Hospitals and Ambulatory Care

H Edu 5100

History

1873 = 178 1909 = 4,300 1946 = 6,000 1970s = 7,200 2000s = 4,000

Growth and Decline

Technology/war Financial incentives Costs

Capital Financing

Hill-Burton Act (1946) Medicare and Medicaid Three factors…

Guaranteed revenuesTax exemptionCost reimbursement

Hospital borrowing

Types of Ownership

Voluntary, not-for-profit Investor-owned, for-profit Government

Legal Structure

Governing board Medical staff Management

Operational Structure

Medical division Nursing division (clinical services) Other Clinical and diagnostic Administrative “Hotel” Services

Patient Rights/Responsibilities

Rights Responsibilities

Informed Consent

Established legal practice Right to know…

Quality of Care

JCAHO Structural reviews Process audits Results focus Indicators Fragmentation

Re-engineering

New models vs incremental change Hospitals = one component vs hub Service orientation

Integration

Horizontal Vertical

Role of Physicians

Admissions What services are used Guest in hospital

Sources of Revenue

Philanthropy Global budgets Charges (price) Cost reimbursement Per case (DRG) Capitation Managed care

Funds Out

Payroll Professional fees Supplies and other Capital depreciation and interest

Who Gets the Profits?

Physicians Hospitals For-profit vs non-profit

Competition Among Hospitals

Good or bad?

Current Issues…

Team-based care Hospitalists Patient Expectation

Magnet Hospitals

Nursing leadership Standards for nurse administrators Protected feedback procedures Unfair labor practices Regulatory compliance Data collection

Ambulatory Care

Origins

Private medical practices Indigent clinics ERs Public health clinics

Evolution of physician practices

Solo Group Multi-specialty groups

Hospital Outpatient Activities

Indigent clinics Outpatient services Outpatient departments Specialty clinics

The Emergency Room

Freestanding Centers

Who owns? Who uses? Hospital concerns Surgical centers

Impact on triangle

Access Quality Cost