Component 1: Introduction to Health Care and Public Health in the U.S. - PowerPoint PPT Presentation

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Component 1: Introduction to Health Care and Public Health in the U.S.

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Component 1: Introduction to Health Care and Public Health in the U.S. Unit 2: Delivering Healthcare Health Care Settings: Outpatient Clinics and Hospitals – PowerPoint PPT presentation

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Title: Component 1: Introduction to Health Care and Public Health in the U.S.


1
Component 1 Introduction to Health Care and
Public Health in the U.S.
  • Unit 2 Delivering Healthcare
  • Health Care Settings Outpatient Clinics and
    Hospitals

2
Health Care Settings Outpatient Clinics and
Hospitals (Overview)
  • Types of Outpatient Clinics- Sole
    proprietership, group practice, corporate group
    practice, individual practice associations,
    preferred provider organizations, federal
    clinics, urgent/immediate care or walk-in
    clinics, multispecialty care center

3
Health Care Settings Outpatient Clinics and
Hospitals (Overview)
  • Types of Hospitals- Community Hospitals, Rural
    Critical Access Hospitals, Federal hospitals,
    Long-term Hospitals, Psychiatric hospitals,
    Specialty hospitals, Private hospitals,
    Multi-hospital systems, Inpatient rehabilitation
    centers

4
Health Care Settings Outpatient Clinics
  • Sole Proprietorship
  • In this practice model, a physician owns his own
    business and provides health care services to
    patients.
  • Many physicians use this model, but this model is
    giving way to the newer group or corporate
    practices that allow physicians to be a more
    effective provider.

5
Health Care Settings Outpatient Clinics
  • Sole Proprietorship (contd)
  • In this model, the physician will see patients in
    his office as well as once the patient is
    admitted to the hospital. The physician usually
    makes hospital visits before or after his regular
    practice.
  • The physician will also have to hire another
    physician to come and cover for this person when
    the physician goes on vacation.

6
Health Care Settings Outpatient Clinics (contd)
  • Group Practice
  • In this practice model, two or more physicians
    enter into a partnership to provide health
    services to people.

7
Health Care Settings Outpatient Clinics (contd)
  • Group Practice (contd)
  • The physicians can enter into arrangements where
    the partners will cover for another physician
    when on vacation or the physicians can take turns
    covering each others patients that are admitted
    to the hospital. It is a win-win situation for
    the physicians and the patients.

8
Health Care Settings Outpatient Clinics (contd)
  • Corporate Group Practice
  • In this model, a hospital or a corporation own
    the practice and the physicians are employees.
  • The physician earns a salary.

9
Health Care Settings Outpatient Clinics (contd)
  • Corporate Group Practice (contd)
  • The physicians are contracted to provide health
    services and the corporation takes care of the
    facilities, utilities, office staff, billing, and
    reimbursement issues. Many times the owners will
    also pay the physicians malpractice insurance.

10
Health Care Settings Outpatient Clinics (contd)
  • Individual Practice Associations (IPA)
  • An IPS is a legal entity where physicians remain
    individual practitioners and retain their
    individual identities and offices.
  • Each physician maintains his own medical records,
    offices, and support staff.

11
Health Care Settings Outpatient Clinics (contd)
  • Individual Practice Associations (IPA) (contd)
  • IPAs recruit physicians of all specialties so
    that they can provide a broad spectrum of
    services within their organization and referrals
    to outside providers are kept to a minimum.
  • The more specialties that are included in an
    IPA, the more attractive the IPA is to health
    plans and HMOS for providing a broad network for
    beneficiaries.

12
Health Care Settings Outpatient Clinics (contd)
  • Preferred Provider Organizations
  • Entities that contract with health benefits plans
    and health insurers to purchase health services
    for covered beneficiaries.
  • PPOs contract directly with hospitals,
    physicians, and other diagnostic facilities.

13
Health Care Settings Outpatient Clinics (contd)
  • Preferred Provider Organizations (contd)
  • Negotiate payment rates
  • Rapid payment terms
  • Utilization management
  • Consumer choice

14
Health Care Settings Outpatient Clinics (contd)
  • Federal Clinics
  • These clinics include VA clinics, military
    clinics, Indian Health Service clinics, Planned
    Parenthood, and grant-funded clinics.
  • Services are provided free of charge to the
    individuals who come to the clinic.

15
Health Care Settings Outpatient Clinics (contd)
  • Federal Clinics (contd)
  • Aside from the VA, Military, and Indian Health
    Service clinics which serve a particular
    population, federally-funded clinics usually
    serve people with no health insurance, low
    incomes, or no income.

16
Health Care Settings Outpatient Clinics (contd)
  • Urgent/Immediate Care Clinics
  • These clinics complement emergency rooms.
  • The urgent care clinic is a walk-in clinic where
    people can be seen for many conditions at a
    fraction of the cost of an emergency room visit.

17
Health Care Settings Outpatient Clinics (contd)
  • Urgent/Immediate Care Clinics (contd)
  • With clinics and physicians office usually open
    from 8 5, Monday through Friday, people that
    wanted to be seen by a physician flocked to the
    emergency rooms of hospitals. Many conditions
    were not life-threatening, but these patients
    were using precious resources.

18
Health Care Settings Outpatient Clinics (contd)
  • Multi-specialty Clinics
  • These are large clinics or groups that typically
    have providers with different specialty licenses
    who enter into a partnership.
  • The physicians pool their resources to create
    this large clinic.

19
Health Care Settings Outpatient Clinics (contd)
  • Multi-specialty Clinics (contd)
  • An example would be a group like the Oregon
    Clinic that includes gastrointestinal pulmonary
    ear, nose, and throat and cardiology in the same
    building.

20
Health Care Settings Outpatient Clinics (contd)
  • Point of Service (POS)- hybrid of HMO and PPO
  • Primary care physicians are reimbursed by a fixed
    payment per member per month (capitation)
  • Physicians are held accountable to make
    utilization targets by holding back a portion of
    their pay.

21
Health Care Settings Outpatient Clinics (contd)
  • Point of Service (POS)- hybrid of HMO and PPO
    (contd)
  • The primary care physician is the gatekeeper for
    all services other than primary care.
  • The amount covered for nonparticipating
    physicians or non-authorized procedures is more
    than for authorized services.
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