Health Policy And Management Chapter 8

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Inpatient

Back 1

overnight stay in a health care facility; a hospital stay

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Hospital

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an institution with at least six beds whose primary function is "to deliver patient services, diagnostic and therapeutic, for particular or general medical conditions"; hospital must be licensed, it must have an organized physician staff, and it must provide continuous nursing services under the supervision of registered nurses; must have an identifiable governing body that is legally responsible for the conduct of the hospital, a chief executive with continuous responsibility for the operation of the hospital, maintenance of medical records on each patient, pharmacy services maintained in the institution and supervised by a registered pharmacist, and food services operations to meet the nutritional and therapeutic requirements of the patients; governed by federal laws; state health department regulations; city ordinances; standards of the Joint Commission on Accreditation of Healthcare Organizations (Joint Commission); and national codse for building, fire protection, and sanitation

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Primary Source of Hospital Revenue

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Private Health Insurance

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Five Main Functions of the Transformation of the Hospital in the US

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Institutions of social welfare; Institutions of care for the sick; Institutions of medical practice; Institutions of medical training and research; Institutions of health service consolidation

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Voluntary Hospitals

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community hospitals financed through local philanthropy, as opposed to taxes

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Swing Beds

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A hospital bed that can be used for acute care or skilled nursing care, depending on fluctuations in demand

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Critical Access Hospital (CAH)

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Medicare designation for small rural hospitals that provide short-term hospitalization for patients with noncomplex health care needs

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Discharge

Back 8

total number of patients discharged from a hospital's acute care beds in a given period

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Inpatient Day (also called a patient day or a hospital day)

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night spent in the hospital by a person admitted as an inpatient

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Days of Care

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cumulative number of patient days over a certain period

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Average Length of Stay (ALOS)

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calculated by dividing the total days of care by the total number of discharges; provides a measure of how many days a patient, on average, spends in the hospital; usually indicates severity of illness

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Average daily census

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average number of beds occupied per day in a hospital; provides an estimate of the number of inpatients receiving care each day at a hospital

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occupancy rate

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derived by dividing the average daily census for that period by the average number of beds (capacity); indicates the proportion of a hospital's total inpatient capacity that is actually utilized

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Public Hospitals

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owned by agencies of federal, state or local governments

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Do not serve the common public

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Federal Hospitals

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Constitute the largest group among federal hospitals; also operates the single largest hospital system in the country

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Veterans Affairs

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Voluntary hospitals

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nongovernment, privately-owned hospitals that are operated on a nonprofit basis; owned and operated by community associations or other nongovernment organizations; called voluntary because the development and financial backing of the institutions is done voluntarily by citizens without government involvement; primary mission is to benefit the community in which they are located

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Largest group of hospitals

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Private Nonprofit sector

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Proprietary Hospitals (also called investor-owned hospitals)

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for profit, owned by individuals, partnerships, or corporations; operated for the financial benefit of the entity that owns the institution, aka the stockholders

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Some of the advantages of multihospital chain affiliation

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economies of scale with administrative overhead, the ability to provide a wide spectrum of care, and increased access to capital markets

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Short-Stay hospital

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hospital in which the average length of stay is less than 30 days (most hospitals)

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Long-term Hospital

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hospitals with an average stays of more than 30 days (ie mental hospitals)

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General Hospital

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provides a variety of services, including general and specialized medicine, general and specialized surgery, and obstetrics, to meet the general medical needs of the community it serves; provides diagnostic, treatment, and surgical services for patients with a variety of medical conditions (most hospitals)

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Specialty hospitals

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forge a distinct service niche; they admit only certain types of patients or those with specified illnesses or conditions; ex. psychiatric hospitals, rehabilitation hospitals, children's hospitals; physicians find these hospitals more efficient

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Rehabilitation hospitals

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specialize in therapeutic services to restore the maximum level of functioning in patients who have suffered recent disability due to an episode of illness or an accident

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Community hospital

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a nonfederal short-stay hospital whose facilities and services are available to the general public

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Urban hospitals

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located in a county that is part of a metropolitan statistical area (MSA); hospital classified based on location; have higher costs because they typically pay higher salaries; they offer a broader scope of more sophisticated services; and generally treat patients requireing more complex care

