CHLH 210 EXAM 1

• increased tuition and fees (since 1984) 50% private schools, 133% public schools. Average debt 2009: $156,456 ... 79% of graduates had more than $100,000 of debt

Medical school

• known as Medicare + Choice, added in 1997 as part of the Balanced Budget Act of 1997, offered managed care type options, Medicare advantage ... funded by parts A and B

Part C

Health Insurance Covers a very wide range of payment arrangements Prepayment plans have been in existence since the beginning of the 20th century

Term used to describe how people pay for the services they have received

• Complex and specialized care delivered in specific institutional settings (nursing homes) •

Tertiary

-: Insurance and Third-Party Payers (insurance company)

The Payment Process

$8,000 per person

The amount of GDP spent on healthcare is the United States is approximately

led to meat inspections

The jungle

• : Physical Therapy, Respiratory Therapy, Occupational Therapy, Recreational Therapy, Speech-Language Pathologist and Audiologist, Pharmaceutical Care

Therapy providers

non-covered benefits, termination of coverage, failure to obtain preauthorization, out-of-network provider, number of reasons

Third party payers may deny claims

Incomplete documentation Such as not selecting your gender on paperwork Non-covered benefits Termination of coverage Failure to obtain preauthorization Out-of-network provider Number of other reasons

Third-Party Payers may deny claims:

Access quality cost also known as iron triangle of health administration

Three Policy Drivers

Provider of health care services Payer for services provided by others Regulator of health care providers

Three roles of the government

Graduating from Med School Successful completion of residency} range 1-7 yrs Passing a licensing exam

Three standards of Licensure

• :: dental care, eye care, chiropractic care, foot care, diet and nutrition -

Total Healthcare Program

• highest care. Surgeons available 24/7: orthopedics, neurology, anesthesiology, emergency, radiology, research and education

Trauma I -

• less volume than trauma I, in collaboration with level I, no research requirements

Trauma II-

• not all specialists, require emergency resuscitation, surgery, ICU, transfer, can handle some emergency situations

Trauma III-

if no level III exists, common in rural areas, require evaluation, stabilization, diagnostic capabilities, transfer

Trauma IV

24/7 emergency care, intensive, trauma surgeons: neurology, orthopedics

Trauma centers:

• hospitalization is higher among African Americans than whites, among people of lower socioeconomic status than the more affluent - less access to primary care, poor likely to suffer from more acute conditions- more frequent hospitalizations, longer stays once admitted, western US has lower hospitalization than other parts of country - more managed care

Trends:

Regulates health care by making laws through the political process Example: Antitrust laws

government regulation

$8,000/person, Taiwan spends $800/person

healthcare cost per person?

hospital bed elimination begins 1970

healthcare costs escalated to alarming rate;

considers the relationship between the body, the mind, and the emotions of the patient

holistic care:

44 million 16%

how many americans lacked insurance in 1990s

19% Among age 15 or older ~3.3 million age 15 or older use a wheelchair 10.5 million use a cane, crutches, or walker

in 2000 how many Americans age 5 or older have a disability

decrease access increase cost

increase quality

when you indemnify something you agree to pay the claim (most TV adds are like this),

indemnity insurance:

1. businesses continually assess their relation to their environment, done through

integrating business and its environment:

One general partner has unlimited liability

limited partnership (LP)

(determines mix of products to meet demands of ppl),

management, marketing

: the use of nutrition to support health in a patient, for example: in patients with diabetes

medical nutrition therapy

...

o Efficiency o Effectiveness

6,500

o More than ______ hospitals are currently operating in the US

...

o Nurse's role:

1960

over 700 insurance companies selling health insurance

(business owned by 2+ people - shared, ex: medical group practice, easy to form, problems: personal liability, difficult to dissolve, if one partner racks up debt you are responsible as well, no market for selling ½ of a partnership, dissolves when founders die),

partnership

prospective payment 1980

payment shifts from cost based to DRG

1940

pennicilin comes to use

1940s

prepaid healthcare begins seen as radical

1950

prices of hospital care doubled

1910s

progressive reformers fight for health insurance; becoming more popular

1902

public health service est

• 49% male, 50% female, 72% Caucasian, AA increased faster than total, Hispanic- d

residents in US,

(employer pays for employees health care),

self-insurers

ommiting health insurance FDR 1936

social security is passed

(business with one owner - dentists/ophthalmologists, one owner, different sizes, easy, personally liable - unlimited liability),

sole proprietorship

denounced by AMA called communist plot by house subcommittee 1940

truman offers single national health plan

$2.5 trillion of GDP

what is spent on healthcare in US?

Board of Medical Examiners

who are standards of liscenceure granted by?

