D065 Healthcare Ecosystems

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Western Governors University *

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D065

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Medicine

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Apr 3, 2024

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HEALTHCARE ECOSYSTEMS D065 ESSENTIAL READING CHAPTER ONE THE US HEALTHCARE DELIVERY SYSTEM Specialty physicians also complete extensive postgraduate medical education. Board certification for specialties requires the completion of postgraduate training and passing standardized examination common specialties include internal medicine, pediatrics, family practice, cardiology, neurology, oncology, radiology. Common surgical specialties include anesthesiology, cardiovascular surgery, obstetrics and gynecology, orthopedics, urology, ophthalmology, plastic and reconstructive surgery, neurosurgery. 1910 Dr. Franklin Martin suggested surgical care needed to pay better attention to patient outcomes. He learned these concepts from Dr. Ernest Codman who thought outcomes should be tracked over time to determine what method worked best. At the time there was a lack of trained medical staff and lax professional standards contributed to problems. In the early 20 th century hospitals were used primarily for performing surgery other nonsurgical care was typically completed at home. The push for hospital reform led to the formation of the American College of Surgeons in 1913 Federal healthcare legislation 1902- Biologics Control Act: regulated the vaccines and serums sold via interstate commerce this assisted in launching the National Institutes of Health and other laboratories 1935-Social Security Act provided states matching funds for maternal and infant care, rehabilitation of crippled children, general public health, an aid for dependent children 1946-Hospital Survey and Construction Act authorized grants for states to construct new hospitals also created a boom in hospital construction grew from 6000 to 7200 1965-Public Law 89-97 amendments to social security that created Medicaid and Medicare providing healthcare benefits to people over 65, disabled, widowed, child survivors, and the poor

1972-Public Law 92-603 expanded initial Medicare and Medicaid requirements for utilization review to include concurrent review and established standards and made efforts to control the rising costs of healthcare by evaluating patient care services for necessity, quality and cost reduction 1974- Health Planning and Resources Development Act created a system of local organizations called health systems to make service and technology decisions along with other legislation it was unsuccessful in slowing cost increases and was repealed in 1986. 1977-Utilization Review Act required hospitals to conduct continued stay reviews to determine medical necessity, includes regulations for fraud and abuse also added additional efforts to control healthcare costs 1982- Peer Review Improvement Act redesigned the PSHRO program, hospitals began to review medical necessity for hospitalization prior to admission 1982-Tax Equity and Fiscal Responsibility Act (TEFRA) introduced the prospective payment system for Medicare reimbursement to control the rising cost of providing healthcare services this also changed Medicare reimbursement from a fee-for-service model to a predetermined level of reimbursement 1982/1983- Prospective Payment Act defined the prospective payment system and the use of DRG’s as the methodology for inpatient care this Act was moderately successful at slowing the rate of healthcare spending in the US 1985/1986- COBRA allowed the federal government to deny reimbursement for substandard services provided to Medicaid and Medicare recipients. This began establishing a link between quality and reimbursement 1986-Helathcare Quality Improvement Act established the National Practitioner Data Bank providing a clearinghouse for medical practitioners who have a history of malpractice suits and other quality problems 1989-Ominibus Budget Reconciliation Act instituted the Agency for Healthcare Policy and Research now known as Agency for Healthcare Research and Quality (AHRQ) 1996-HIPAA addressed issues related to the portability of health insurance after leaving employment and administrative simplification of healthcare also reduced barriers to changing employers due to existing health conditions and created a federal floor for healthcare policy

1996- Mental Health Parity Act, if metal health benefits are provided by an employer the benefits must be equal to the benefits provided under medical policies 2009- HITECH accelerated the adoption of and use of information technology in healthcare through economic incentive and planned future financial penalties, this also expanded HIPAA privacy protections and established regional extension centers 2010- Affordable Care Act, Obamacare required most US citizens to have healthcare coverage through increased access to health insurance, tax credits to employers offering health insurance, expansion of Medicaid programs The HHS updates their strategy every four years 2014-2018 contains the following goals Strengthen healthcare, advance scientific knowledge and innovation, advance the health safety and well-being of the American people, and to increase the efficiency transparency accounting and effectiveness of all HHS programs BIOMEDICAL AND TECHNOLOGICAL ADVANCES IN MEDICINE Biotechnology is defined as the field devoted to applying techniques of biochemistry, cellular, biology, biophysics, and molecular biology to addressing practical issues related to human beings, agriculture and the environment. Two examples are pharma and medical device companies. A medical device company produces devices such as instruments, machines, or an implement or apparatus intended for use in the diagnosis of disease or for monitoring or treatment of a condition. Below is a chronological timeline of advancements in biomedicine and technology  1842- first recorded use of ether as an anesthetic  1860s Louis Pasteur laid the foundation for modern bacteriology  1865 Joseph Lister was the first to apply Pasteur’s research to treatment of infected wounds  1880s-1890s steam first used in sterilization  1895 Wilhelm Roentgen made observations that led to the development of X-ray technology  1898 Introduction of rubber surgical gloves, sterilization, and antisepsis  1940 studies of prothrombin time first made available

 1941-1946 studies of electrolytes; development of major pharmaceuticals  1957 studies of blood gas  1961 studies of creatine phosphokinase  1970s surgical advances in cardiac bypass surgery, surgery for joint replacement and organ transplantation  1971 computed tomography first used in England  1974 introduction of whole-body scanners  1980s introduction of MRI  1990s further technological advances in pharmaceuticals and genetics including the Human Genome Project  200s NIH creates roadmap to accelerate biomedical advances, creates effective prevention strategies and new treatments, and bridges knowledge gaps in the 21 st century ORGANIZATION AND OPERATION OF MODERN HOSPITALS The term hospital can be applied to any healthcare facility with the following four characteristics: An organized medical staff, Permanent inpatient beds, Around-the-clock nursing services and Diagnostic and therapeutic services. Most hospitals provide some level of acute care which is defined as short-term care provided to diagnose and treat an illness or injury. Types of services provided - Rehab services for those with chronic, debilitating illness or injury patients often stay here for several months - Psychiatric hospitals provide inpatient care to individuals with mental or developmental disorders patients typically spend several days to months in these hospitals and often require repeat hospitalizations for chronic psychiatric illness - General and acute care hospitals provide a wide range of medical and surgical services used to diagnose and treat illness and injury - Specialty hospitals provide diagnostic and therapeutic services for a limited range of conditions (burns, cancer, TB, OBGYN etc.) Hospitals can be owned by a variety of entities. Government owned hospitals are operated by the state, federal, and local governments. Government owned are also called public hospitals they are supported at least in part by tax dollars.

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