NURS 1130 Chapter 5

outpatient services

Services that do not need an overnight stay in a hospital. These services are often provided in a doctor's office, hospital or clinic.

safety-net hospitals

- Hospitals that provide more charitable care than other hospitals

Health centers

-Community-based and patient-directed organizations that serve populations with limited access to health care. Provide culturally competent primary healthcare services to the uninsured or indignent population. These include low-income populations, the uninsured, those with limited English proficiency, migrant and seasonal farm workers, individuals and families experiencing homelessness, infants and children, patients with HIV, substance abusers, minorities, and those living in public housing. -operate on 4 fundamentals: they are located in high-service-need community; they are governed by a community board; they provide comprehensive primary care; they must achieve performance objectives -often located in urban and rural areas where there is a designated need -provide more preventive services to their designated populations, including healthcare education, mammograms, pap smears, and adult immunizations than do other healthcare providers

Women's Health centers

-Created because women seek care more often than men and women have unique health needs that require specialized medical facilities -Women's life expectancy is longer than men's so they will represent a larger portion of the elder population -mission is to promote women's and girls' health by gender specific health activities -focus iincludes opioid abuse in women, human trafficking, college sexual assault, and prevention of AIDs awareness

Doctors Without Borders

-Doctors volunteer all over the world to help people with emergency medical aid from war, conflict, epidemics, disasters, and poverty. -non-governmental organization that helps people in war-torn regions and aids developing countries facing endemic disease. -an international medical organization that provides quality medical care to indivudals threatened by violence, catastrophe, lack of health care, natural disasters, epidemics, or wars in 70 countries

Hospital emergency medical services

-Emergency departments -provide care for patients with emergency healthcare needs -ed use is more likely among low-income people, people in fair or poor health, the elderly, infants and young children, and peoplem with Medicaid coverage -hospitals traditionally provide inpatient services, although nearly all community hospitals provide emergency services hat are considered outpatient services -although eds have the technology to treat emergency situations, many eds are used for nonemergency issues

Senior Centers

-Local community centers for older adults that provide opportunities to congregate and socialize. Many centers offer subsidized meals, wellness programs, health education, counseling, and referral services. -services provided include meal and nutrition programs, education, recreational programs, health and wellness programs, transportation services, volunteer opportunities, counseling and other servics -seniors who participate can learn to manage their chronic diseases and have an improved quality of life -With the estimated increase in life expectancy, senior centers will continue to expand and offer more services to seniors who have chronic disease that can be managed on an outpatient basis

American Red Cross (ARC)

-a nonprofit, humanitarian organization led by volunteers and guided by its Congressional Charter that provides relief to victims of disasters -provides emergency response to victims of war and natural and manmade disasters -also offers services to the indignent and military; it analyzes and distributes blood products, provides education, and organizes international relief programs

Ambulatory Surgery Centers

-are for surgeries that do not require an overnight stay. -provides an opportunity for physicians to have more control over their surgical practices as they grew frustrated bt hopsital policies, wait times for surgical rooms, and delays in new equipment -advances in technology and new anesthesia agents to help patients recover more quickly from grogginess have enabled more surgeries to be performed on an outpatient basis -outpatient surgery is a major contributor ro growth in ambulatory care -procedues performed at ASCs cost nearly 50% less than inpatient surgeries -patient surveys indicate over 90% consumer satisfaction

Remote Area Medical Volunteer Corps

-founded in 1985 to develop a mobile efficient workforce to provide free health care to areas of need worldwide -more than 120,000 volunteers, including physicians, nurses, and other healthcare professionals, provide general medical, surgical, eye, dental, and veterinary care to thousands of indiviudals worldwide

Telehealth

-has reimbursement purposes to include office visits and consultations that are provided using an interactive two-way telecommunications system (with real-time audio and video) by a doctor or certain other healthcare provider who is not at the location. -most frequently used in pathology and radiology because images can be transmitted to a distany locaion where a specialist will read the results -becoming more common because it increases healthcare access in remote locations, such as rural areas; it is also a cost-effective mode of treatment Includes: synchronous electronic consulting between primary care providers and specialists; remote patient monitoring, which includes sending electronically patient data to a remote location; provision of electronic health consumer information; provision of medical education to healthcare professionals

