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Hospitals and Ambulatory Care

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Hospitals and Ambulatory Care. H Edu 5100. History. 1873 = 178. 1909 = 4,300. 1946 ... Magnet Hospitals. Nursing leadership. Standards for nurse administrators ... – PowerPoint PPT presentation

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Title: Hospitals and Ambulatory Care


1
Hospitals and Ambulatory Care
  • H Edu 5100

2
History
  • 1873 178
  • 1909 4,300
  • 1946 6,000
  • 1970s 7,200
  • 2000s 4,000

3
Growth and Decline
  • Technology/war
  • Financial incentives
  • Costs

4
Capital Financing
  • Hill-Burton Act (1946)
  • Medicare and Medicaid
  • Three factors
  • Guaranteed revenues
  • Tax exemption
  • Cost reimbursement
  • Hospital borrowing

5
Types of Ownership
  • Voluntary, not-for-profit
  • Investor-owned, for-profit
  • Government

6
Legal Structure
  • Governing board
  • Medical staff
  • Management

7
Operational Structure
  • Medical division
  • Nursing division (clinical services)
  • Other Clinical and diagnostic
  • Administrative
  • Hotel Services

8
Patient Rights/Responsibilities
  • Rights
  • Responsibilities

9
Informed Consent
  • Established legal practice
  • Right to know

10
Quality of Care
  • JCAHO
  • Structural reviews
  • Process audits
  • Results focus
  • Indicators
  • Fragmentation

11
Re-engineering
  • New models vs incremental change
  • Hospitals one component vs hub
  • Service orientation

12
Integration
  • Horizontal
  • Vertical

13
Role of Physicians
  • Admissions
  • What services are used
  • Guest in hospital

14
Sources of Revenue
  • Philanthropy
  • Global budgets
  • Charges (price)
  • Cost reimbursement
  • Per case (DRG)
  • Capitation
  • Managed care

15
Funds Out
  • Payroll
  • Professional fees
  • Supplies and other
  • Capital depreciation and interest

16
Who Gets the Profits?
  • Physicians
  • Hospitals
  • For-profit vs non-profit

17
Competition Among Hospitals
  • Good or bad?

18
Current Issues
  • Team-based care
  • Hospitalists
  • Patient Expectation

19
Magnet Hospitals
  • Nursing leadership
  • Standards for nurse administrators
  • Protected feedback procedures
  • Unfair labor practices
  • Regulatory compliance
  • Data collection

20
Ambulatory Care
21
Origins
  • Private medical practices
  • Indigent clinics
  • ERs
  • Public health clinics

22
Evolution of physician practices
  • Solo
  • Group
  • Multi-specialty groups

23
Hospital Outpatient Activities
  • Indigent clinics
  • Outpatient services
  • Outpatient departments
  • Specialty clinics

24
The Emergency Room
25
Freestanding Centers
  • Who owns?
  • Who uses?
  • Hospital concerns
  • Surgical centers

26
Impact on triangle
  • Access
  • Quality
  • Cost
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