1. THE UNITED STATES HEALTH CARE SYSTEM Combining Business, Health, and Delivery CHAPTER Copyright ©2012 by Pearson Education, Inc. All rights reserved. The United States Health Care System: Combining Business, Health, and Delivery, Second Edition Anne Austin Victoria Wetle Offices, Clinics, and Hospitals 7

2. Copyright ©2012 by Pearson Education, Inc. All rights reserved. The United States Health Care System: Combining Business, Health, and Delivery, Second Edition Anne Austin Victoria Wetle Objectives Describe the ways a health care delivery system can be classified. Describe the contents of a health information record. Distinguish between the types of practice arrangements. List the sources of physicians’ revenues.

3. Copyright ©2012 by Pearson Education, Inc. All rights reserved. The United States Health Care System: Combining Business, Health, and Delivery, Second Edition Anne Austin Victoria Wetle Objectives (cont.) Describe the impact of legal issues and customer relations on practice management. Classify the different types of hospitals. List the role and function of the governing board, medical staff, and hospital administration.

4. Copyright ©2012 by Pearson Education, Inc. All rights reserved. The United States Health Care System: Combining Business, Health, and Delivery, Second Edition Anne Austin Victoria Wetle Objectives (cont.) Discuss the management, marketing, and finance functions that a hospital administrator must perform. List the various utilization measures that hospital administrators use to evaluate performance. List various measure of health care quality.

5. Copyright ©2012 by Pearson Education, Inc. All rights reserved. The United States Health Care System: Combining Business, Health, and Delivery, Second Edition Anne Austin Victoria Wetle Introduction Delivery system classifications: –Ambulatory care: Patients are fully mobile; they can bring themselves to the physician’s office or to a clinic. –Acute care: Implies a level of urgency. –Inpatient care: Patient is admitted to a hospital. –Tertiary care: Complex and specialized care delivered in specific institutional settings.

6. Copyright ©2012 by Pearson Education, Inc. All rights reserved. The United States Health Care System: Combining Business, Health, and Delivery, Second Edition Anne Austin Victoria Wetle Introduction (cont.) Delivery system classifications: (cont.) –Outpatient care: No need for an overnight stay in a hospital; primary care routine surgery. –Primary care: Basic and routine care delivered in an office or clinic by a primary care provider. –Secondary care: Routine hospitalization and surgery.

7. Copyright ©2012 by Pearson Education, Inc. All rights reserved. The United States Health Care System: Combining Business, Health, and Delivery, Second Edition Anne Austin Victoria Wetle Introduction (cont.) In 2007, 1.2 billion ambulatory care visits. Primary care physicians provide almost 88% of all preventive care. The uninsured have a much lower visit rate, putting them at risk for more serious health issues.

8. Copyright ©2012 by Pearson Education, Inc. All rights reserved. The United States Health Care System: Combining Business, Health, and Delivery, Second Edition Anne Austin Victoria Wetle

9. Copyright ©2012 by Pearson Education, Inc. All rights reserved. The United States Health Care System: Combining Business, Health, and Delivery, Second Edition Anne Austin Victoria Wetle Providers’ Offices and Clinics The office or clinic is a business as well as a place to obtain health care services. Non-clinical or administrative staff include: –Office manager/Receptionist –Filing/Record clerks –Health information management specialists –Coding and billing specialists –Accounts receivable/Payroll clerks

10. Copyright ©2012 by Pearson Education, Inc. All rights reserved. The United States Health Care System: Combining Business, Health, and Delivery, Second Edition Anne Austin Victoria Wetle Providers’ Offices and Clinics (cont.) Health information records contain: –Patient’s personal, financial, and social data –Patient’s medical data, including descriptions of the patient’s history, condition, diagnostic and therapeutic treatment, and the results of treatment HIPAA protects the privacy of the entire record.

11. Copyright ©2012 by Pearson Education, Inc. All rights reserved. The United States Health Care System: Combining Business, Health, and Delivery, Second Edition Anne Austin Victoria Wetle Providers’ Offices and Clinics (cont.) Health care providers in a solo practice are usually legally organized as sole proprietorships. A group practice allows the individual provider to share facilities, equipment, and personnel.

12. Copyright ©2012 by Pearson Education, Inc. All rights reserved. The United States Health Care System: Combining Business, Health, and Delivery, Second Edition Anne Austin Victoria Wetle Providers’ Offices and Clinics (cont.) A partnership is the traditional legal structure for a medical group practice. A limited liability partnership (LLP) is where each partner’s liability is limited to his or her capital contribution.

13. Copyright ©2012 by Pearson Education, Inc. All rights reserved. The United States Health Care System: Combining Business, Health, and Delivery, Second Edition Anne Austin Victoria Wetle Medical Practice A medical practice can be organized as a corporation. –Physician remains personally responsible for his own malpractice; the employer is not legally responsible. –The financial health of a medical practice depends on revenue maximization and cost minimization. –The practice must understand, control, and reduce its costs.

