Transcript Medical Delivery Management Providers

Outpatient Services and
Primary Health Care
Christy Harris Lemak, Ph.D
Associate Professor
Health Services Administration
Overview for Today
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Outpatient Care
Primary Care
What are key issues?
Some Key Terms
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Outpatient Services
Ambulatory Care
Primary Care
Definitions
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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?
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Physician offices
Hospital outpatient departments
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Diagnostic (e.g. lab, radiology)
Therapeutic (e.g. PT, chemotherapy)
Hospital emergency departments
Home health agencies
Ambulatory clinics and surgery centers
Chiropractors, other types of providers
Neighborhood health centers
Public health centers/services
Hospice
Outpatient Care = Growth!
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All trend lines are up, up, up
Why?
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Reimbursement changes
Payments
 Utilization controls
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New technologies
Patient preferences
Important Considerations
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Outpatient services are delivered….
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In a variety of settings
By various types of providers
For various conditions
Acute
 Chronic
 Preventive
 Primary, secondary, tertiary
 Etc.
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Some Trends to Watch
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Telephone and Email visits
Group visits
Use of the Internet in various ways
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Information (general, specific)
Tracking care (conditions, progress)
Finding providers
Finding support groups, “community”
Increased role of the consumer/patient
The Health Services System
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Preventive Care
Primary Care
Secondary Care
Tertiary Care
Restorative Care
Continuing Care
The Health Services System
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Preventive Care
Primary Care
Secondary Care
Tertiary Care
Restorative Care
Continuing Care
Understanding Primary Care
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Primary Care
Secondary Care
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Tertiary Care
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Short-term, sporadic consultation from a specialist
for expert opinion or surgical/other intervention
Typically includes hospitalization, surgery,
rehabilitation
Complex care for conditions that are relatively
uncommon (usually institution-based and
technology-driven)
Can be long-term
Quaternary Care
Two Dimensions to Consider
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Type of Care
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Preventive ----- Continuing
Location of Care
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Inpatient --- Outpatient
With various inpatient sites (e.g. hospital,
nursing home) and outpatient locations (e.g.
physician office, surgery center, home)
Primary Care
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Three key elements
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Point of Entry
Coordination of Care
Essential Care
Point of Entry
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First contact with health care system
Gatekeepers
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Patients come “through” primary care
physicians to hospitals and specialists
Con: Limits care?
 Pro: Prevents unnecessary care?
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Coordination of Care
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PCPs coordinate delivery of care from
many sources
Patient advisors, patient advocates
Ensure continuity and comprehensiveness
The Evidence
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this works (better health outcomes)
people prefer it (patient satisfaction)
Essential Care
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Meeting needs to optimize population
health
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What is population health?
Why do we care?
Ideal Attributes of Primary Care
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Integrated
Coordinating
Continuity of care
Accessibility
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Remove barriers of geography, financing,
race, language, culture
Accountability
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For both patients and providers
Who Provides Primary Care?
 Physicians
 Doctors
 Extenders
 Nurses
 Ancillary
 Alternative
Physicians
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PCPs (Primary Care Physicians)
Typically…
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Family Practice
General Internal Medicine
Pediatrics
Obstetrics & Gynecology
Others
Controversy
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Who?
Specialized primary care training?
PCP Trends
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Historically
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over-supply of specialists
Bias towards specialists and sub-specialists
Follow the money
Future
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Growing demand for PCPs
Income still lower
New organizational and financial structures
promoting use of primary care physicians
Doctors
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Allopathy
Osteopathy
Optometry
Psychology
Podiatry
Pharmacy
Physician Extenders or
Nonphysician Practitioners
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Nurse Practitioners
Physician Assistants
Nurse Midwives
Social Workers
Nutritionist
Alternative Medicine Providers
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Also known as “complementary medicine”
Examples include…
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Chiropractic
Homeopathy, herbal formulas
Acupuncture
Meditation, biofeedback
Spiritual guidance
Others
Trends:
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Growth!
Growing acceptance by traditional health care
systems
Primary Care Tools
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Clinical guidelines
Disease management
Case management
Pharmacy care management
Others
Future Trends/Issues
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The aftermath of September 11, 2001
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Mental health needs
Potential for bioterrorism
Conclusions