2. 1.03 #1 PPP Healthcare Agencies (5.6 days for PPP x 3)

3. Journal Entry You have 15 min to write a paragraph about an experience at a healthcare agency (ie: dentist, pediatrician, physical therapist, nurse, lab tech, etc). Describe the experience, the healthcare professional you encountered, and the type of agency where you received care. Then share with the class.

4. 1.03 Understand healthcare agencies, finances, and trends Public Healthcare Systems 3

5. 1.03 Understand healthcare agencies, finances, and trends Public Healthcare Systems Also known as National Healthcare Plan Provide healthcare to all citizens Often seen in other countries –Canada –Europe No cost to the patient Residents pay high taxes 4

6. 1.03 Understand healthcare agencies, finances, and trends Private Healthcare Systems 5

7. 1.03 Understand healthcare agencies, finances, and trends Private Healthcare Systems Individuals purchase a health insurance plan and/or pay out-of-pocket. Predominate system in the United States Systems in the United States are a combination of public and private funding. 6

8. 1.03 Understand healthcare agencies, finances, and trends Healthcare Agencies Explain each of the following and record answers in notebook: government non-profit for-profit international national state local in-patient out-patient 7

9. Government Healthcare Agencies 1.03 Understand healthcare agencies, finances, and trends 8

10. Government Healthcare Agencies - International - W orld H ealth O rganization (WHO) Functions: –assess health trends –compile statistics related to disease –investigate health problems worldwide –publish health information http://www.who.int/en/ 9

11. 1.03 Understand healthcare agencies, finances, and trends Government Healthcare Agencies - National - U. S. D epartment of H ealth and H uman S ervices (USDHHS) Functions: – compile statistics related to disease –investigate health problems in the United States –prevent disease by immunizations –provide comprehensive health services –publish health information http://www.hhs.gov/ 10

12. 1.03 Understand healthcare agencies, finances, and trends N ational I nstitutes of H ealth (NIH) Functions: – World’s leading research organization –Research includes AIDScancer Alzheimer’s diabetes arthritisheart disease http://www.nih.gov/ 11

13. 1.03 Understand healthcare agencies, finances, and trends C enters for D isease C ontrol and Prevention (CDC) Functions: disease control disease prevention http://www.cdc.gov/ 12 Government Healthcare Agencies - National -

14. 1.03 Understand healthcare agencies, finances, and trends Government Healthcare Agencies - National - (USDHHS) F ood and D rug A dministration (FDA) Functions: - regulates safety of food and cosmetics - regulates safety and efficacy of drugs, biological products and medical devices http://www.fda.gov/ 13

15. 1.03 Understand healthcare agencies, finances, and trends Government Healthcare Agencies - National - (USDHHS) A gency for H ealthcare R esearch and Q uality (AHRQ) Formerly called Agency for Healthcare Policy and Research (AHCPR) Functions: - investigate quality of healthcare delivery - establish standards for healthcare treatment http://www.ahrq.gov/ 14

16. 1.03 Understand healthcare agencies, finances, and trends Government Healthcare Agencies - National - O ccupational S afety and H ealth A dministration (OSHA) Division of the US Department of Labor Functions: - create job safety standards - implement job safety standards ABC http://www.osha.gov/ 15

17. 1.03 Understand healthcare agencies, finances, and trends Government Healthcare Agencies - National - O ccupational S afety and H ealth A dministration (OSHA) OSHA standards specific to healthcare include: - personal protective equipment - blood borne pathogens - hazard communication - ergonomics http://www.osha.gov/ ABC 16

18. 1.03 Understand healthcare agencies, finances, and trends Government Healthcare Agencies - State - (USDHHS) N. C.DHHS N. C. D epartment of H ealth and H uman S ervices (NCDHHS) Functions to provide many services: AdoptionMedicaid Deaf/blind servicesMental health services Emergency servicesPregnancy services Food and nutrition servicesSenior centers In-Homes AidesVital records http://www.dhhs.state.nc.us/index.htm 17

19. 1.03 Understand healthcare agencies, finances, and trends Government Healthcare Agencies - State - (USDHHS) N. C.DHHS N. C. D epartment of H ealth and H uman S ervices (NCDHHS) Functions to provide information: Disease and health informationSafety End of life issuesTeen issues Environmental healthWellness Minority health www.dhhs.state.nc.us/index.htm 18

20. 1.03 Understand healthcare agencies, finances, and trends Government Healthcare Agencies - Local - (USDHHS, NCDHHS) County Health Department Functions: Provides services Communicable disease control Laboratory services Health inspections Oral health Immunizations Woman and child health Provides information Health education Statistics related to health, birth and death 19