14. Copyright ©2012 by Pearson Education, Inc. All rights reserved. The United States Health Care System: Combining Business, Health, and Delivery, Second Edition Anne Austin Victoria Wetle

15. Copyright ©2012 by Pearson Education, Inc. All rights reserved. The United States Health Care System: Combining Business, Health, and Delivery, Second Edition Anne Austin Victoria Wetle Laws The federal antitrust laws are designed to prohibit activities that lessen competition in the marketplace. Under HIPAA (Health Insurance Portability and Accountability Act) patients have the right to access and control their health records.

16. Copyright ©2012 by Pearson Education, Inc. All rights reserved. The United States Health Care System: Combining Business, Health, and Delivery, Second Edition Anne Austin Victoria Wetle Laws (cont.) Malpractice is the act of providing medical services that are below the standard of quality. –Health care professionals carry malpractice insurance.

17. Copyright ©2012 by Pearson Education, Inc. All rights reserved. The United States Health Care System: Combining Business, Health, and Delivery, Second Edition Anne Austin Victoria Wetle Customer Service Important physician interpersonal skills: –Treats you with dignity and respect –Listens carefully to your health care concerns and questions –Easy to talk to –Up-to-date with the latest medical research and treatment

18. Copyright ©2012 by Pearson Education, Inc. All rights reserved. The United States Health Care System: Combining Business, Health, and Delivery, Second Edition Anne Austin Victoria Wetle Hospitals First hospitals were charitable institutions created for the poor. By the 1920s surgery was the heart of the American hospitals. 6,500 hospitals in the United States today. Public hospitals are owned by the federal or state/local government.

19. Copyright ©2012 by Pearson Education, Inc. All rights reserved. The United States Health Care System: Combining Business, Health, and Delivery, Second Edition Anne Austin Victoria Wetle

20. Copyright ©2012 by Pearson Education, Inc. All rights reserved. The United States Health Care System: Combining Business, Health, and Delivery, Second Edition Anne Austin Victoria Wetle Hospitals (cont.) Privately owned hospitals can operate on a not-for-profit or a for-profit basis. Not-for-profit hospitals benefit from provisions in state and federal tax regulations. Private hospitals operate on a for-profit basis (proprietary hospitals).

21. Copyright ©2012 by Pearson Education, Inc. All rights reserved. The United States Health Care System: Combining Business, Health, and Delivery, Second Edition Anne Austin Victoria Wetle Hospitals (cont.) General hospitals provide a range of non- specialized services. Specialized services include categories of patients services (such as veterans) or one type of disease or illness. Other hospital classifications include size, length of stay, and location.

22. Copyright ©2012 by Pearson Education, Inc. All rights reserved. The United States Health Care System: Combining Business, Health, and Delivery, Second Edition Anne Austin Victoria Wetle Hospitals (cont.) A community hospital is available to the general public. The governing board sets institutional policy and goals. The medical staff sees that patients receive quality care.

23. Copyright ©2012 by Pearson Education, Inc. All rights reserved. The United States Health Care System: Combining Business, Health, and Delivery, Second Edition Anne Austin Victoria Wetle Hospitals (cont.) The chief of staff leads the medical staff. Administrative work of the medical staff is carried out by committees. The hospital administrator operates the hospital as a business.

24. Copyright ©2012 by Pearson Education, Inc. All rights reserved. The United States Health Care System: Combining Business, Health, and Delivery, Second Edition Anne Austin Victoria Wetle Figure 7.1 Hospital Organization

25. Copyright ©2012 by Pearson Education, Inc. All rights reserved. The United States Health Care System: Combining Business, Health, and Delivery, Second Edition Anne Austin Victoria Wetle Figure 7.2 Organization Chart for ABC Hospital Administration

26. Copyright ©2012 by Pearson Education, Inc. All rights reserved. The United States Health Care System: Combining Business, Health, and Delivery, Second Edition Anne Austin Victoria Wetle Hospitals (cont.) Hospital Personnel –Patient Services –Nursing –Ancillary Services –Support Services –General Patient/Facilities –Administrative/Out-sourcing –Business Functions

27. Copyright ©2012 by Pearson Education, Inc. All rights reserved. The United States Health Care System: Combining Business, Health, and Delivery, Second Edition Anne Austin Victoria Wetle Hospitals (cont.) Issues Affecting Hospital Administration –Standards are used as a way to measure performance –Pay close attention to financial flows –Utilization measures track and compare the performance of hospitals –Measuring hospital quality

28. Copyright ©2012 by Pearson Education, Inc. All rights reserved. The United States Health Care System: Combining Business, Health, and Delivery, Second Edition Anne Austin Victoria Wetle Hospitals (cont.) Every hospital must be licensed to operate by the state in which it is located. Hospitals can also be certified. Hospitals voluntarily participate in the accreditation standards of The Joint Commission.