Medical Practice Act

who are standards of liscensure set by?

1970

women in medicine up from 9% to 25%

• . personal, financial, social 2. descriptions of the patient's history, condition, diagnostic and therapeutic treatment, results of treatment

your medical record contains two types of patient data

embodies whole healthcare debate (Policy Drivers) Access quality and cost

• Iron Triangle,

19.4%

• State and local government - %

• efficiency, cost containment, utilization review

Managed care:

What every girl should know sent to workhouse for nuisance 1916

Margaret Sanger

• a federal and state program, funds health care primarily based on the basis of the recipient's income, 15% of total national health expenditures, serves approximately 42 million people, almost half are children.

Medicaid:

Focuses in the diagnosis and treatment of disease Focuses on individual while sick

Medical model

decrease quality

cut cost

1960

fear of doctor shortage

1950 kidney involving twins

first transplant

management, marketing accounting ($), production information technology

1. activities required in order for a business to provide products and services to their customers (business functions)

o hospitals established,.. as we know them today 1920s

1752:

exited to provide food and shelter to the destitute, medical care was secondary and primitive, financed through charity and local governments, isolated the sick in infirmaries, people stayed for months at a time.

1800s municipal almshouses

68.2 f 60.8 m

1940s life expectancy

(gets service from 2nd party, but pays 3rd party for it) , 2nd party provider, 3rd party insurance (reimbursement to provider)

1st party patient

almost 60% by women, 85% by whites, more than 50% by people ages 25-64, 16% by people younger than 15 years old, least likely to visit: people ages 15-24 (only 7.6%)

2007: More than 910 million ambulatory care visits -

• 994.3 million were to physician's offices, 9 million were to outpatient departments, 117 million visits were to the ED, 42.4 million were related to injuries, 13% resulted in hospital admission

2009: More than 1.2 billion ambulatory care visits

Answer: All of the above

3. National health care plans were proposed in which decade? 1930s- social security 1990s - Clinton establishes advisory panel for national health care 1960s - Medicare/Medicaid 2000s - Obama's work towards healthcare

tax exemption for those that donate - gifts must be verified, public charity: receives substantial income from general public and government.

501 (c3)

1960

69% of doctors considered specialists

hospitals (40%), nursing or residential care facilities (22%), physicians' offices (16%)

: 3 major places of employment in health care:

• be licensed, have an organized physician staff, have RNs supervise continuous nursing care, an identifiable governing body, a CEO with continuous responsibility, medical records on each patient, registered pharmacist supervising a pharmacy, food service that meets patient needs

:. Hospital must

relief of poor, distressed, and underprivileged, advancement of religion education, and science or lessening neighborhood tensions, eliminating prejudice and discrimination, defending human and civil rights, combating community deterioration and Juvenile delinquency

Charitable:

(Taft 1912) 2 million under 16 working bill to improve lives of children and families

Childrens beareu

Consumer's side: the lower the price of a product falls, the more of it they are willing to buy

Concept of Supply and Demand

as many people as possible should be able to receive health care services, everyone should get healthcare, those that pay should get it,

Access:

specalize

Advanced Practice Nurses (NP)

1950

Advances in treatment of diseases like polio

connect the patient to resources, represent/protect their patient

Advocate

• - treats disease by standard treatments, such as surgery and drugs, these are the majority of the physicians out there (MDs)

Allopathic Medicine

also referred to as "competition laws" - are statutes developed by the U.S. Government to protect consumers from predatory business practices by ensuring that fair competition exists in an open-market economy. Antitrust laws are applied to a wide range of questionable business activities

Antitrust law

• : average number of beds occupied each day, total inpatient days of care during a given period are divided by the number of days in that period ... total patient days: 54,750 .. time period = 365 days ... ADC = 150

Average daily census

dividing the total days of care by total discharges, provides how many days a patient, on average, spends in the hospital, indicator of severity of illness, resources used for categories of patients.. total patient days 54,750. total discharges = 10,000 ... 57,450/10,000 = 5.5 days

Average length of stay calculated by:

• of prospective payment, alternative services - home health, sub acute long term care - declined from 8.2 in 1970 to 5.6 in 2004

Average length of stay declined because

Why this boom? after WWII, happy time in America, lots of kids, 1960s-1970s

Baby Boomers

76 million Predicted in 2030, 1 in 5 will be 65 or older MAKES US NERVOUS BECAUSE EVERYDAY MORE PEOPLE ARE ELIGIBLE FOR MEDICAID

Between 2010-2030, How many ppl with reach 65

1930s

Blue cross begins offering private coverage for hospital care in dozens of states

o A psychological condition in which a person loses the ability to care and becomes apathetic, sometimes caused by stress and being overwork, in certain professions, such as nursing

Burnout:

provides goods and services to customers for profit, for profit and not for profit must make a profit to remain in business, more than 700,000 businesses part of healthcare industry

Business Side of Health Care

1. Japan = #1, Mexicans live 4 years less than US and spend 30% of what we do.

By life expectancy

• Consolidated Omnibus Budget Reconciliation Act - employee may continue to be insured under employer even after employment termination, however, employee must pay the total cost themselves

COBRA

Able to earn a profit - called a surplus Surplus retained by organization Not paid to investors

Can Not-for-profits make a profit?

