HA Chapter 5 (mid term)
Urgent care center
A facility that provides walk-in, extended-hour access for acute illness and injury care that is either beyond the scope or the availability of the typical primary care practice or retail clinic. Urgent care centers also may provide other health services such as occupational medicine, travel medicine, and sports and school physicals.
Federally qualified health center (FQHC)
Community-based primary care center staffed by a multidisciplinary team of health care and related support personnel, with fees adjusted based on ability to pay. FQHCs also provide services to link patients with other community resources. Funded by the Health Resources and Services Administration to serve the neediest populations, FQHCs must meet specific operating parameters and may be organized as part of a local health department, a larger human services organization, or a stand-alone, not-for-profit agency
Retail clinic
Operated at retail sites such as pharmacies and supermarkets under consumer-friendly names, such as "MinuteClinic" and "TakeCare." Staffed by nurse practitioners or physician assistants; a physician is not required on site; clinics have physician consultation available by phone.
The Emergency Severity Index (ESI) includes five levels. In recent history, which level typically is the largest percentage of emergency room visits?
Urgent
Telehealth of telemedicine may be best described as
a collection of means of methods for enhancing health care, public health, and health education delivery and support using telecommunications technologies.
Ambulatory care is best defined as?
care that does not require an overnight stay in a hospital.
The predominant services of local public health departments today are?
child and adult immunizations.
In addition to providing primary and preventive care, federally qualified community health centers also?
help patients link with other supportive programs and services such as welfare, Medicaid, the Women, Infants and Children supplemental nutrition program (WIC) and the Child Health Insurance Program.
In addition to providing primary care and preventive care, federally qualified health centers (FQHCs) also
help patients link with other supportive services.
The Patient-Centered Medical Home (PCMH):
is responsible for providing all of a patient's healthcare needs or appropriately arranging a patient's care with other qualified professionals.
The early acute care not for profit hospitals were
located predominantly in urban centers whose indigent populations lacked access to private medical care.
In the 1990s, ambulatory care facilities of all types proliferated. Reasons for this proliferation include which of the following?
-Consumer preferences -Physician freedom from hospital facility scheduling -Physician profit-making opportunities -All of these are correct.
Which of the following is not a principle of a patient-centered medical home?
-Use of electronic health information technology for patient communication is discouraged -The personal physician leads a team of individuals in the practice who take responsibility for the ongoing care of patients -Care is coordinated and integrated across all elements of the delivery system (subspecialty, hospital, home, nursing home., facilitated by electronic record registries -Providing for all of a patient's healthcare needs or appropriately arranging care with other qualified professionals
All of the following influenced the origins of not-for-profit ambulatory care services except
-addressing needs of population groups afflicted by specific diseases or conditions. -government-imposed requirements for community organizations to fill gaps in the healthcare delivery system. -addressing the needs of population groups for whom existing community services were inadequate. -advocacy for special needs populations.
In today's hospitals, outpatient clinics frequently provide?
-teaching sites for medical residents. -primary-care services organized similarly to private physician offices. -care for those without private physicians. -All of these are correct.
Telehealth
A collection of means or methods for enhancing health care, public health, and health education delivery and support using telecommunications technologies.
Ambulatory surgery center (ASC)
A facility performing surgical and nonsurgical procedures on an ambulatory (outpatient) basis in a hospital or freestanding center's general operating rooms, dedicated ambulatory surgery rooms, and other specialized rooms such as endoscopy units and cardiac catheterization labs.
Accountable Care Organization (ACO)
A group of providers and suppliers of health care, health related services, and others involved in caring for Medicare patients that voluntarily work together to coordinate care for the patients they serve under the original Medicare (not Medicare Advantage managed care) program. The ACA enables ACOs to share in savings to the federal government based on performance in improving quality and reducing healthcare costs.
Patient-centered medical home (PCMH)
A team-based model of care led by a personal physician who provides continuous and coordinated care throughout a patient's lifetime to maximize health outcomes, including appropriately arranging patients' care with other qualified professionals for preventive services, treatment of acute and chronic illness, and assistance with end-of-life issues.
Clinical observation unit (COU)
Dedicated locations adjacent to hospital EDs or as beds located in other areas of the hospital, COUs use a period of 6-24 hours to triage, diagnose, treat and monitor patient responses while common complaints such as chest pain, abdominal pain, cardiac arrhythmias, and congestive heart failure are assessed.
Hospital emergency departments continue to be used as important sources of primary medical care by large numbers of medically underserved populations. What are the implications of this for the patients, on healthcare costs, and quality of care? Suggest possible solutions to this situation.