Hospital-Based Outpatient Clinics

-many outpatient clinics are found in teaching hospitals; they used outpatient clinics as an opportunity to tech and perform research -clinics categorized as surgical, medical, and other -they may operate as part of the hospital or as a hospital-owned entity

Home Health Agencies and visiting nurse agencies

-offers its patients home care, therapy services, administration and assistance with medication and other services so the patient can remain at home yet still obtain the care needed -provide medical services in a patient's home -this care is often provided to the elderly or disabled individuals or patients who are too weak to come to the hopsital or physicians' office or have just been released from the hospital -contemporary home health services include both medical and social services, incorporating skilled nursing care and home health aide care, such as dispensing medicationsm assisting with ADLs, and meal planning; physical, speech, and occupational therapy can also be provided at home - medical equipment, sich as oxygen tanks and hospital beds may also be provided -Medicare is the largest single payor of home health services -can be private nonprofit, governmental, or private for-profit; nearly 80% of the agencies are for profit -very popular with patientsm but there have been problems with the quality of home health care being offered, as well as issues with fraudulent Medicare reimbursement for services not needed. -it is important that home health agencies be Medicare certified because they are required to comply with CMS regulations

Adult Day Service centers

-provide a medical model of care, with medical and therapeutic services; a social model, with meals, recreation, and some basic medical health; or a medical-social model, with social interaction and intensive medical-related activities, all depending on the needs of the patients -an opportunity to provide a break for informal caregivers as well as to prolong the patient's life at home -regulated by state licensing and may be certified by a particular community agency. -are often affiliated with larger formal healthcare or skilled nursing care facilities, medical centers, or senior organizations

Hospice Care

-provides care for patients who have a life-threatening illness and comfort for the patients' family members -focuses on a type of care, not a specific place of care; on palliative care, not curative treatment, and on quality of life -medicare, private health insurance, and medicaid offer hospice care for qualified patients -hospice team: doctors, nurses, home health aides, clergy or other spiritual counselors (minister, priest, rabbi), social workers, volunteers, occupational, phsyical, and speech therapists -can be offered as both inpatient and outpatient services -hospitals may have designated hospice units -home health agencies may also offer a hospice program

Planned Parenthood Federation of America (PPFA)

-provides family services to men, women, and teenagers regarding sexual health, family planning, and more, both online and at sitea across the US -provides sexual and reproductive health care, education, information, and outreach to many -provides LGBT health care, including hormone therapy to transgender individuals -works with partner organizations worldwide to improve the sexual health and well-being of individuals and families everywhere -the only source of family planning for a large proportion of the women they serve

Meals on Wheels Association of America (MOWAA)

-represents communitty-based senior nutrition programs -a community-supported nutrition program in which prepared meals are delivered to elders in their homes, usually by volunteers -some programs serve meals at senior centers, others deliver meals directly to the homes of seniors whose mobility is limited, and many provide both services

Urgent and Emergent Care Centers

-used for consumers who need medical care but their situation is not life-threatening -this would take the place of the hospital emergency room visit -these centers can see patients in the evenings and on weekends and holidays -many are both walk-in and appointment facilities but do not take the place of a patient's primary care provider -accessible to consumers because located in convenient areas lie strip malls or medical buildings -many managed care organizations will reimburse member visits because they are less expensive than emergency room visits -relieve the eds from seeing patients who do not have life threatening conditions; so it is anticipated that there will be an increase in urgent care because of this need -this type of medical care has become the consumer preference because there is less wait time compared to an emergency department visit

Respite care or temporary care programs

-useful when family and friends are the primary caregivers of chronically ill patients and they also have a job and family to take care of on top of the patient -provides systematic relief to those caregivers who need a break -forestalls the ill patient from being placed in a facility -long term care insurance may pay for a portion of respite care -ex. adult day care, furloughs to facilities for the patient, and in home health aides

