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2. Objectives . Define hospital categoriesIdentify types of hospital patientsDifferentiate among freestanding, hospital-based, and hospital-owned ambulatory care settingsDistinguish among various types of behavioral health care facilities. 3. Journal . http://www.intl.elsevierhealth.com/journals/
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1. Chapter 3: Health Care Settings Feipei Lai National Taiwan University
2. 2 Objectives Define hospital categories
Identify types of hospital patients
Differentiate among freestanding, hospital-based, and hospital-owned ambulatory care settings
Distinguish among various types of behavioral health care facilities
3. 3 Journal http://www.intl.elsevierhealth.com/journals/ijmi/
4. 4 Diagnosis-related groups (DRGs) Classify inpatient hospital cases into groups that are expected to consume similar hospital resources.
5. 5 Australian National Diagnosis Related Groups (AN-DRGs) To ensure the clinical coherence of AN-DRGs, every effort is made to assign each episode of care to one of 23 Major Diagnostic Categories (MDCs).
Most MDCs are defined by body system or disease type, and correspond with a particular specialty.
6. 6 Acute Care Facilities An acute care facility is a hospital that provides health care services to patients who have serious, sudden, or acute illnesses or injuries and/or who need certain surgeries.
7. 7 Acute Care Facilities ACFs provide a full range of health care services, including ancillary services, emergency and critical care, surgery, obstetrics, and so on.
8. 8 Acute Care Facilities Single hospitals
Multi-hospital systems
Two or more hospitals owned, managed, or leased by a single organization
Ancillary services
Diagnostic
Therapeutic
Acute care/short-term care
Long-term care
9. 9 Bed size The hospital bed size is the total number of inpatient beds for which the facility is licensed by the state; the hospital must be equipped and staffed to care for these patient admissions.
8:1 medical center
10:1 regional hospital
10. 10 Hospital Categories Critical access hospitals (CAH)
Located more than 35 miles from any other hospital or another CAH, or they are state certified as being a necessary provider of health care to area residents. Mileage criteria is reduced to 15 miles in areas where only secondary roads are available or in mountainous terrain.
General hospitals
Specialty hospitals
Rehabilitation hospitals
Behavioral health care hospitals
11. 11 General hospitals Provide emergency care, perform general surgery, and admit patients for a range of problems from fractures to heart disease.
12. 12 Specialty hospitals Concentrate on a particular population of patients or disease category.
13. 13 Rehabilitation hospitals Admit patients who are diagnosed with trauma (e.g., car accident) or disease (e.g., stroke) and need to learn how to function.
14. 14 Behavioral health care hospitals Specialize in treating individuals with mental health diagnoses.
15. 15 Hospital Patients Ambulatory patients (outpatients)
Ambulatory surgery patients (day surgery)
Emergency care patients
Inpatients
Newborn patients
Observation care patients
Subacute care patients
16. 16 Ambulatory patients (outpatients) Are treated and released the same day and do not stay overnight in the hospital.
17. 17 Ambulatory surgery patients (day surgery) Undergo certain procedures that can be performed on an outpatient basis, with the patient treated and released the same day.
18. 18 Emergency care patients Are treated for urgent problems and are either released the same day or admitted to the hospital as inpatients.
19. 19 Inpatients Are provided with room and board and nursing services.
20. 20 Newborn patients Receive infant care upon birth and if necessary they receive neonatal intensive care.
21. 21 Observation patients Receive services furnished on a hospitals premises that are ordered by a physician or other authorized individual, including use of a bed and periodic monitoring by nursing or other staff, which are reasonable and necessary to evaluate an outpatients condition or determine the need for a possible admission as an inpatient.
22. 22 Subacute care Is provided in hospitals that provide specialized long-term acute care such as chemotherapy, injury rehabilitation, ventilator (breathing machine) support, wound care, and other types of health care services provided to seriously ill patients.
