term
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Definition
| Pain and symptom management, may or may not be done in conjunction with life prolonging and curative treatment. |
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Term
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Definition
1. Charges for room and board
2. Charges for necessary services and supplies sometimes referred to as 'hospital extras', 'other hospital extras', 'miscellaneous charges', and 'ancillary charges.' |
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Term
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Definition
1. Surgical procedures
2. Rehabilitation therapy
3. Physical therapy |
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Term
| Physician Hospital Organization (PHO) |
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Definition
| Arrangement between a group of physicians and a hospital, where the hospital owns the practice and employs the physician. This administrative alliance between the two gives them leverage power with insurance companies |
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Term
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Definition
| A program that provides physical and mental resotration of disabled insured individuals to maximum independence and productivity. Individuals in need of, for example, orthopedic care transfer from a regular hospital setting to a rehabilitation hospital where they receive care from a mix of providers, such as occupational therapists, physical therapists, doctors, and nursing staff. |
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Term
| Skilled Nursing Facility (SNF) |
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Definition
| A licensed institution that provides regular medical care and treatment to sick and injured persons. Daily medical records are kept and patients are under the care of a licensed physician. |
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Term
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Definition
| - A system of care where a group of integrated services are delivered over an extended period of time (over 90 days). They can be rehabilitative or custodial services, and can be used by young persons too, not just the elderly. |
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Term
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Definition
| - Activities of Daily Living, the most commonly used measure of disability, they determine whether an individual needs assistance to perform basic functions, such as eating, bathing, dressing, toileting, or getting in or out of a chair. |
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Term
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Definition
| - Instrumental Activities of Daily Living, measure a persons ability to perform household and social tasks necessary for independence, such as home maintenance, cooking, shopping, and managing money. |
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Term
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Definition
| - Retrospective, measurement focus, policy and procedure development and checking. |
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Term
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Definition
| Prospective, focused on change, implementation of policy and procedures. |
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Term
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Definition
| - Also known as Medical Directives, they are written instructions for care in the event that a person is not able to make medical decisions for him or herself. 47 states have laws authorizing living wills. |
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Term
| Medical Power of Attorney |
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Definition
| - Also known as health care power of attorney, it is a document that appoints a person (health care proxy or agent) to make health care decisions for a patient who is unable to do so for him or herself. They are authorized by all 50 states, 28 states specify the types of decisions that health care proxies can make. |
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