Chapter 2 HIM 1000
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HIM 1000 1
Chapter 2: Healthcare Delivery Systems
United States Healthcare System
- Covers a wide range of services from Preventative care like immunizations to Complex procedures like heart transplants.
- Individual contact with the healthcare system begins at birth and continues through death
- Employs an estimated 16 million workers
Medical Practices
- “Doctor” refers to a graduate degree.
- Examples of doctors who are practitioners: o
Chiropractor (DC—Doctor of Chiropractic): focuses on the diagnosis, treatment, and
prevention of disorders of the neuromusculoskeletal system.
o
Dentist (DDS or DMD—Doctor of Dental Surgery or Doctor of Medicine in Dentistry):
focuses on the diagnosis, prevention, and treatment of diseases and conditions of the oral cavity.
o
Medical (MD—Doctor of Medicine): focuses on the diagnosis, treatments, and education of any human disease or condition; most prevalent in U.S.
o
Optometrist (OD—Doctor of Optometry): focuses on vision and visual systems and is trained to prescribe and fit lenses to improve vision.
o
Osteopath (OD—Doctor of Osteopathic Medicine): not only focuses on manipulation
of muscles and bones but also incorporates the diagnosis an treatment of diseases.
o
Podiatrist (DPM—Doctor of Podiatric Medicine): focuses on the treatment of disorders of the foot, ankle, and lower extremities.
- Main difference between a DO and MD is in the philosophy and approach to medical treatment. o
The DO practices osteopathic medicine, which places emphasis on the muscular system, stresses preventative medicine, and takes a holistic approach to patient care.
o
MDs practice allopathic medicine, which utilizes medical treatment as an active intervention to counteract and neutralize the effects of disease. MDs may utilize preventative combined with allopathic medicine.
- Physicians can be categorized as generalists or specialists. o
Generalists are trained in family medicine, general practice, general internal medicine, and general pediatrics. Generalists are considered primary care physicians.
o
Specialists are non-primary care physicians. They must obtain additional certification in their specialty. Pg. 23-26
- Medical specialties are divided into 6 major categories: 1) subspecialties of internal medicine 2) broad medical specialties 3) obstetrics and gynecology 4) surgery 5) hospital-based radiology and anesthesiology 6) psychiatry. o
Sample medical specialties: internal medicine, pediatrics, family practice, cardiology
o
Sample surgical specialties: anesthesiology, orthopedics, cardiovascular surgery
o
Hospitalist—a physician who specializes in the care of inpatient hospital patients. Care is transferred to PCP.
HIM 1000 2
o
Physician Assistants (PA)—licensed to provide care and perform medical procedures only under the supervision of a physician. In most states, Pas have the authority to prescribe medications.
Nursing Practices o
Licensed practical nurses (LPN)—nurses who graduate from nonacademic training programs. Work under direct supervision of RN. o
Registered nurses (RN)—associate degree or bachelor degree
o
Nurse practitioner—RN plus postgraduate education
o
Nurse specialization: surgery, psychiatry, intensive care, nurse-midwives
Allied Health Professions
o
Support physicians, nurses, and physician assistants
o
Receive certificate or higher in healthcare-related science
o
All 50 states require licensure for some allied health professions
o
Significant shortages in many allied health professions are expected to reach up to 2.5 million by 2020.
o
Examples of Allied Health Professions—clinical laboratory science, diagnostic imaging technology, dietetics, emergency medical technology, health information management, occupational therapy, physical therapy, respiratory therapy, speech-
language pathology and audiology. Pg. 28-29
Check your understanding 2.1
1.
Which of the following physicians specializing in the care of inpatient hospital patients? Hospitalist 2.
Which healthcare professional is licensed to practice medicine with physician supervision? Physician Assistant
3.
Which service diagnoses and treats patients who have acute or chronic lung disorders? Respiratory therapy
4.
Which healthcare provider utilizes ultrasound, computed tomography, or magnetic resonance imaging? Radiologic technologist
5.
Which of the following is surgical specialty? Orthopedics
6.
Which statement is true about RNs? RNs are required to have a license in the state in which they practice
7.
Who performs a wide array of tests on body fluids, tissues, and cells to assist in the
detection, diagnosis, and treatment of diseases and illnesses. Clinical laboratory scientists 8.
T or F: HIM professionals are responsible for ensuring the availability, accuracy, and
protection of clinical information. True
9.
T or F: Audiologists provide comprehensive diagnostic and treatment and rehabilitative services for auditory, vestibular, and related impairments. True
10.
