Outpatient Services and Primary Health Care Heidi Kinsell Manager, Academic Programs Health Services Administration

Overview for Today Outpatient Care Primary Care What are key issues?

Some Key Terms Outpatient Services Ambulatory Care Primary Care

Definitions Outpatient Services = those that do not require overnight hospital stay. Ambulatory Services = services provided to the “walking” patient. Community Medicine = services provided in the immediate “community” where patients live

Where is Outpatient Care Provided? Physician offices Hospital outpatient departments Diagnostic (e.g. lab, radiology) Therapeutic (e.g. PT, chemotherapy) Hospital emergency departments Nursing homes, Home health, Hospice Ambulatory clinics and surgery centers Chiropractors Public health centers/services Retail Clinics

Outpatient Care = Growth! All trend lines are up, up, up Why? Reimbursement changes Payments Utilization controls New technologies Patient preferences

Important Considerations Outpatient services are delivered…. In a variety of settings By various types of providers For various conditions Acute Chronic Preventive Primary, secondary, tertiary Etc.

Retail Clinics Use of the Internet in various ways Information (general, specific) Tracking care (conditions, progress) Finding providers, support groups, “community” Increased role of the patient/consumer “Medical Home” and Phone visits Trends to Watch

The Health Services System Preventive Care Primary Care Secondary Care Tertiary Care Restorative Care Continuing Care

The Health Services System Preventive Care Primary Care Secondary Care Tertiary Care Restorative Care Continuing Care

Understanding Primary Care Primary Care Main health care provider in non-emergency situations Secondary Care Specialist for expert opinion or surgical/other intervention. Tertiary Care Complex care for relatively uncommon conditions (usually institution-based and technology-driven)

Two Dimensions to Consider Type of Care Preventive-- Coordination-- Continuing Location of Care Inpatient --- Outpatient With various inpatient sites (e.g. hospital, nursing home) and outpatient locations (e.g. physician office, surgery center, home)

Primary Care Three key elements Point of Entry Coordination of Care Essential Care

Point of Entry First contact with health care system Gatekeepers Patients come “through” primary care physicians to hospitals and specialists Con: Limits care? Pro: Prevents unnecessary care?

Coordination of Care PCPs coordinate delivery of care from many sources Patient advisors, patient advocates Ensure continuity and comprehensiveness The Evidence this works (better health outcomes) people prefer it (patient satisfaction)

Ideal Attributes of Primary Care Integrated Coordinating Continuity of care Accessibility Remove barriers of geography, financing, race, language, culture Accountability For both patients and providers

Who Provides Primary Care?  Physicians/Doctors  Extenders Nurses Ancillary Alternative

Physicians PCPs (Primary Care Physicians) Typically… Family Practice General Internal Medicine Pediatrics Obstetrics & Gynecology Others Controversy Who? Specialized primary care training?

PCP Trends Historically over-supply of specialists Bias towards specialists and sub-specialists Follow the money Now/Future Growing demand for PCPs Income still lower New organizational and financial structures promoting use of primary care physicians

Physician Extenders or Nonphysician Practitioners Nurse Practitioners Physician Assistants Nurse Midwives Social Workers Nutritionist

Alternative Medicine Providers Also known as “complementary medicine” Examples include… Chiropractic Homeopathy, herbal formulas Acupuncture Meditation, biofeedback Spiritual guidance Others

Primary Care Tools Clinical guidelines Disease management Case management Pharmacy care management Others

Future Trends/Issues Will the system “adjust” to appropriate mix of primary & speciality care? Enough primary care physicians in the right places? (Rural, Urban) Healthcare Reform-GME payments

Conclusions Primary care is a fundamental component of the health care system today and tomorrow.