23. 23 Ambulatory and Outpatient Care Allows patients to receive care in one day without the need for inpatient hospitalization.
24. 24 Ambulatory and Outpatient Care Ambulatory surgical centers (freestanding)
Hospital-based outpatient department
Hospital-based emergency department
Hospital-based ambulatory surgery
Hospital-based partial hospitalization program (behavior health, geriatric, rehabilitative care)
Hospital-owned satellite clinics
25. 25 Ambulatory and Outpatient Care Industrial health clinics
Neighborhood health centers
Physician offices
Public health departments
Satellite clinics
Staff model health maintenance organization
Urgent care centers
26. 26 Freestanding Centers and Facilities Ambulatory Surgical Center (ASC)
Clinical laboratory
Heart and vascular center
Staff model health maintenance organization (HMO)
Imaging center
Industrial health clinic
27. 27 Freestanding Centers and Facilities Infusion center
Neighborhood health center
Pain management center
Physician office
Primary care center
Public health center
Urgent care center
28. 28 Infusion center Freestanding center that dispenses and administers prescribed medications by continuous or intermittent infusion to ambulatory patients.
29. 29 Hospital-based departments and programs Ambulatory surgery
Outpatient department
Emergency department
Partial hospitalization program
30. 30 Hospital-owned facilities Hospital-own physician practice
At least partially owned by the hospital, and the physician participate in a compensation plan provided by the hospital.
Satellite clinics
Ambulatory care centers that are established remotely from the hospital.
31. 31 Alternate Care Facilities Behavioral health care facilities
Home care and hospice
Long-term care
Managed care to control cost
32. 32 Managed care Originally referred to the prepaid health care sector (e.g., HMOs), which combined health care delivery with the financing of health care services.
Increasingly referred to preferred provider organizations (PPOs) and some forms of indemnity coverage that incorporate utilization management activities.
33. 33 Behavioral health care Chemical dependency program
Crisis service
Day treatment program
Developmentally disabled/mentally retarded facilities
Emergency care facilities
Family support services
Home health care
34. 34 Crisis service Provides short-term (usually fewer than 15 days) crisis intervention and treatment.
Patients receive 24-hour-a-day supervision.
35. 35 Behavioral Health Care Hospital treatment
Intensive case management
Outpatient clinic
Partial hospitalization program
Residential treatment facility
36. 36 Residential treatment facility Seriously disturbed patients receive intensive and comprehensive psychiatric treatment on a long-term basis.
37. 37 Behavioral Health Care Respite care
Patient care provided in the home or institution intermittently in order to provide temporary relief to the family home care giver.
Therapeutic group home
Any group of patients meeting together for mutual psychotherapeutic, personal development, and life change goals.
38. 38 Home care and hospice Home care allows people who are seriously ill or dying to remain at home and receive treatment from nurses, social workers, therapists, and other licensed health care professionals who provide skilled care in the home.
39. 39 Skilled care Includes services that are ordered by a physician and provided under the supervision of a registered nurse, or physical, occupational, or speech therapist.
Skilled care service include:
Assessment/monitoring of illnesses
Intravenous (IV) and medication administration
Insertion of catheters ??
Tube feedings
Wound care
40. 40 Home care and hospice Home health care also covers the use of durable medical equipment (DME), which includes the following:
Canes
Crutches (?????)??
IV supplies
Hospital beds
Ostomy supplies ????
Oxygen
Prostheses ??
Walkers
Wheelchairs
41. 41 Personal care and support services Provide assistance in performing daily living activities
Bathing
Dressing,
Grooming
Going to the toilet
Mealtime assistance
Travel training
Accessing recreation services
42. 42 Home infusion care Provided by home health care agencies when intravenous administration of medication is medically appropriate for the patients condition, and treatment is administered in the home instead of on an inpatient hospital basis.
E.g. chemotherapy, drug therapy, hydration therapy, pain management, total parenteral nutrition (TPN) ????