EDs are organized to treat episodes of serious illness and injury and therefore are not a good choice for routine care. First, care is much more expensive than in an appropriate ambulatory setting because it consumes the time of specialist personnel for conditions in which that level of personnel is unnecessary. Second, waiting times are often long because life-threatening cases appropriately have priority. Third, the ED, by its nature, is not organized or staffed to provide follow-up care. To facilitate follow-up care, ED staff often refers patients to ambulatory care services. Increased ED use coupled with ED closures has resulted in a phenomenon called "ED crowding." Decades-long reports have cited the ongoing need to divert ambulances to alternative EDs because of immediate lack of capacity. A solution to crowding has gained traction among hospital EDs in the form of clinical observation units (COUs). Established as dedicated locations adjacent to hospital EDs or as beds located in other areas of the hospital, COUs use a period of 6-24 hours to triage, diagnose, treat, and monitor patient responses while common complaints such as chest pain, abdominal pain, cardiac arrhythmias, and congestive heart failure are assessed. After the assessment period, a determination is made whether to discharge or admit the patient to the hospital. Despite the well-documented recognition that inappropriate ED use drives up costs and lacks continuity of care, individuals without resources or who may be unaware of other sources of care find the ED their most accessible choice. Even for individuals with a usual source of primary care, lack of provider availability outside normal business hours contributes to ED use for non-urgent conditions. In accordance with the ACA goal of improving access to primary care, recent research evidence suggests that extended-hours access such as that required in the PCMH model can help to reduce unnecessary ED use and hospitalizations. Such findings are adding strength to the rationale for continued robust support for primary care practices' pivotal role in meeting the population's basic needs.
Not-for-profit ambulatory services
Evolved from many sources, often cause-related, to address needs of population groups afflicted by specific diseases or types of conditions. As not-for-profit organizations, many are chartered by states as charitable organizations and maintain tax-exempt status with the IRS. These designations allow them to solicit charitable contributions for which their donors may receive tax deductions. Governed by boards of directors who receive no compensation for their services, these organizations may be operated by an all-volunteer staff or employ numerous paid professionals and have annual operating budgets of several million dollars.
Healthcare professionals such as dentists, podiatrist, social workers, psychologists, physical therapists, and optometrists, typically conduct proctices in acute care settings.
False
Many U.S. citizens support the role of public health departments in providing preventive and treatment services as necessary to fill gaps in the system for the medically needy. Others believe these services are more efficiently and effectively provided through private organizations. What is your position on this issue? Explain your rationale.
I do not support this view. Primary care should be equivalent regardless of where it is performed. Ambulatory services of public health agencies are facing many challenges including constrained resources and the need to adapt to changes in the healthcare delivery system. LHDs (Local Health Department) recognize their roles in sustaining essential public health services in their communities and continue seeking additional revenue streams, including billing for some clinical services, in order to remain as important resources for their communities' most vulnerable citizens. With the issue of EDs being used for primary care services, the LHDs could potentially fill that void and relieve unnecessary pressure off the EDs. If LHDs were to work in conjunction with PCPs and residents from local teaching hospitals the cost of staffing could be lowered while achieving learning goals for the new residents being able to provide care for underserved. Insurance companies could assist by providing no copay options when using services of LHDs for primary care to support the use of government provided healthcare.
The primary owners of community-based ambulatory surgical centers are?
Physicians
Which of the following maintains the largest ownership interest in ambulatory surgery centers?
Physicians
Technological and clinical advances that allow many surgical procedures to be safely performed on an ambulatory basis had what corollary effect on hospitals?
Physicians became competitors with hospitals for the same lines of business.
Identify major factors that have resulted in the shift in utilization from inpatient hospitalization to ambulatory care services. Describe the implications of this shift for hospitals, consumers, and the healthcare delivery system as a whole.
Physicians led the development of ASCs. They saw opportunities to establish high-quality and cost-effective alternatives to inpatient surgery. Physicians were frustrated with hospital bureaucracy, operating room schedule difficulties, and patient inconvenience. ASCs provided physicians with professional autonomy in procedure scheduling, selecting staff, equipment, and facilities. Advancements in medical technology, reimbursement criteria and in anesthesia that resolved safely and quickly were primary drivers for the move from IP to AMB. With these and other technological advances making outpatient surgery safe, Medicare and private insurers prefer the less costly of ASC setting unless physicians were able to document the necessity of hospitalization. Initially hospitals converted underused inpatient space into efficient, cost-effective care delivery areas, encouraging the development of separate surgical management systems for ambulatory and complicated cases. Quality and the patient care experience have benefited significantly from improved technology applied in the ambulatory setting. Patients experience fewer complications, much faster recovery, and less disruption to normal activity than from inpatient surgery. Continuing advances provide future opportunities to move even more types of inpatient surgery into the ambulatory setting. Patients view ASC facilities as user friendly and responsive to their needs with 92 percent reporting a high degree of satisfaction
Private physician office practices constitute the predominant mode of ambulatory care in the US.
True
Retail clinics are so-named because they:
are located in sites such as pharmacies, grocery and "big box" stores
Beginning in the 1980s, a significant advance in the provision of hospital emergency department services occurred with the introduction of?
board-certified emergency medicine physicians.
The primary organizational mode of medical care in the United States, in terms of volume of services delivered, is?
private practice physicians' offices.
"Urgent Care" is best described as care?
provided on a walk-in, extended-hour basis for acute illness and injury that is either beyond the scope of or availability of a primary care practice or retail clinic.
Clinical observation units (COUs. may be best described as hospital units associated with emergency departments which?
use a period of 6-24 hours to triage, diagnose, treat, and monitor patients with common complaints.