Employee Assistance Programs

-voluntary, work-based programs that offer free and confidential assessments, short-term counseling, referrals, and follow-up services to employees who have personal and/or work related problems -work in a consulative role with managers and supervisors to address employee and organizational challenges and needs -active in helping organizations prevent and cope with workplace violence, trauma, and other emergency response situations -staffed by psychologists, social workers, substance abuse counselors, and psychiatric nurses -good resource for addressing issues regarding workplace bullying, workplace, violence, and other personnel matters -address a broad and complex body of issues affecting mental and emotional well-being, such as alcohol and other substance abuse, stress, grief, family problems, and psychological disorders

6 quality dimensions of healthcare

1. safety: no medical errors that endanger the patient 2. patient centeredness: patients informed about their care, producing a healthy outcome 3. efficiency: delivery of effective care in an economic manner 4. effectiveness: evidence-based medicine tha produces a healthy outcome 5. equity: access to health care in order to produce a healthy outcome 6. timeliness: care is given in a timely manner to produce a healthy outcome

Certificate of Need (CON)

A state-directed program that requires healthcare facilities to submit detailed plans and justifications for the purchase of new equipment, new buildings, or new service offerings that cost in excess of a certain amount laws to ensure that the state approved any capital expenditures associated with hospital and medical facilities' construction and expansion important because it encouraged state planning to ensure that their medical systems are based on need

Balanced Budget Act of 1997

As a result of this, the federal government authorized an outpatient Medicare reimbursement system, which has supported hospital outpatient services efforts

Patient Bill of Rights

Established in 1973, a list of rights that are designed to protect both the patient and HCP a development by the American Medical Association that guarantees a patient the right to receive courteous, considerate,respectful treatment in a clean/safe environment; appropriate healthcare; information about his/her health treatment plan in a way that he or she understands; a continuity of care; confidentiality privacy;participation in planning care and treatment; refusal of care; use of grievance mechanisms; treatment without discrimination;an itemized bill and explanation of all charges; and review of the medical record and/or copy at reasonable fee.

proprietary hospitals

Investor-owned hospitals are for-profit institutions and are owned by corporations, individuals, or partnerships their primary goal is to generate a profit they have the lowest utilization rates

Cost Plus Reimbursement

allows for capital costs, which enables these facilities to expand

accrediation

a private standard developed by accepted organizations as a way to meet certain standards ex. accrediation of a hospital by The Joint Commission (TJC) means that hospitals have met Medicare and Medicaid standards and do not have to be certified TJC has had tremendous impact on how healthcare organizations are accredited. has expanded its accreditation beyond hospitals

International Organization for Standardization (ISO)

a worldwide organization that promotes standards from different countries although this is not an accrediting organization, those organizations that register with the ISO are promoted as having higher standards many healthcare organizations are registered with the ISO

Medicare Rural Hospital Flexibility Program (MRHFP)

allows some rural hospitals to be classified as critical access hospitals if they have no more than 25 acute care beds, and are at least 35 miles away from another hospital, provide emergency care, and are eligible for grants to increase access to consumers. this classification enables them to receive additional Medicare reimbursement called cost plus

Patient Self-Determination Act of 1990

also referred to as the Patient Bill of Rights requires hospitals and other facilities that participate in the Medicare and Medicaid programs to provide patients, on admission, with information on their rights if you enter any hospital, you will see the Bill of Rights posted on its walls this law requires that the hopsital maintain confidentiality of the patients' personal and medical information. patients also have the right to be provided accurate and easy to understand information about their medical condition, so that they may provide informed consent for any of their medical care

Provider-Based Outpatient Clinics

are actually physicians' offices are now part of a hospital

county and city hospitals

are open to the general population and are supported by taxes many of these hospitals are located in urban areas to serve the poor and elderly

public hosptials

are the oldest type of hospital and are owned by the federal, state, or local government