22. Private Healthcare Agencies 1.03 Understand healthcare agencies, finances, and trends 21

23. 1.03 Understand healthcare agencies, finances, and trends Private Healthcare Agencies Non-Profit Supported by –donations –fees –fundraisers –grants Usual focus: –one disease or condition –related group of disorders Examples 22

24. 1.03 Understand healthcare agencies, finances, and trends Private Healthcare Agencies Non-Profit Participate in: research services education 23

25. Private Healthcare Agencies For-Profit 1.03 Understand healthcare agencies, finances, and trends 24

26. 1.03 Understand healthcare agencies, finances, and trends Private Healthcare Agencies For-Profit Provide patient services Expect monetary profit Use profit for agency growth and to increase services 25

27. 1.03 Understand healthcare agencies, finances, and trends Private Healthcare Agencies For-Profit -Inpatient- An inpatient facility is where patients stay overnight to receive medical care and treatment. 26

28. 1.03 Understand healthcare agencies, finances, and trends Private Healthcare Agencies For-Profit -Inpatient- Hospital Mostly inpatient services with some outpatient services Type is determined by size, ownership, and services offered. –General –Specialty –Government –University or college medical centers 27

29. 1.03 Understand healthcare agencies, finances, and trends Private Healthcare Agencies For-Profit -Inpatient- Long Term Care Facilities Care provided to patients who: - have chronic conditions or disabilities that require assistance with daily activities - are adults over the age of 18 - need long term or short term care 28

30. 1.03 Understand healthcare agencies, finances, and trends Private Healthcare Agencies For-Profit -Inpatient- Types of long term care facilities –Adult care homes –Assisted living facilities –Continuing care retirement communities –Nursing homes 29

31. 1.03 Understand healthcare agencies, finances, and trends Private Healthcare Agencies For-Profit Outpatient Patient receives ambulatory care. Patient does not stay overnight in the facility. 30

32. 1.03 Understand healthcare agencies, finances, and trends Private Healthcare Agencies For-Profit Outpatient 31

33. 1.03 Understand healthcare agencies, finances, and trends Private Healthcare Agencies For-Profit Outpatient Adult Day Care 32

34. 1.03 Understand healthcare agencies, finances, and trends Private Healthcare Agencies For-Profit Outpatient Doctors’ Offices 33

35. 1.03 Understand healthcare agencies, finances, and trends Private Healthcare Agencies For-Profit Outpatient Emergency Care 34

36. 1.03 Understand healthcare agencies, finances, and trends Private Healthcare Agencies For-Profit Outpatient Home Health 35

37. 1.03 Understand healthcare agencies, finances, and trends Private Healthcare Agencies For-Profit Outpatient Hospice Care Life expectancy is less than 6 months Patient care Family care 36

38. 1.03 Understand healthcare agencies, finances, and trends Private Healthcare Agencies For-Profit Outpatient Industrial Healthcare 37

39. 1.03 Understand healthcare agencies, finances, and trends Private Healthcare Agencies For-Profit Outpatient Laboratory Services 38

40. 1.03 Understand healthcare agencies, finances, and trends Private Healthcare Agencies For-Profit Outpatient Mental Health Services 39

41. 1.03 Understand healthcare agencies, finances, and trends Private Healthcare Agencies For-Profit Outpatient Outpatient Clinics 40

42. 1.03 Understand healthcare agencies, finances, and trends Private Healthcare Agencies For-Profit Outpatient School Health Services 41

43. Healthcare Agency Research You have one class period to research a healthcare agency chosen from the next slide handout (a different agency for each student). Develop a poster representing the agency you choose—follow the HOSA competitive events guidelines for Extemporaneous Health Poster www.hosa.org/natorg/sectb/cat-iii/ehp.pdf OR www.hosa.org/natorg/sectb/cat-iii/ehp.pdf You may develop your poster using Virtual Poster at edu.glogster.com You will present to class and graded using HOSA competitive events guidelines for Extemporaneous Speaking www.hosa.org/natorg/sectb/cat-iii/es.pdf www.hosa.org/natorg/sectb/cat-iii/es.pdf You have 2 days to prepare presentation and 3 min to present to class Info to include in presentation: -services provided -healthcare professionals employed by the agency -sources of finance for agency -three agencies in the commuity that provide similar services

45. Working in groups of 3-4 Complete the assignment on next slide. Discuss each scenario and patient options then document responses.

