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
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