Physicians Offices

basic form of outpatient care is a patient seeing their physician in the physician's office. both general practitioners and specialists offer ambulatory care as either solitary practitioners or in group practice

how can hospitals be classified

by who owns them, length of stay, and type of services provided

certification

certification of hospitals enables them to obtain Medicare and Medicaid reimbursement. this type of certification is mandated by the HHS all hospitals that receive Medicare and Medicaid reimbursement must adhere to conditions of participation that emphasize patient health and safety

church-related hospitals

developed as a way to perform spiritual work these hospitals are community general hospitals they could be affiliated with a medical school

osteopathic hospitals

focus on a holistic approach to care they emphasize diet and environmental factors that influence health as well as the manipulation of the body their focus is preventetive care

inpatient care in hopsitals

focuses on acute care, which includes secondary and tertiary care levels that most likely require inpatient care inpatient care is very expensive, so many hospitals have begun offering more outpatient services because they do not require an overnight stay and are less financially taxing on the healthcare system

state licensure

focuses on building codes, sanitation, equipment, and personnel hospitals must be licensd to operate with a certin number of beds

ACA patient bill of rights

focuses on implementing consumer-oriented practices from insurance companies, which will help childreb abd adults with preexisting conditions to obtain and keep insurance coverage, to end lifetime reimbursement limits on healthcare insurance reimbursements, and to increase the opportunities for consumers to choose their physicians

long term care hospitals

focuses on patients who stay an average of more than 30 days rehabilitation and chronic disease hospitals are examples of long term care hospitals

Federal hospitals

generally do not serve the general public but operate for federal beneficiaries such as military personnel, veterans, and Native Americans ex. The U.S. Department of Veterans Affairs (VA) hospitals are the largest group of federal hospitals. they have high utilization rates by veterans

academic medical centers

hospitals organized around a medical school

teaching hospitals

hospitals that have one or more graduate resident programs approved by the AMA

treatment services

include same-day surgeries and therapies, such as chemotherapy or kidney dialysis

rural hospitals

located in a county that has no urban areas tend to see more poor and elderly patienrs, and, consequent;y have financial issues

urban hospitals

located in a county with designated urban or city geographc areas tebd ti pay higher salaries and offer more complex care because of the highly trained providers and staff

ambulatory care

outpatient care

voluntary hospitals

privately (not government) owned and nonprofit facilities. considered voluntary because their financial support is the result of community organizational efforts. their focus is their community. private, nonprofit hospitals are the largest group of hospitals

specialty hospitals

provide services for a specific disease or target population

Hospitalist

providers that focus specifically on the care of patients when they are hospitalized; recognized the need for providing quality hospital care

general hospital

provides many different types of services to meet the general needs of its population most hospitals are general hospitals

three major types of hospitals by ownership

public voluntary proprietary hospitals

rehabilitation services

refer to occupational and physical therapies

diagnostic services

refers to X-rays as well as laboratory and blood tests

wellness

refers to basic and preventive medical care like seeing your primary doctor

inpatient services

services that involve an overnight stay of a patient

acute care hospital

short-stay hospital focuses on patients who stay an average of less than 30 days community hospitals are short term

Who oversses the licensure of healthcare facilities?

state governments states set their own standards all facilities must be licensed but do not have to be accredited

Leapfrog Group

the founders believed they could take "leaps" forward with their employees by rewarding hospitals that achieve quality and safety performance. initiated an annual hopsital survey to assess hospital safety performance standards to reduce preventable medical mistakes; these surveys can be voluntarily completed by any US hospital and are implemented annually. the survey data are for public consumption, so consumers can find out which safety issues are occuring in their local hospitals initiated the Hospital Safety Scorw which is a ltter-frade rating of how well hospitals protect patients from accidents, infections, injuries, and errors

inpatient hospital services

the patient is admitted to the hospital based on a doctor's order to treat an illness or injury

4 categories included under ambulatory care

wellness diagnosis treatment rehabilitation