T or F: Physical therapists and occupational therapists are the only members
of the rehabilitation service team. False
Organization and Operation of Modern Hospitals
o
Integrated delivery system (IDS): Second curve of healthcare. o
Hospitals/ healthcare facilities merged to form IDS. o
These healthcare systems combine financial and clinical aspects of healthcare and
uses a group of healthcare providers, selected on the basis of quantity and cost
HIM 1000 3
management criteria, to furnish comprehensive health service across the continuum of care.
o
Integrated delivery network (IDN)
o
Health expenditures: Approx $3.5 trillion; 17.9% of the total American economy
o
Hospital
- Has organized medical staff
- Provides permanent medical staff
- Provides permanent inpatient beds
- Offers around-the-clock nursing service
- Provides diagnostic and therapeutic services
o
Acute Care hospital
- Short-term care provided to diagnose treat illness or injury
- Average length of stay is 25 days or less
-Includes long term acute care hospitals
- Inpatient and outpatient care
Hospital Classification
o
5 major criteria used to classify hospital types: pg. 33-34
- Functionality, location, number of beds, specialization, types of ownership. o
Number of beds: - Bed capacity (licensed or staffed); Adult and Pediatric
o
Types of Services provided: - Rehabilitation, Psychiatric, General, Specialty
o
Types of patients served
o
For-profit or not-for-profit status
o
Type of ownership: pg. 34
- Government-owned, proprietary, voluntary
o
Safety net hospitals - Highest number of inpatient stays that were paid by Medicaid or uninsured
- More likely to be a teaching hospital
- Large number of inpatient beds
- 27% located in large metropolitan areas
o
Critical access hospital
- Part of Balanced Budget Act of 1997
- If specific criteria are met, CAH are allowed a separate payment system not
subject to
IPPS or OPPS, and pays 101% of reasonable costs
-Criteria to qualify—
- Located in a state that accepted a grant under the Medicare Rural Hospital Flexibility Program
- Located in a rural area
- Furnish 24-hour emergency care services
- Maintain no more than 25 inpatient beds
- Have an ALOS of 96 hours or less per patient (ALOS is the mean length of stay
HIM 1000 4
for hospital inpatients discharged during a given period of time)
- Be located more than 35 miles from any other hospital
- Be certified as CAH prior to January 1, 2006
Organization of Hospital Services
- Board of directors:
o
Aka the governing board or board of trustees
o
Has primary responsibility for setting the overall direction of the hospital. o
Develops hospital’s strategic direction, mission, vision, and values. o
Establishing bylaws in accordance with organization’s legal and licensing requirements. o
Selecting qualified administrators.
o
Approving the organization and makeup of the clinical staff
o
Monitoring the quality of care
o
Pg 35
- Professional medical staff:
o
Consists of physicians who have received extensive training in various medical disciplines.
o
Primary objective to provide high quality patient care to the patients who come to hospital o
Diagnose illnesses and develop patient centered treatment regimens
o
May serve on hospitals governing board
o
Medical staff classifications—active, provisional, honorary, consulting, courtesy, and medical resident assignments
o
Diagnose and treat patients, clinical privileges, officers, medical staff bylaws
o
Pg.36
- Executive administrative staff:
o
CEO is leader
o
CEO implements policies and strategic direction set by hospitals board of directors
o
CEO responsible for building an effective executive management team and coordinating the hospital’s services
o
Chief Financial Officer (CFO): senior manager responsibly for fiscal management of
the organization
o
Chief Operating Officer (COO): executive responsible for high level day-to-day operations
o
Chief Information Officer (CIO): senior manager responsible foe the management of information resources
o
Chief Nursing Officer (CNO)
o
Team is responsible for managing the hospital’s finances and ensuring compliance
with the federal, state, and local rules, standards, and laws that govern the delivery of healthcare services
- Medical and surgical services
- Patient care (nursing) services:
o
Most direct patient care in hospitals provided by professional nurses.
HIM 1000 5
o
In almost every hospital, patient care services makes up the largest clinical department in terms of staffing, budget, specialized services offered, and clinical expertise required
o
Responsible for performing patient assessments, creating care plans, evaluating the appropriateness of treatment, and evaluating effectiveness of care. - Diagnostic services:
o
Allied health professionals
o
Clinical laboratory, radiology, and nuclear medicine. Therapeutic services include clinical lab services, radiology and radiation therapy.
- Rehabilitation services:
o
Dedicated to eliminating patient’s disability or alleviating it as fully as possible. o
Goal is to improve the cognitive, social, and physical abilities of patients impaired
by chronic disease or injury.
o
Include: physicians, burses, occupational therapists, physical therapists,
respiratory therapists, speech therapists
o
Service can be provided within the acute-care setting or in specialty hospitals
performing many forms of rehab. - Ancillary Support services:
o
Provide vital clinical and administrative support services to patients, medical
staff, visitors & employees
o
Provides following services—pharmaceutical, food and nutrition, health
information , social work and social services, patient advocacy, environmental
(housekeeping), purchasing, central supply, and materials management services,
engineering and plant operations (maintenance)
- Administrative Support Services
o
Admissions and central registration, claims and billing, accounting, information
services, human resources, public relations, fund development, marketing
- Healthcare Organizational Chart—pg. 38
Check your understanding 2.2
1. The emphasis on treating individual patients at the level of care required by their
treatment across all healthcare services refers to? Continuum of care
2. Who has the primary responsibility to guide the direction of the hospital? Board of
directors
3. What is an example of a federally run hospital? Veterans Administration
4. This type of hospital has the majority of its inpatient visits paid for through Medicaid?
Safety net hospitals
5. Dr. Smith has been granted permission by community hospital to perform cardiac
catheterizations. This permission is called? Clinical privileges 6. T or F: Acute-care hospitals provide short term care to diagnose or treat an illness.
True
7. T or F: Case management is the ongoing, concurrent review to ensure the necessity
and effectiveness of clinical services provided to patients. True
8. T or F: Pharmaceutical services are considered part of the clinical support services.
True
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