Outpatient Services and Primary Health Care

1. Outpatient Services andPrimary Health Care Heidi Kinsell Master of Health Administration (MHA) Health Services Research, Management and Policy

2. Overview for Today • Outpatient Care • Primary Care • Key Issues

3. 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.

4. 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

5. Outpatient Care = Growth! • All trend lines are up, up, up • Reimbursement changes • Payments • Utilization controls • New technologies • Patient preferences

6. 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

7. The Health Services System • Preventive Care • Primary Care • Secondary Care • Tertiary Care • Restorative Care • Continuing Care

8. 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)

9. 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)

10. Primary Care • Three key elements • Point of Entry • Coordination of Care • Essential Care

11. 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?

12. 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)

13. Ideal Attributes of Primary Care • Integrated • Coordinating • Continuity of care • Accessibility • Accountability • For both patients and providers

14. Primary Care Tools • Clinical guidelines • Disease management • Case management • Pharmacy care management • Others

15. Who Provides Primary Care? • Physicians • Extenders • Nurses • Ancillary • Alternative providers

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

17. Extenders & Non-physician Practitioners • Nurse Practitioners • Physician Assistants • Nurse Midwives • Other Health Care Providers

18. 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

19. HC Reform & Primary Care • Patient Centered Medical Home (PCMH) • Community Health Focus • More grant funding & payments for PC training • Increased Medicare reimbursements for PCPs

20. 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 • CA’s Eisenhower Medical Center gets teaching approval for primary care • 1 in 4 New Docs Regret Career Path

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