47. 1.03 #2 PPP Healthcare Finances (5.6 days for PPP x3)

49. 1.03 Understand healthcare agencies, finances, and trends Healthcare Finances Government Finances Private Finances 48

50. 1.03 Understand healthcare agencies, finances, and trends Healthcare Finances Government Funded by taxes 49

51. 1.03 Understand healthcare agencies, finances, and trends Healthcare Finances Government Medicare –Pays 80% of the charges for care –Serves patients Over age 65 Over age 65 Who have received social security disability benefits for at least 2 years Who have received social security disability benefits for at least 2 years With end stage renal disease With end stage renal disease 50

52. 1.03 Understand healthcare agencies, finances, and trends Healthcare Finances Government Medicare Plans A – hospital care B – outpatient medical care C- advantage plan D – medication 51

53. 1.03 Understand healthcare agencies, finances, and trends Healthcare Finances Government Medicare Plan A –The original Medicare plan –Automatically enrolled unless the patient specifically enrolls in a Medicare Advantage Plan (Part C) –Fee-for service –Pay a deductible and co-pay 52

54. 1.03 Understand healthcare agencies, finances, and trends Healthcare Finances Government Medicare Plan A –Hospital insurance at no cost to most people –Coverage includes inpatient care skilled nursing facilities critical access hospitals hospitalshospice home health 53

55. 1.03 Understand healthcare agencies, finances, and trends Healthcare Finances Government Medicare Plan B –Pays for necessary medical services and supplies –Most people pay a premium for Plan B –Covers outpatient care doctor’s services physical or occupational therapies additional home healthcare 54

56. 1.03 Understand healthcare agencies, finances, and trends Healthcare Finances Government Medicare Plan C –Combination of Part A and Part B –Provided through private insurance companies approved by Medicare –Option of adding Part D –Includes HMOsPPOs Private fee-for-service plans Medicare special needs 55

57. 1.03 Understand healthcare agencies, finances, and trends Healthcare Finances Government Medicare Plan D –stand-alone prescription drug coverage –most people pay a premium –plans vary and cover different drugs –can choose the best plan for patient’s needs 56

58. 1.03 Understand healthcare agencies, finances, and trends Healthcare Finances Government Medigap –A private individual insurance policy that pays the difference between the charges for care and the amount Medicare pays. 57

59. 1.03 Understand healthcare agencies, finances, and trends Healthcare Finances Government Medicaid Provides Provides healthcare for: people with low incomes children who qualify for assistance people who are disabled or blind 58

60. 1.03 Understand healthcare agencies, finances, and trends Healthcare Finances Government Medicaid –Funded by federal government but regulated by individual state government –Not all people with low income qualify 59

61. 1.03 Understand healthcare agencies, finances, and trends Healthcare Finances Government TRICARE Military health plan Serves: Active duty personnel and family Survivors of military personnel Retired military personnel 60

62. 1.03 Understand healthcare agencies, finances, and trends Healthcare Finances Government Veterans Health Administration P rovides healthcare services to former military personnel 61

63. -Discussion- *Record responses in notebook Explain how a patient might be eligible for both Medicare and Medicaid benefits. What are some healthcare costs the patient will have to pay, even with support from government finance?

65. 1.03 Understand healthcare agencies, finances, and trends Healthcare Finances Private Private Insurance – –Individual insurance plan, the insured pays the total amount of the monthly premium Group insurance plan – –the insured individual and their employer share the amount of the monthly premium 64

66. 1.03 Understand healthcare agencies, finances, and trends Healthcare Finances Private Health Maintenance Organization (HMO) –care is directed toward prevention of disease –patient must see only HMO approved providers –pay a monthly fee, no additional charge for care –care from non-HMO provider generally not covered 65

67. 1.03 Understand healthcare agencies, finances, and trends Healthcare Finances Private Preferred Provider Organization (PPO) –Group of doctors and/or hospitals that provide care to a specific group –PPO provides services to the insured at a reduced rate –Usually require a deductible and a co-pay –Less coverage for treatment provided by non- PPO provider 66

68. 1.03 Understand healthcare agencies, finances, and trends Healthcare Finances Private Indemnity Plan ־ Traditional plan with freedom to visit physician of choice ־ No referral required by insurance company ־ Pay “up front” ־ Get reimbursed amount allowed by insurance policy; amounts may vary 67

69. 1.03 Understand healthcare agencies, finances, and trends Healthcare Finances Private Out of pocket CASH 68

70. 1.03 Understand healthcare agencies, finances, and trends Healthcare Finances Private Workers’ Compensation http://www.comp.state.nc.us Pays for the healthcare of workers injured on the job 69

71. -Discussion- *Record responses in notebook Compare an HMO and a PPO. What are some costs the patient will have to pay?