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Rural hospitals

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Located in a county that is not part of an MSA; MSA is a geographical area that includes at least one city with a population of 50,000 or more or an urbanized area of at least 50,000 inhabitants and a total MSA population of at least 100,000

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Most Popular Type of Community Hospital

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Nonprofit and voluntary

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Teaching hospital

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hospitals with approved residency programs for physicians; often has one or more graduate residency programs approved by the American Medical Associaton

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Three main traits which separate teaching and nonteaching hospitals

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teaching hospitals provide medical training to physicians, research opportunities to health services researchers, and specialized care to patients; teaching hospital has a broader and more complex scope of services; teaching hospitals operate several intensive care units, possess the latest medical technologies, and attract a diverse group of physicians representing most specialties and many subspecialties; many of the major teaching hospitals are located in economically depressed, older inner-city areas and are generally owned by state or local governments; teaching hospitals often provide disproportional amounts of uncompensated care to the uninsured patients

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Osteopathic medicine

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Community general hospitals; represents an approach to medical practice employing all the methods traditionally associated with allopathic medicine, such as pharmaceuticals, laboratory tests, X-ray diagnostics, and surgery; it takes a holistic approach and goes a step further in advocating treatment that involves correction of the position of the joints or tissues, and in emphasizing diet and environment as factors that might influence natural resistance

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What Makes a Hospital Nonprofit?

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These organizations must provide some defined public good, such as service, education, or community welfare, and not distribute any profits to any individuals

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Hospital Governance: Three major sources of authority

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CEO, the board of trustees, and the chief of staff (medical director)

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Board of trustees (also called the governing body or board of directors)

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consists of influential business and community leaders, is responsible for defining the hospital's mission and longterm direction; sets policy guidelines that establish the overall framework for day-to-day operations; approves long-range plans and annual budgets, and monitors performance against plans and budgets; legally responsible for the operations of the hospital; CEO is generally a member of the board

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Executive committee

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has continuing monitoring responsibility and authority over the hospital; usually receives reports from other committeess, monitors policy implementation and provides direction

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Medical staff committee

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charged with medical staff relations; it reviews admitting privileges and the performance of the medical staff

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chief of staff

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heads the medical staff

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Chief of service

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heads each speciality within a hospital, ie a chief of cardiology

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medical staff committees

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the other committees, like credentials committee, medical records committee, utilization review committee, infection control committee, and quality improvement committee, which are common to most hospitals. Medical staff generally have their own exectuve committee that sets general policies and is the main decision-making body for the medical staff, which medical staff committees work in addition to

Front 41

Credentials committee

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grants and reviews admitting privileges for those already credentialed and for new doctors whose skills are yet untested

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Medical Records Committee

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ensures that accurate documentation is maintained on the entire regimen of care given to each patient; also oversees confidentiality issues related to medical records

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Utilization review committee

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performs routine checks to ensure that inpatient placements, as well as the length of stay, are clinically appropriate

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infection control committee

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responsible for reviewing policies and procedures for minimizing infections in the hospital

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quality improvement committee

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responsible for overseeing the program for continuous quality improvement

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Oversees the licensure of health care facilities

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state governments

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State licensure standards

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strongly emphasize the physical plant's compliance with building codes, fire safety, climate control, space allocations, and sanitation; minimum standards are also established for equipment and personnel

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Conditions of participation

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developed by the Department of Health and Human Services; specifications that gives a hospital the authority to participate in Medicare and Medicaid; DHHS generally contracts with each state's department of health to carry out inspections to verify whether facilities meet these conditions

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Joint Commission

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sets standards and accredits most of the nation's general hospitals, as well as many of the long-term care facilities, psychiatric hospitals, substance abuse programs, outpatient surgery centers, urgent care clinics, group practices, community health centers, hospices, and home health agencies

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Four important principles of ethics

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respect for others, beneficence, nonmaleficence, and justice

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Principle of respect for others has four elements

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autonomy (allows people to govern themselves by choosing and pursuing a course of action without external coercion), truth-telling, confidentiality, and fidelity

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Informed Consent

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refers to the patient's right to make an informed choice regarding medical treatment

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Advance Directives

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refers to the patient's wishes regarding continuation or withdrawal of treatment when the patient lacks decision-making capacity