* focus on quality: with expertese you get more efficient and you get better at it and faster you get. More ppl, cut out errors, become more efficient

Can only focus on 2 parts of iron triangle

Not all are curable, lifestyle ones ARE)

Can you prevent disease?

• number of beds set up and staffed for inpatient use determined the size or capacity, 84% of hospitals have fewer than 300 beds, average is 165, rural average is 65

Capacity:

o PAYING PER PERSON Capitation, in the context of health care systems, is a method of paying health care service providers (e.g., physicians or nurse practitioners). Generally these providers are contracted with a type of health maintenance organization (HMO) known as an independent practice association (IPA). The HMO contracts with the providers to have the latter take care of patients enrolled in the HMO. Most often, payment for such a service is under the capitation system.

Capitation:

• providing quality health care services, staying financially secure for the future, total beneficiary spending, distribution of spending, fraud - serious concern, Medicare pays 15-30 days, based on Prospective Payment System - means the amount of reimbursement is determined prior to the patient receiving services • Ex: Miami Fraud- $55 million in false claims, operated 7 medical clinics, treatment of Medicare beneficiaries for a wide variety of ailments, ex: HIV, AIDS, cancer, varicose veins • 10% of Medicare employees spend 63% of total Medicare, some people use a lot, most use Medicare a little

Challenges

• per 2000 US Census Bureau, 2,697,000 RNs, 2.2 million were employed in nursing jobs, 4X more RNs than Physicians, 90% women, age breakdown ( 75% b/w 30-55, 37% b/w 40-50, less than 3% under the age of 25) this may cause nursing shortages in the future

Characteristics:

The poor, distressed, and underprivileged Advancement of Religion, Education, and Science

Charitable organizations relieve who? advantage who?

Medical Practice Act Conditions: Unprofessional conduct Commission of a crime Personal incapacity to perform one's duties

Conditions for these to occurred are laid out by the state's

(multiple owners, amount they own is determined by the amount of shares they own) EX. Pharmaceutical Companies (i.e., Abbott Labs) Often many owners (shareholders) -determined by the number of shares -Managers run business (meaning they make the decisions) -Liability : loss limited to initial investment

Corporation

healthcare services should not cost too much, government, individual, society, efficiency: doing the most with lesser amount of money (ideal)

Cost:

• 29% women, Asians 9%, Hispanics 4%, African Americans 3%. Employment 661,400 physicians in active practice - 53% office-based practice (55% women) 19% employed by hospitals self employed 66% men, 44% women, non-active: teachers, administers, researchers

Currently 941,000 physicians in the US, historically a profession for only white men, minorities in the profession now ...

1907 first known carrier of typhoid fever

Decade of Mary Mallon? who was she

1910

Decade pain meds introduced to hospital

1900

Decade railroads are the leading industry to develop extensive employee medical programs

1900

Decade; American Medical Association becomes powerful

1900

Decade; Doctors are no longer expected to provide free medical services to ALL hospital patients

1900

Decade; Surgeries are common

1900

Decade; period of organized medicine

the amount of goods that we're willing to buy at a given price. Lower price to increase demand, too much product? Lower price. Healthcare does not follow the supply/demand pattern. More doctors? = more surgeries?

Demand:

Demographics are the most recent statistical characteristics of a population.. Commonly examined demographics include gender, race, age, disabilities, mobility, home ownership, employment status, and even location. 308 million oubled since 1990, 15% of Americans ages 5 of older have a disability ADA 1990

Demographics

Economy comes to a near standstill

Depression

1930s greater emphasis on old age benifits

Depression changes priorities

• : A diagnostic test is any kind of medical test performed to aid in the diagnosis or detection of disease.

Diagnostic testing

o For profit o Not-for-Profit

Different types of businesses

stay licensed Annual renewal fee Complete additional education Continuing Medical Education (CME) Intended: To keep physicians up-to-date To prevent continuation of outmoded or dangerous medical procedures Can only practice medicine in the state they are licensed.

