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Medical Practice and Allied Health Professionals

Medical Practice and Allied Health Professionals. Chapter 4. Today’s Health Care Environment. Major changes in past 15 years Growth rate of older adults Technological discoveries Preventative care and patient education stressed Government legislation Fixed-payment plans

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Medical Practice and Allied Health Professionals

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  1. Medical Practice and Allied Health Professionals Chapter 4

  2. Today’s Health Care Environment • Major changes in past 15 years • Growth rate of older adults • Technological discoveries • Preventative care and patient education stressed • Government legislation • Fixed-payment plans • Third-party payers

  3. Managed Care • Gatekeeper • Health Maintenance Organization (HMO) • Preferred Provider Organization (PPO) • Exclusive Provider Organization (EPO)

  4. Federal Assistance Programs • Medicare • Health care coverage for elderly and disabled with kidney disease or other debilitation aliments regardless of wealth or income • Rationing of health care

  5. Medicaid • Federal program implemented by individual states • Financial assistance to insure poor and indigent • Rationing takes place

  6. Diagnostic Related Groups (DRGs) • Classifies Medicare patient by illness • 467 illness categories • Hospitals receive preset sum for treatment of category regardless of “bed days” used • Discourages treatment of severely ill patients; patients often are discharged before ready

  7. Ethical Considerations of Managed Care • Wealthy may do better than poor patients • Decent minimum standard of care to everyone • Patients must be fully informed of consequences of obtaining health care elsewhere • Bait-and-switch • Profit more important than patient

  8. Types of Medical Practice • Solo practice • Sole proprietorship • Partnership • Associate practice • Group practice • Professional corporation

  9. Group practice Figure 4-1

  10. Ethics of Fee Splitting • Fee splitting: (unethical) one physician offers to pay another for referral • Fee splitting vs. referrals • Franchise: (ethical) business run by individual to whom franchisor grants exclusive right to market product or service in certain market area • Franchisees: persons or companies that hold a franchise

  11. Medical Specialty Boards • Over 23 specialty boards • Seek to improve quality of medical care • Encourage physicians to further education and training • Evaluate candidates who apply and pass exam • Board-certifies those who pass

  12. American College of Surgeons • Fellow of American College of Surgeons (FACS) • American College of Physicians • Fellow of American College of Physicians (FACP)

  13. Allied Health Professionals • Licensed personnel • registered nurse • nurse practitioner • licensed practical nurse • pharmacist • Certified personnel • physician assistant • medical assistant • medical transcriptionist • lab technician • lab technologist

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