73. -Discussion- What do you think happens to the patient that is not able to pay for their healthcare? Where would the patient that cannot pay go for healthcare?

74. 1.03 #3 PPP Healthcare Trends (5.6 Days for PPP x3)

75. 1.03 Understand healthcare agencies, finances, and trends Healthcare Trends Technology Epidemiology Geriatric Care Wellness Cost Containment Measures 74

76. 1.03 Understand healthcare agencies, finances, and trends Healthcare Trends Technology Telemedicine – –Imaging procedures (digital x-rays) – –Telehealth – –Home telehealth 75

77. 1.03 Understand healthcare agencies, finances, and trends Healthcare Trends Technology Robotic Surgery - Shorter hospital stay - Less pain and scarring - Less wound infections - Less blood loss - Faster recovery - Quicker return to normal activities 76

78. 1.03 Understand healthcare agencies, finances, and trends Healthcare Trends Technology Health Information Management Systems – –Patient records – –Billing – –Scheduling – –Supply inventory 77

79. 1.03 Understand healthcare agencies, finances, and trends Healthcare Trends Epidemiology Study of disease patterns within a population – –Identifies risks of disease – –Indicates methods of disease prevention or containment Changes in treatment – –Advances in diagnostics – –Early intervention – –Development of treatment options Increased patient awareness and education 78

80. 1.03 Understand healthcare agencies, finances, and trends Healthcare Trends Geriatric Care Need for geriatric care –People live longer –Average age will continue to increase –Older people need more assistance –They need care more frequently 79

81. 1.03 Understand healthcare agencies, finances, and trends Healthcare Trends Geriatric Care Geriatric care facilities –Adult Day Care –Independent living facilities –Nursing Homes –Retirement incomes 80

82. 1.03 Understand healthcare agencies, finances, and trends Healthcare Trends Wellness Common wellness practices – –Weight management – –Health foods – –Nutrition – –Stress reduction – –Healthy behaviors 81

83. 1.03 Understand healthcare agencies, finances, and trends Healthcare Trends Healthcare Trends Cost Containment Measures Outpatient Care –Patient receives ambulatory care. –Does not stay overnight in the facility. 82

84. 1.03 Understand healthcare agencies, finances, and trends Healthcare Trends Healthcare Trends Cost Containment Measures Diagnostic Related Groups (DRGs) – –Classification of similar clinical conditions that have similar expected use of hospital resources – –Criteria Diagnoses Procedures Age Sex Discharge status Presence of complications 83

85. 1.03 Understand healthcare agencies, finances, and trends Healthcare Trends Healthcare Trends Cost Containment Measures Managed Care – –Designed to reduce the cost of healthcare – –Contacts with a specific group of providers – –Requires prior approval to see a specialist 84

86. 1.03 Understand healthcare agencies, finances, and trends Healthcare Trends Healthcare Trends Cost Containment Measures Preventative Care – –Focus is to maintain wellness and to prevent illness – –It is less expensive to maintain good health than to treat or cure an illness – –Focus is on diet, exercise, and health maintenance activities such as yearly physicals, health screenings and immunizations 85

87. 1.03 Understand healthcare agencies, finances, and trends Healthcare Trends Healthcare Trends Cost Containment Measures Energy Conservation – –Reduce, Reuse, Recycle – –Turn off electrical equipment when not in use – –Maintain comfortable temperature – –Use resources wisely 86

88. 1.03 Understand healthcare agencies, finances, and trends Healthcare Trends Cost Containment Measures Outpatient Care Diagnostic Related Groups (DRGs) Managed Care Preventative Care Energy Conservation 87

89. 1.03 Understand healthcare agencies, finances, and trends Healthcare Trends Technology Epidemiology Geriatric Care Wellness Cost Containment Measures 88

90. -Discussion- What impact do current trends have on the healthcare system? What impact do current trends have on patient access to care? What can we do to reduce the cost of healthcare?

91. Biomedical Debate Using HOSA Competitive Events guidelines ( www.hosa.org/natorg/sectb/cat-iv/bmd.pdf ) for Biomedical Debate, research and prepare to debate on The National Healthcare Plan: Solution for All Healthcare Needswww.hosa.org/natorg/sectb/cat-iv/bmd.pdf Groups of 3-4 (*need 4 groups) 2 groups are Affirmative and 2 are Negative One class period to research Groups will debate as presented on page 2 of event guidelines. A script is on page 8. Use Judges rating sheets to evaluate debates.

92. O bjective 1.03 Understand healthcare agencies, finances, and trends.