Doctors must Must

(personnel care for patients at accident scene, transport by ambulance),

EMT-basic

(administer intravenous fluids, use defibrillators, advance airway techniques and equipment),

EMT-intermediate

(administer drugs, interpret EKGs and use other complex equipment)

EMT-paramedic

exclusive provider organizations, has features similar to both HMOs and PPOs, delivery networks in which patients must use the services of those providers, regulated by state insurance laws

EPO:

• become a discipline, finances, organized into departments such as X-ray, efficiency important element as services were expanded while cost needed to be controlled, advance in medical sciences led to a need for hospitals to be the center of info, desirable venue for clinical studies, led to collaboration with universities

Early 20th century saw hospital administration

how the health of the overall economy is analyzed Key measurements that provide information about the health of the economy: Interest Inflation Unemployment All these pieces together make up the Business Cycle interest rates up, economy good

Economic Indicators

• undergraduate, pre-med or any major as long as you took the required science courses: biology, anatomy, chemistry (organic, inorganic, pharmacology). Medical School, residency - on the job training

Education & Training of physicians

doing the most with the least amount of money (ideal plan)

Efficiency

differ from state to state, 2 eligible groups: poverty-related (determined by income and resources), designed to provide health care to those who are unable to afford it, medically needy

Eligibility Medicaid

over the age of 65 and is eligible for Social Security retirement benefits - 86% enrollees qualify due to age, make up 12% of US population, permanently disabled, has end-stage renal disease

Eligibility criteria Medicare

• EMT- emergency medical technician, four levels: First responder, EMT-basic, EMT-intermediate, EMT-paramedic

Emergency Care Providers

Not-For-Profit

Exist primarily to provide programs and services of benefit to others Not provided by government

1990s

Expansion of medical care eases costs

o For profit- making a profit is the primary reasons for business to exist ex: Abbott Laboratory, a pharmaceutical company

FOR PROFIT

• : special groups of beneficiaries, Native Americans, military, generally not for the common public, classification

Federal hospitals

o 1st- hospitals and physician services: all states' Medicaid programs must cover these services o 2nd- pharmaceutical, dental, vision, state may provide these services o 3rd- list of services the state may NOT provide ex: abortions

Federal law specifies three categories of benefits

4.2%

Federal- %

1950s

Feds provide welfare for sick poor

o charitable institutions created for poor, food rest, shelter

First hospital

basic care

First responder

visted med schools, closed 1/2 of all hospitals women kicked out

Flexner report; decade? what was it?

1918 6% of population was lost

Flu epidemic

investor owned, profits are main objective, reinvest or redistribute to investor owners , provide quality services, managers expected to minimize shareholder wealth, taxes paid by shareholders, ex: HCA and General Electric

Forms of business organization:

sole proprietorship partnership , other types: limited partnership (LP) , limited liability company (LLC), limited liability partnership (LLP), corporation (Abbott Lab), stock exchange opportunities

Forms of business ownership

Founder of hospital in chicago 1920

Frank Billings

taxpayers income tax to the government's general revenue

Funding Medicaid

1920

GM HIRES metlife to ensure 120,000 workers

primary care provider: screen and direct care (act as gate keeper: restricting access to services)

Gate keeper concept

with primary care physicians, 1st line of defense

Gatekeeper concept starts

1. women live longer than men, reproductive healthcare, general healthcare, income for woman less than men ($.71 per every $1 a man makes) , violence against women

Gender issues:

Diagnose & treat a variety of illnesses in patients of all ages

General and Family Practitioners

Public corporations owned by a state or local government Serve community Additional benefit is they can raise money through taxation Also face political pressure

Government Health Care Organizations

public corporations owned by state or local government, ex: Cook County Hospital -serves community, not interested in profit, raise money through taxation, face political pressure

Government Health Care Organizations

• physicians who focus on providing care to hospitalized patients, close to 30,000 hospitalist, due to declining revenues, desire for work-life balance, hospital shortages of PCP, shortage of ER coverage, decreased physician involvement in hospital quality initiatives

Growing employment trend: hospitalist:

• Health Insurance Portability and Accountability Act - mandates insurance portability, sets up procedures for electronic data exchange

HIPPA (1996):

utilization review, providers are reviewed to determine if they are giving more or less services than the contract states

HMO:

Nixion 1970 plan for national helath insurance rejected by liberals and labor starts WAR ON CANCER

HMOS ENDORSED

Expensive benefit for an employer to offer its employees

Health Care Cost

Seeks to change "Who is insured" How? Law mandates that all U.S. citizens and legal residents will have health insurance Each plan will: Include basic care and prescription coverage Limit deductibles and copays Not be able to refuse coverage

Health Care Reform

• expensive benefit for an employer to offer its employees

Health care cost

1990s

Health care costs coninue at 2 times infflation

• health administration and managers, careers in health information - coding specialist, other support staff

