Outpatient Services and Primary Health Care

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Outpatient Services andPrimary Health Care

• Heidi Kinsell
• Master of Health Administration (MHA)
• Health Services Research, Management and Policy

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Overview for Today

• Outpatient Care
• Primary Care
• Key Issues

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Definitions

• Outpatient Do Not require overnight hospital
  stay.
• Ambulatory Services services provided to the
  walking patient.
• Community Medicine services provided in the
  immediate community where patients live.

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Where is Outpatient Care Provided?

• Physician offices
• Hospital outpatient departments
• Diagnostic (e.g. lab, radiology)
• Therapeutic (e.g. PT, chemotherapy)
• Hospital EDs
• Nursing homes, Home health, Hospice
• Ambulatory Surgery Centers
• Public Health Centers
• Retail Clinic/Convenient Care Clinic

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Outpatient Care Growth!

• All trend lines are up, up, up
• Reimbursement changes
• Payments
• Utilization controls
• New technologies
• Patient preferences

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Important Considerations

• Outpatient services are delivered.
• In a variety of settings
• By various types of providers
• For various conditions
• Acute
• Chronic
• Preventive
• Primary, secondary, tertiary

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The Health Services System

• Preventive Care
• Primary Care
• Secondary Care
• Tertiary Care
• Restorative Care
• Continuing Care

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Understanding Primary Care

• Primary Care
• Main health care provider in non-emergency
  situations
• Secondary Care
• Specialist for expert opinion or surgical/other
  intervention
• May include hospitalization, surgery,
  rehabilitation
• Tertiary Care
• Complex care for relatively uncommon conditions
  (usually institution-based and technology-driven)

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Two Dimensions to Consider

• Type of Care
• Preventive --Coordination--- Continuing
• Location of Care
• Inpatient --- Outpatient
• With various inpatient sites (e.g. hospital,
  nursing home) and outpatient locations (e.g.
  physician office, surgery center, home)

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Primary Care

• Three key elements
• Point of Entry
• Coordination of Care
• Essential Care

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Point of Entry

• First contact with health care system
• Gatekeepers
• Patients come through primary care physicians
  to hospitals and specialists
• Con Limits care?
• Pro Prevents unnecessary care?

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Coordination of Care

• PCPs coordinate delivery of care from many
  sources
• Patient advisors, patient advocates
• Ensure continuity and comprehensiveness
• The Evidence
• this works (better health outcomes)
• people prefer it (patient satisfaction)

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Ideal Attributes of Primary Care

• Integrated
• Coordinating
• Continuity of care
• Accessibility
• Accountability
• For both patients and providers

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Primary Care Tools

• Clinical guidelines
• Disease management
• Case management
• Pharmacy care management
• Others

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Who Provides Primary Care?

• Physicians
• Extenders
• Nurses
• Ancillary
• Alternative providers

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Physicians

• PCPs (Primary Care Physicians)
• Typically
• Family Practice
• General Internal Medicine
• General Pediatrics
• Obstetrics Gynecology
• Controversy
• Who?
• Specialized primary care training?

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Extenders Non-physician Practitioners

• Nurse Practitioners
• Physician Assistants
• Nurse Midwives
• Other Health Care Providers

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Trends

• Historically
• Over-supply of specialists
• Bias towards specialists and sub-specialists
• Follow the money
• Now/Future
• Growing demand for PCPs
• Income still lower
• New organizational and financial structures
  promoting use of primary care physicians

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HC Reform Primary Care

• Patient Centered Medical Home (PCMH)
• Community Health Focus
• More grant funding payments for PC training
• Increased Medicare reimbursements for PCPs

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Conclusion

• Will the system adjust to appropriate mix of
  primary specialty care?
• Primary care is a fundamental component of the
  health care system today and tomorrow.
• UnitedHealthcare, RI Foundation offer 250K for
  primary care docs
• CAs Eisenhower Medical Center gets teaching
  approval for primary care
• 1 in 4 New Docs Regret Career Path

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• Master of Health Administration, MHA
• Health Management Policy Concentration of MPH
• PhD in Health Services Research
• http//hsrmp.phhp.ufl.edu