Transcript Medical Delivery Management Providers

Outpatient Services and
Primary Health Care
Heidi Kinsell
Master of Health Administration (MHA)
Health Services Research, Management and
Policy
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Overview for Today
 Outpatient
Care
 Primary Care
 Key Issues
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Definitions
Outpatient = 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.
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Where is Outpatient Care Provided?
Physician offices
Hospital outpatient departments
◦ Diagnostic (e.g. lab, radiology)
◦ Therapeutic (e.g. PT, chemotherapy)
 Hospital EDs
 Nursing homes, Home health, Hospice
 Ambulatory Surgery Centers
 Public Health Centers
 Retail Clinic/Convenient Care Clinic
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Outpatient Care = Growth!
All trend lines are up, up, up
 Reimbursement changes

◦ Payments
◦ Utilization controls
New technologies
 Patient preferences
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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
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The Health Services System
Preventive Care
 Primary Care
 Secondary Care
 Tertiary Care
 Restorative Care
 Continuing Care
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Understanding Primary Care

Primary Care
◦ Main health care provider in non-emergency situations

Secondary Care
◦ Specialist for expert opinion or surgical/other
intervention
◦ May include hospitalization, surgery, rehabilitation

Tertiary Care
◦ Complex care for relatively uncommon conditions
(usually institution-based and technology-driven)
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Two Dimensions to Consider

Type of Care
◦ Preventive --Coordination--- Continuing
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Location of Care
◦ Inpatient --- Outpatient
◦ With various inpatient sites (e.g. hospital,
nursing home) and outpatient locations (e.g.
physician office, surgery center, home)
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Primary Care

Three key elements
◦ Point of Entry
◦ Coordination of Care
◦ Essential Care
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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?
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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)
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Ideal Attributes of Primary Care
Integrated
 Coordinating
 Continuity of care
 Accessibility
 Accountability

◦ For both patients and providers
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Primary Care Tools
Clinical guidelines
 Disease management
 Case management
 Pharmacy care management
 Others
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Who Provides Primary Care?
Physicians
 Extenders
 Nurses
 Ancillary
 Alternative providers
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Physicians
PCPs (Primary Care Physicians)
 Typically…
◦ Family Practice
◦ General Internal Medicine
◦ General Pediatrics
◦ Obstetrics & Gynecology
 Controversy
◦ Who?
◦ Specialized primary care training?
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Extenders & Non-physician
Practitioners
Nurse Practitioners
 Physician Assistants
 Nurse Midwives
 Other Health Care Providers
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Trends

Historically
◦ Over-supply of specialists
◦ Bias towards specialists and sub-specialists
◦ Follow the money
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Now/Future
◦ Growing demand for PCPs
◦ Income still lower
◦ New organizational and financial structures
promoting use of primary care physicians
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HC Reform & Primary Care
Patient Centered Medical Home (PCMH)
 Community Health Focus
 More grant funding & payments for PC
training
 Increased Medicare reimbursements for
PCPs
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Conclusion
Will the system “adjust” to appropriate
mix of primary & specialty care?
 Primary care is a fundamental component
of the health care system today and
tomorrow.
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◦ UnitedHealthcare, RI Foundation offer $250K for
primary care docs
◦ CA’s Eisenhower Medical Center gets teaching
approval for primary care
◦ 1 in 4 New Docs Regret Career Path
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Master of Health Administration, MHA
 Health Management & Policy
Concentration of MPH
 PhD in Health Services Research
 http://hsrmp.phhp.ufl.edu
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