Health care employment in non-clinical positions:

1. professional (43.3%), service (31.8%), office and administrative (18%), management, business, financial (under 5%) 411,000 self-employed physicians and dental workers, b/w 2008 and 2018 - 22% new jobs will be in health care, increase income care by 50%, medical assistants by 34%, PTs by 33%, Pas by 39%

Health care occupation categories

your medical record contains two types of patient data

Health information record

• is a term used to describe how people pay for the services they have received, covers a wide range of payment arrangements, prepayment plans have been in existence singe the beginning of the 20th century, a serious illness, then as now, can financially devastate a family

Health insurance

1920s

Healthcare costs increase especially among middle class; physicians begin to be payed more and admired

1946 build more hospitals

Hill burton act

• end of way, severe shortage of hospitals, provided grants to states for construction of new community hospital beds, based on bed-to-population ratios, 1946- 3.2 hospital beds/1000 population, goal was to reach 4.5/1000 ... by 1980 goal was achieved, at the same time another piece of legislation tried to reduce the number to 4.. currently it is at 3

Hill-Burton Act: Hospital Survey and Construction Act of 1946:

an institution with at least 6 beds, primary function to deliver patient services, diagnostic and therapeutic, for particular or general medical conditions. American Hospital Association

Hospital

of advanced medical services and surgery that could not be done at home

Hospitals were now necessary b/c

1. Singapore best. 2005- Infant mortality rate charts.. US = 7 deaths/1,000 live births - Slovakia below US, US is 2nd to last

How healthy are Americans?

140,000 60%

How many americans had aids in 1990s? what was the mortality rate?

Policy makers usually discover they can only achieve 2/3 of these objectives, not all 3 at the same time, health care managers must make trade offs since these cannot be achieved at the same time,

How many of these objectives can policy makers acheive? why

quality decreases and cost increases

If you increase access

1. private or free enterprise system, competitive selling market, central feature: competition- in order for business to succeed, they must provide a product that customers want like value, measured by quality and customer satisfaction

Impact of economy:

Uses real people Costs about $1000 Given in only 5 cities

In 2004, the National Board Medical Examination (NBME) began giving a clinical skills assessment

• Physician Assistants, Medical Assistants, Surgical Technologists

In addition to contact with nurses and physicians, you may also come in contact with:

o An indemnity is a sum paid by A to B by way of compensation for a particular loss suffered by B. The indemnitor (A) may or may not be responsible for the loss suffered by the indemnitee (B). Forms of indemnity include cash payments, repairs, replacement, and reinstatement.

Indemnity:

one party is exempted from incurred liabilities by the other, defined as "fee for service" - decides how much health care is needed

Indemnity:

Joint Commission on Accreditation of Healthcare Organizations (JCAHO)

Industry created own regulatory group

American Medical Association (AMA) American Hospital Association Medical associations at the state-level Lobby legislators

Industry representatives

• also called a patient day, night spent in the hospital by a person admitted as an inpatient, cumulative number over a given time period is known as days of care

Inpatient days:

o patient that gets services, diagnosis, food, lodging

Inpatient:

1. Graduated in 1980 with Accounting Major 2. Learn from others 3. Nursing home industry has grown over the years, has a bad rep 4. State contracts with managed care programs

Insight from Scott on Future of Healthcare 10/17

• shifting the risk of loss from the individual to a third party

Insurance is the business of

risk of loss from the individual to a third party

Insurance is the business of shifting the

Focuses on body's organs

Internal Medicine

-Profits are main objective -Reinvested or distributed to investor owners -While providing quality service, managers are expected to maximize shareholder wealth -Company and the shareholders pay taxes Examples are HCA and General Electric

Investor Owned Business

1950; private system evolves for those who can pay

Korea distracts attention from medical care

, more than 200 employees, almost all offer health care benefits.

Large companies

Large companies (more than 200 employees) Almost all offer health care benefits Small companies Only 59% offer health care benefits

Large companies vs. Small companies

based on wellness model, healthier lifestyles, diet, safe sex practices, preventative measures, vaccines, clean air act - toxic waste cites contained

Leading causes of disease have declined...

1. can only sue business not home or belongings and assets.

