Medical Practice and Allied Health Professionals

1. Medical Practice and Allied Health Professionals Chapter 4

2. Today’s Health Care Environment • Major changes in past 15 years • Growth rate of older adults • Technological discoveries • Preventative care and patient education stressed • Government legislation • Fixed-payment plans • Third-party payers

3. Managed Care • Gatekeeper • Health Maintenance Organization (HMO) • Preferred Provider Organization (PPO) • Exclusive Provider Organization (EPO)

4. Federal Assistance Programs • Medicare • Health care coverage for elderly and disabled with kidney disease or other debilitation aliments regardless of wealth or income • Rationing of health care

5. Medicaid • Federal program implemented by individual states • Financial assistance to insure poor and indigent • Rationing takes place

6. Diagnostic Related Groups (DRGs) • Classifies Medicare patient by illness • 467 illness categories • Hospitals receive preset sum for treatment of category regardless of “bed days” used • Discourages treatment of severely ill patients; patients often are discharged before ready

7. Ethical Considerations of Managed Care • Wealthy may do better than poor patients • Decent minimum standard of care to everyone • Patients must be fully informed of consequences of obtaining health care elsewhere • Bait-and-switch • Profit more important than patient

8. Types of Medical Practice • Solo practice • Sole proprietorship • Partnership • Associate practice • Group practice • Professional corporation

9. Group practice Figure 4-1

10. Ethics of Fee Splitting • Fee splitting: (unethical) one physician offers to pay another for referral • Fee splitting vs. referrals • Franchise: (ethical) business run by individual to whom franchisor grants exclusive right to market product or service in certain market area • Franchisees: persons or companies that hold a franchise

11. Medical Specialty Boards • Over 23 specialty boards • Seek to improve quality of medical care • Encourage physicians to further education and training • Evaluate candidates who apply and pass exam • Board-certifies those who pass

12. American College of Surgeons • Fellow of American College of Surgeons (FACS) • American College of Physicians • Fellow of American College of Physicians (FACP)

13. Allied Health Professionals • Licensed personnel • registered nurse • nurse practitioner • licensed practical nurse • pharmacist • Certified personnel • physician assistant • medical assistant • medical transcriptionist • lab technician • lab technologist