Session 8 – February 24, 2011

Health Care Processes, Service Delivery & the Continuum of Care

Organization, Integration and New Strategies for Improving the System

Group presentation #5: Race Against Time

Health System Organization

1

Ambulatory/Outpatient Services:Scope and Definition

By service: preventive, diagnostic, therapeutic, emergent

By location:community, hospital

By discipline:medicine, dental, vision, complementary

By setting:surgi-centers, clinics, dialysis, psychiatric

By level:primary, secondary, tertiary2

Why the Growth in Outpatient Care?

3

Outpatient SurgeryNew Diagnostic TestsTechnologyReimbursementSpecialized Treatment Centers/Physician

Office PracticesSocial FactorsSettings and Overall Increase in Demand

Growth in Outpatient Services:The Issue of AccessE.D. Use by Patient

Flow

E.D. Use by Frequency and PayerInsurance

Status1 ED Visit 2 ED Visits 3+ ED Visits

Private Insurance

78% 14% 8%

Medicaid 75% 16% 9%

Medicare 72% 17% 11%

Uninsured 86% 11% 3%

Time Period Percent of Visits

8 a.m. – 4 p.m. 44%

4 p.m. – 12 a.m. 37%

12 a.m. – 8 a.m. 19%

4

Reasons for Seeking Care in the ED

Medical33% - fever, flu, cough,

etc.19% - pain11% - injury8% - gastro-intestinal28% - other

Duration of Medical Problem21% - a few hours23% - one day21% - two or three days19% - four to seven

days9% - more than a week7% - more than a month

Contact with Medical Personnel Prior to Coming to ED35% - yes63% - no2% - Tried, but unable

Reason for Not Going to Usual Source of Care*51% - Prefer ED because

no appointment required, don’t have to wait

31% - Office/clinic closed14% - Told to go to ED4% - Financial/insurance

reasons*Does not include those without a usual source of care.

5

Inpatient Care and Institutions

6

Social Welfare Role

Care for the Sick

Institutions for Medical Practice

Institutions for Medical Training and Research

Expansions, Consolidation & Expansion of Complex Health Systems

Inpatient Concepts

7

Discharges, (In)patient daysAverage length of stayCapacityAverage Daily CensusOccupancy Rate

Does Ownership Matter?

8

PublicNon-ProfitInvestor Owned/Proprietary

RuralCritical Access

TeachingReligious AffiliationOsteopathic

Other Considerations

9

Ownership & GovernanceLicensure, Certification &

AccreditationEthical & Legal Issues

Break

When You Return:Group 5 Presentation

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