Liability protection:

Must pass a national licensure exam

Licensed Practical (LPN) or Licensed Vocational Nurse (LVN),

Board Certification is voluntary Requires: An additional residency in that specialty Pass an exam 24 boards Controlled by two organizations: American Board of Medical Specialists American Osteopathic Association

Licensure is MANDATORY

50 years old

Life expectancy in 1900s

Limited liability of partners

Limited Liability Company (LLC) and, Limited Liability Partnership (LLP)

• : hospitals are open to the public, often in inner cities in large urban areas, declined because of limited reimbursement, higher ALOS, local generally own full service hospitals

Local government

is an efficient way to offer quality health care and constrain prices, combine paying for and providing services in one business, belief that HMOs and managed care organizations will compete with each other- prepaid health plan, capitation: paying per person

Managed care

started in 1973 - most people have this, a system for paying health care providers and a system for delivering health care services, 95% of workers covered by an employers plan were enrolled in managed care, up since 27%-1988

Managed care models

• Created in 1965 • Serves 41 million • Costs government about $301 billion • You hit 65 and you are eligible for Medicare if you worked • Federal program, provides healthcare for the elderly, permanently disabled, individuals with end-stage renal disease - kidney failure • 20% Medicare, $2.6 trillion total national health expenditures, gov programs are ½ to every dollar we spend, 1966-2010 total health exp up

Medicare

passed in 1965 President johnson darkens chances for national comprehensive plan

Medicare and medicaid

covers inpatient hospital services, critical access to hospitals, skilled nursing facilities include hospice care, home health care (both only following inpatient hospital care), 36% of all Medicare expenditures, no premium, deductible - in 2010: $1100 ... funded by 2.9% payroll tax - 1.45% from employee and employer, each, incomes over $200ksingle, $250k couple

Medicare part A

An economy with only one seller. The one seller is able to set whatever price it chooses Example: the one gas station in Loda, IL

Monopoly

3. True.

More than half of bankruptcies were related to medical costs.

mental institutions

Most state hospitals are

o Not-for-Profit - primary reason for the business is something other than making a profit, better quality, access, cost/efficiency, etc. ex: Cunningham Children's Home

Not-for-Profit

Example - NFP Hospitals -Owned by the community, not investors serve community, not maximize profit -Profits are invested back into the organizations or held as cash reserves -Run as a business to ensure survival -Usually tax exempt from federal and property taxes. -provide public benefit -Services may not be profitable -In addition to patient revenue Fund-raising Grants Donations

Not-for-Profit Business-Oriented

Voluntary services Tax exempt Rely on donations Examples include the Red Cross, American Cancer Society, and others Can be small or very large 501(c)(3) public benefit corporations

Not-for-Profit Non Business-Oriented

Various charitable, non-profit, religious, and educational organizations Provides donors of 501 (c)(3)'s deduction for federal taxes Gifts must be verified

Not-for-Profit Organizations 501 (c)(3)

1. owned by community, serve community, not maximize profit, profits held as cash reserves, invested back into organizations, run as a business to ensure survival- Carle charges for parking, usually tax exempt from federal and property taxes, provide public benefic, services are not profitable, fund raise, grants, donations, voluntary services, ex: Red Cross, American Cancer Society - example of donations, can be large or small, Not-for-profits must be a corporation and have a board of directors, 501 (c3) - tax exemption for those that donate - gifts must be verified, public charity: receives substantial income from general public and government. Private foundation - receives income from investments and endowments, makes grants to other organizations. Private Operating Foundation- use earning and assets to conduct its tax exempt purpose

Not-for-Profit:

-be a corporation -Must have a board of directors -Unrelated business income is taxed -Can lose not-for-profit status -Often activities don't generate break even revenue

Not-for-Profits Must

• (Certified Nursing Assistants) most common phrase used in this area as most are required to get this credential

Nurse's Aids (NAs) also known as CNAs

there are numerous definitions of nursing, all include an aspect of care for the patient as a whole, take care of people: interviewing, examining, evaluating, treatment, care, referral services, advocacy, disease prevention and health promotion

Nursing

an organization framework that provides a systematic method to deliver patient care

Nursing process

• divide the average daily census by the number of beds available (capacity), expressed as a percentage. Average daily census = 150, capacity = 200 ... 150/200 = 75% occupancy rate

Occupancy rate:

• providers for diagnostic testing, therapy providers, emergency care providers, total health care program

Office or hospital visit,

• ::: 96%, prescriptions: 86%, deductibles: 79%

Office visits

An economy with only a few sellers Example: the amount of dentists in Rantoul, IL

Oligopoly

Anti trust laws and HIPAA - referrals to related businesses and malpractice

Only 3 legal structures for operating a business in the United States

May opt-out as they cannot afford the employee share of the premiums

Only 81% of employees choose health care benefits

• advance of medical science transformed hospitals, discoveries of causes of disease, devices for diagnosis and treatment: anesthesia- aided significantly in surgery, germ theory and antiseptic and sterilization techniques, X-rays, more acceptable to middle and upper class that could pay

Organized institutions of medical practice

• preventative care, smaller set (DOs), do the same as allopathic does plus holistic care ...

