Medical Delivery Management Providers
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Transcript Medical Delivery Management Providers
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.
Trends to Watch
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”
Email and Phone visits
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.
http://hsrmp.phhp.ufl.edu