Hospitals and Ambulatory Care

1
Hospitals and Ambulatory Care

• H Edu 5100

2
History

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

3
Growth and Decline

• Technology/war
• Financial incentives
• Costs

4
Capital Financing

• Hill-Burton Act (1946)
• Medicare and Medicaid
• Three factors
• Guaranteed revenues
• Tax exemption
• Cost reimbursement
• Hospital borrowing

5
Types of Ownership

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

6
Legal Structure

• Governing board
• Medical staff
• Management

7
Operational Structure

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

8
Patient Rights/Responsibilities

• Rights
• Responsibilities

9
Informed Consent

• Established legal practice
• Right to know

10
Quality of Care

• JCAHO
• Structural reviews
• Process audits
• Results focus
• Indicators
• Fragmentation

11
Re-engineering

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

12
Integration

• Horizontal
• Vertical

13
Role of Physicians

• Admissions
• What services are used
• Guest in hospital

14
Sources of Revenue

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

15
Funds Out

• Payroll
• Professional fees
• Supplies and other
• Capital depreciation and interest

16
Who Gets the Profits?

• Physicians
• Hospitals
• For-profit vs non-profit

17
Competition Among Hospitals

• Good or bad?

18
Current Issues

• Team-based care
• Hospitalists
• Patient Expectation

19
Magnet Hospitals

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

20
Ambulatory Care
21
Origins

• Private medical practices
• Indigent clinics
• ERs
• Public health clinics

22
Evolution of physician practices

• Solo
• Group
• Multi-specialty groups

23
Hospital Outpatient Activities

• Indigent clinics
• Outpatient services
• Outpatient departments
• Specialty clinics

24
The Emergency Room
25
Freestanding Centers

• Who owns?
• Who uses?
• Hospital concerns
• Surgical centers

26
Impact on triangle

• Access
• Quality
• Cost