Osteopathic Medicine-

• 2.3%

Other nonfederal - $

• New York Hospital (1791) , Massachusetts General (1821), Almshouses: took overflow and incurables, many hospitals modeled after the first 3 voluntary hospitals

Other voluntary hospitals

o came to hospital for diagnosis and service but does not need lodging of food

Outpatient:

• preferred provider organization, delivery network that manages and negotiates contracts on behalf of the providers, who provide services at low cost

PPO

• covers physician services, outpatient hospital care, some services and supplies, 29% of Medicare expenditures, premium - $88.50/month, deductible: $124 ... funded by general revenues, beneficiary premiums: $110.50/month in 2010, some lower, higher incomes, over $85K will pay more

Part B:

• drugs, extremely expensive, modification established in 2003, as part of the Medicare Prescription Drug, Improvement, and Modernization Act of 2003 (MMA), prescriptions, preventive care ... funded by general revenues, beneficiary premiums, state funding, average premium is $37

Part D

Focuses on providing care to children

Pediatricians

NOT USED FOR 20 YEARS! 1920

Pennicilin discovered

• 1852, city already had an almshouse and pesthouses, Benjamin Franklin involved in promoting the idea, contributors had the right to govern the operation, control was in governing board, not the physicians, model still used today

Pennsylvania Hospital in Philadelphia-

insurance is a financially successful way of making $, spread risk over population

People with jobs are insured,

o used to quarantine people with sick contagious diseases in order to protect the community, people did not want to be admitted, little care given, most illnesses were treated at home

Pesthouses

increase

Population of people with disabilities is likely to _______ as baby boomer generation ages

• 2005 avg. single $4,024, family: $10,880, cost to employees: single up to 15.2%, family down to 24%

Premiums

Risen about 130%

Premiums fir employers have _____ in the past decade

Sees a patient regularly for routine and preventative care Important to build relationship with pcp for accurate diagnosis

Primary Care Physicians (PCP)

• defined as basic and routine care that can be delivered in an office or clinic by a primary care provider

Primary care:

- receives income from investments and endowments Makes grants to other organizations

Private Foundation

- use earning and assets to conduct its tax exempt purpose

Private Operating Foundation

uses earnings and assets to conduct its tax exempt purpose

Private Operating Foundation -

14.5%

Private for profit %

receives income from investments and endowments, makes grants to other organizations.

Private foundation -

• called for-profit, investor owned, more common about 1900, lower occupancy rate than community hospitals, more particular about amount of Medicare patients they take, do not need to treat non-emergency patients, stabilize ER patient and then transfer then elsewhere

Propriety:

Times are good

Prosperity

• 8.1%

Psychiatric %

- receives substantial income from general public and government.

Public Charity

owned by the federal, state, local government, public connotes government ownership

Public hospitals:

health care services should be of the highest possible quality, effectiveness: observed results meet expected results, do people get better?,

Quality:

Economy slows down

Recession

Government intervention by lower interest rates & tax cuts Things begin to improve

Recovery

make up the majority of this profession, must pass a national licensure exam,

Registered Nurse (RN),

fee for service/episode of care basis

Reimbursement:

If statistically 2 in every 1,000 people will collect payouts each year, each one collecting $40,000, the insurance company will provide $80,000 in payouts

Risk Loss

If 1,000 people pay $100 a year in premiums, the insurance company collects $100,000

Risk pooling

1940

Roosevelt asks congress for right to adequet healthcare

1920

Rural health facilities clearly inadequate

economic constraints, swing bed designation, EMS services

Rural hospital closures

• social security and for needy families

SSI & TANF -

SWOT: strengths, weaknesses, opportunities, threats

SWOT

• routine hospitalizations and surgery

Secondary care:

• physical location (office, clinic, hospital) and patient's condition

Services can be classified by

integrate hospital/healthcare system 1980

Shift to corporation run of healthcare

• : only 59% offer health care benefits

Small companies

• drastic change from 1840-1900, from merely supplying food, shelter, meager medical care to: sick paupers, armies, those infected with contagious diseases, the insane, those needing emergency treatment.

Source: Health Forum 2001, History of Hospitals

(funded by employers, administered by government, provides health care for workers who were injured on the job)

State Children's Health Insurance Program, Federal Employees Health Benefits Program, TRICARE (military), Worker's Compensation

• generally limited to mental and TB hospitals, reflects early role in protecting people, isolate mentally ill, isolate persons with contagious disease

State government:

Performs operations

Surgeons

• Medical Imaging Technologists and Technicians, Nuclear Medicine Technologists, Cardiovascular Technologists and Technicians, Diagnostic Medical Sonographer, Clinical Laboratory Technologists and Technicians ex: phlebotomist - draws blood

Technologist versus technician, providers:

3. ( Taft - 1900s) HMO's established by Nixon in '83

Two million children under the age of 16 were working, which caused President Taft to establish Children's Bureau ...

