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28 Cards in this Set

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Ambulatory care
Health care services provided on an outpatient basis to people who are able to move about and don’t need to be confined to a hospital bed.
Ambulatory Patient Classification (APC):
A method used by CMS (Centers for Medicare and Medicaid Services-AKA: HCFA –Health care financing Administration) to classify episodes of outpatient care. Hospitals are then reimbursed based on the APC.
Majority of ambulatory care is provided by who?
-office-based physicians and
-physician assistants
What are the current problems in medical practice?
----A. Physicians are being faced with a decline of professional autonomy.
----B. Increased competition among themselves.
----C. Changes in the method of payment for their services.
----D. Deprofessionalization
What are the reasons for the current problems?
--Cost containment efforts that seek to provide more efficient, effective medical care.
--The major factor is the growing supply of physicians.
What does increasing physician/patient ratio do?
intensifies competition
(encourages group practices or salaried positions with managed care organizations or hospitals)
How do you know if you need more physicians?
Complex
Affected by the age characteristics of the population. (elderly having greater needs)
Existing health problems
Government programs
Level of investment that needs to be made in research and facilities.
Extent to which physicians are willing to use other health workers.
The population’s willingness to accept other practitioners.
Expectations of the population regarding health care services delivery.
Current Statistics show the United States will be over 100,000 physicians/PA’s short in 5-7yrs.
Thus, there is no more consensus on the correct number of physicians as there is on the correct amount of money to spend on health care!
What triggered the practice of medicine to change significantly?
practice of medicine began to change significantly as hospital use increased
What are the advantages to solo practice?
Greater autonomy for the physician
A more personal patient-physician relationship
Little bureaucracy for both patient and the physician
What are the risks of solo practice?
Very Great
Financial
Administrative responsibilities
Long Hours
Limited access to capital
Difficulty in contracting in a market-driven environment.
Group practice:
What is the Mayo Clinic?
Mayo Clinic is the largest medical group practice (# of physicians) in the US (2005)
-has 1,447 physicians
What are the advantages of physicians practice together?
-share expenses, offices, office personnel, equipment
-have practice covered when one physician takes vacation
-income tends to be a little higher than solo practice (sharing risk)
-have more peer interaction (availability of "instant" consultations
-practice manager so physicians don't have to spend their extra time in administration duties
What are the group practice disadvantages?
-Physician loses some individual autonomy
-Groups must decide about office hours, office location(s), staffing, and capital investments.
-All physicians in group have additional legal and ethical risks.
a. The peer group is expected to be aware of each other’s medical practice habits, ability, and decision making capabilities—they are responsible for each other.
-Difficult to structure reimbursement to individuals—who works the most—is everyone paid the same?
Why would a physician choose to be an employee and not an owner?
No investment necessary
Limited financial risk
More defined working hours
Few if any administrative duties
What are the disadvatages of being employee?
--Limited income potential
--Limited input into management decisions
--Few if any administrative duties
The first hostpitals built in the US were built specifically for what?
what kind of hospitals were they?
built specifically to care for the sick in the general population
-voluntary hospitals
Why and who voluntarily donated to hospitals?
-money came from laypeople and depended on gifts and subscriptions from donors who felt responsible for those less fortunate
(religious or humanitarian reasons)
-wealthy and social elite governed the hospitals
-success of hospitals depended on the willingness of the wealthy to help the poor because poor sick people were virtually all of the hospital's patients
What was the first PERMANENT hospital for civilians?
Pennsylvania Hospital
(in Philadelphia)
-was a voluntary hospital
Boston Marine Hospital
because Boston was an important seaport, confronted with many sick and injured seamen with no home or families to care for them
-it opened the Boston Marine Hospital in 1804
-accommodated 30 patients
Why was Boston Marine Hospital possible?
because in 1778
-congress enacted a law requiring that 20 cents a month be withheld from the wages of each seaman on US ships to support seaman's hospitals in each seaport
Financing Massachusetts General Hospital
1825 the Boston trustees proposed a successful method of increasing operating funds called ***The free bed subscription.
Mullanphy Hospital
was the first private instituation in the West to establish a regular nursing school
-first hospital in the US to establish a maternity hospital and foundling asylum
Hospitalist
term for a physician who is hired by the hospital to work with staff physicians to cover their patients while they are hospitalized
Nosocomial Infection
an infection acquired by a patient while hospitalized
(that is why they don't have plants or flowers in the ICU)
Triage
the assessment and categorization of patients to determine the level of care needed and to prioritize who should be treated first
In 1865, Joseph Lister, an English surgeon
reduction of surgical infection
-dramatically reduced surgical infections by using carbolic acid sprays during surgery. He postulated that microorganisms in the air caused infection.
-He later realized that organisms were present on hands as well, and required washing of hands as well as sanitizers to hands instruments and dressings.
Johns Hopkins Hospital
Located in Baltimore—became world renowned because it incorporated many of the advances in hospital design and function, medical education and medical care.
Why was Johns Hopkins Hospital unique?
***Hopkins stipulated that the hospital’s staff should be surgeons and physicians of the highest character and greatest skill, and that the facility should be used as a teaching facility for the university’s medical students.