43. 43 hydration therapy intravenous administration of fluids, electrolytes, and other additives
44. 44 Hospice care Provides comprehensive medical and supportive social, emotional, and spiritual care to terminally ill patients and their families.
The goal of hospice is palliative care (comfort management) rather than curative care (therapeutic).
45. 45 Long-term care Includes a range of nursing, social and rehabilitative services for people who need on-going assistance.
46. 46 Managed care models Exclusive provider organization (EPO)
Integrated delivery system (IDS)
Group practice without walls (GPWW)
Medical foundation
Integrated provider organization (IPO)
Management service organization (MSO)
Physician-hospital organization (PHO)
47. 47 Exclusive provider organization (EPO) Provides benefits to subscribers who receive health care services from the network providers, which are physicians and health care facilities under contract to the managed care plan.
48. 48 Integrated delivery system (IDS) An organization of affiliated provider sites that offer joint health care services to subscribers.
49. 49 Group practice without walls (GPWW) Managed care contract in which physicians maintain their own offices and share services to plan members.
50. 50 Medical foundation Nonprofit organization that contracts with and acquires the clinical and business assets of physician practices.
51. 51 Integrated provider organization (IPO) Manages health care services provided by hospitals, physicians, and other health care organizations.
52. 52 Management service organization (MSO) Provides practice management services, including administrative and support services, to individual physician practices.
53. 53 Physician-hospital organization (PHO) Managed care contracts are negotiated by hospital(s) and physician groups.
Physicians maintain their own practices and provide service to plan members.
54. 54 Managed care models Health Maintenance Organization (HMO)
Group model HMO
Staff model HMO
Direct contract model HMO
Individual practice association (IPA)
Network model HMO
55. 55 Group model HMO Participating physicians who are members of an independent multi-specialty group provide health care services.
Physician groups either contract with the HMO or they are owned or managed by the HMO.
56. 56 Staff model HMO Physicians are employed by the HMO, premiums are paid to the HMO, and usually all ambulatory care services are provided within HMO corporate buildings.
57. 57 Direct contract model HMO Individual physicians in the community deliver contracted health care services to subscribers.
58. 58 Individual practice association (IPA) Physicians who remain in their independent office settings provide contracted health care services to subscribers.
The IPA negotiates the HMO contract and manages the capitation payment.
59. 59 Network model HMO Two or more physician multi-specialty group practices provide contracted health care services to subscribers.
60. 60 Managed care models Point-of-Service Plan (POS)
Preferred provider organization (PPO)
A network of physicians and hospitals join together to contract with third-party payers, employers, and other organization to provide health care to subscribers for a discounted fee.
Triple option plan
Provides subscribers and employees with a choice of HMO, PPO, or traditional health insurance plan.
61. 61 Federal, State, and Local Health Care Correctional facilities
Military Health System (MHS)
Veterans Health Administration (VHA)
U.S. Public Health Service (PHS)
62. 62 U.S. Public Health Service (PHS) Administration for Children and Families (ACF)
Administration on Aging (AoA)
Agency for Healthcare Research and Quality (AHRQ)
Agency for Toxic Substance and Disease Registry (ATSDR)
Centers for Disease Control and Prevention (CDC)
63. 63 U.S. Public Health Service (PHS) Food and Drug Administration (FDA)
Health Resources and Services Administration (HRSA)
Indian Health Service (IHS)
National Institutes of Health (NIH)
Office of Public Health and Service (OPHS)
Office of the Secretary of Health and Human Services (OS)
Program Support Center (PSC)
Substance Abuse and Mental Health Services Administration (SAMHSA)
64. 64 Program Support Center (PSC) is a service-for-fee organization that utilizes a business enterprise approach to provide government support services throughout the Department of Health and Human Services (DHHS) as well as other federal agencies.
Administrative operations, financial management, and human resources are solution- and customer-oriented, state-of-the-art, and highly responsive to customer needs.