Public Charity Private Foundation Private Operating Foundation

Types of 501 (c)(3)

Indemnity Insurers Self-Insurers Blue Cross/Blue Shield Managed Care Models Managed Care Structures HMO PPO EPO

Types of Third party payers

3 step exam End of second year of med school Evaluates understanding of medical concepts & how they relate to medicine Just before graduation Assesses understandings of medical knowledge & clinical science During first year of residency Evaluates applicability of medical and scientific knowledge when practicing unsupervised

US Medical Licensing Examination (USMLE) (1992

• discharges, number of discharges per 1000 pop: measures access and utilization, babies born not in admissions, number of patients discharged from acute beds in a given period. Declined from 122.3 in 1990 to 119.2 in 2004. 10,000 discharges in a year, 100,000 people living in the area... 10,000 X 100,000 X 1,000 = 100/1,000 pop

Utilization measures:

served all classes of society, built specifically to care for the sick, financed through local philanthropy, led by influential physicians, care for indigent and paying patients, more private than religious based in the US

Voluntary Hospital

• privately owned, voluntary because the development and financial backing is done voluntarily by residents, primary mission is to benefit the community

Voluntary hospitals:

• - 51.5% - largest occupancy rate

Voluntary nonprofit %

Focuses on prevention on disease We should want this.. We would have no disease & LESS $$$$ Focuses on pupulation only 3% of money is spent on wellenss

WELLNESS MODEL

1970

WHO declares smallpox eradicated

1940s

WWII wage and price controls health insurance is offered to compete for workers raise based on coverage

1. education 2.socioeconomic status (income) The higher it is the healthier you are

What 2 indicators are closely related to good health?

State regulates health care, different among different states

What agency is charged with regulatory authority of insurance companies?

Overall wellbeing mental, physical, spiritual (established in 1948)

What is the definition of health?

In the us we resort to medical ( more expensive)

What model of health is used in US?

3. Level of education and income

What two indicators are closely related to good health?

Market economy aka Private or Free Enterprise system

What type of economy does US operate under?

Nixon -1970

When were national health plans proposed

• Social Security was established - 1936

Which did not occur in the 1960s? • Medicare was establishes - 1965 • Medicaid was established - 1965 • Assassination of President John Kennedy - 1963 • First moon walk - 1969

3. Medical - also known as the sickness model of health care

Which model of health focuses on diagnosis and treatment of disease?

3. Wellness

Which model of health focuses on the prevention of disease?

• Americans under age 65.. only 5% purchase private insurance, 61% have employer sponsored insurance (decreased by 4% since 2000), 16% covered by Medicare, 18% are without insurance (63% low income families, 69% family with at least one full time worker) • Only 85% of employees choose health care benefits, may opt out as they cannot afford the employee share of the premiums

Who is insured?

CDC

Who's responsible for collecting an interpreting health care stats that present a picture of illness among Americans?

1920

Women can vote

3. have reproductive health care, live longer than men, income usually less than men (live in poverty), violence against women. ALL OF THE ABOVE

Women's Health is unique because in addition to general health care women ...

• 43% report working more than 50 hours/week, group practices help alleviate heavy workload. Earnings: median $186,000. Varies based on # of years in practice, geographic location, hours worked, specialty (net median for specialty fields: $340,000). Expansion: need for physicians predicted to grow more that 20% through 2018... due to baby boomers, job prospects are better in specialties like cardiology or radiology

Work hours

(need produce to sell/offer)

accounting ($), production ,

(blue cross:1929- covers hospitalization, blue shields: 1939- covers doctors visits), MERGED in 1982 - merged because of pressure from growth of managed care and threat of healthcare reform, managed care models, managed care structures (HMO), EPO, PPO

blue cross/blue shield

1. A psychological condition in which a person loses the ability to care and becomes apathetic, sometimes caused by stress and being overwork, in certain professions, such as nursing is known as ...

burnout

in order for a business to succeed, they must provide a product that customers want Provide value Measured by quality and customer satisfaction level

central feature of market economy

1940s

cold war begins

1. Assessment, gathering information 2. Diagnosis: the North American Nursing Diagnosis Association (NANDA) 3. Care planning: written client goals, planning interventions to achieve these goals (486 per NIC) 4. Implementation 5. Outcome evaluation (260 identified outcomes per the NOC)

• five stages of Nursing Process: