Introduction to Healthcare and Public Health in the US

1. Introduction to Healthcareand Public Health in the US Delivering Healthcare (Part 1) Lecture c This material (Comp1_Unit2c) was developed by Oregon Health and Science University, funded by the Department of Health and Human Services, Office of the National Coordinator for Health Information Technology under Award Number IU24OC000015.

2. Delivering Healthcare (Part 1)Learning Objectives • Describe the organization of healthcare at the federal, state and local levels (Lecture a) • Describe the organization of the VA system and Military Health System (Lecture b) • Describe the structure and function of hospital clinical and administrative units (Lecture c) • Describe different types of long term care facilities, with an emphasis on their function (Lecture d) Introduction to Healthcare and Public Health in the US Delivering Healthcare (part 1) Lecture c

3. Delivering Healthcare (Part 1)Learning Objectives • Describe not only hospitals but also outpatient clinics. • Relevant facilities include: • Individual and group physician practices • Health maintenance organizations (HMOs), preferred provider organizations (PPOs) • Urgent or immediate-care clinics • Hospitals • Hospital systems Introduction to Healthcare and Public Health in the US Delivering Healthcare (part 1) Lecture c

4. Sole Proprietorship Clinic • Functions as a small private office • Run by a single physician with a small staff • Owner assumes all obligations/liabilities • This type of practice is increasingly rare Introduction to Healthcare and Public Health in the US Delivering Healthcare (part 1) Lecture c

5. Group Practice Clinic • Partnership includes 2 or more physicians • Corporate group practice: a corporation owns the practice, and physicians are employees • Independent Practice Association (IPA) • Practice is a legal entity (e.g., corporation) • Each physician has a separate office • Physicians own the practice • May contract with HMOs to provide healthcare Introduction to Healthcare and Public Health in the US Delivering Healthcare (part 1) Lecture c

6. Managed Healthcare • HMO • Provides discounted healthcare via provider network • Physicians are paid per patient • Patient gives co-payments for service, obtains referrals for specialty care • PPO • Similar to an HMO, but physicians are independent • Patient pays fees but does not need referrals • Point-of-service plan • Works as a combination of HMO and PPO Introduction to Healthcare and Public Health in the US Delivering Healthcare (part 1) Lecture c

7. Urgent Care Centers • Also called immediate care centers • For acute illness or injury not serious enough for a hospital emergency room (ER) • Capability is intermediate between retail clinic and ER • Service is available on walk-in basis • Extended hours • Advantageous for US healthcare system • Provide more healthcare for more people • Reserve ERs for life-threatening emergencies Introduction to Healthcare and Public Health in the US Delivering Healthcare (part 1) Lecture c

8. Community Health Centers • Provide primary care for disadvantaged people • Treat those who cannot pay and/or have no insurance (e.g., poor, homeless, migrant workers) • Found in all 50 states and territories • Usually rely on public financing • Advantageous for US healthcare system • Improve healthcare access for all • Reserve ERs for true emergencies • Community mental health centers also exist Introduction to Healthcare and Public Health in the US Delivering Healthcare (part 1) Lecture c

9. Community Hospitals • Defined as non-federal, short-term, general public hospitals • Provide general or specialty care • Operate on for-profit or nonprofit basis • Advantageous for US healthcare system • Well-suited for routine illness/surgery • Provide cost-effective and accessible care Introduction to Healthcare and Public Health in the US Delivering Healthcare (part 1) Lecture c

10. Teaching/Research Hospitals • Large institutions affiliated with medical schools • Employ state-of-the-art medications, surgical procedures, equipment, technology • Treat complex medical problems, rare diseases • Teach physicians and other healthcare providers • Support and perform medical research • Provide critical care for the community • Accept uninsured patients • Example: Massachusetts General Hospital Introduction to Healthcare and Public Health in the US Delivering Healthcare (part 1) Lecture c

11. Critical Access Hospitals • Certified for reimbursement by Medicare • Typically are licensed acute-care hospitals in rural locations • Sometimes health clinics are eligible • Reimbursement may save the hospital from closing Introduction to Healthcare and Public Health in the US Delivering Healthcare (part 1) Lecture c

12. Healthcare Accreditation • Joint Commission certifies medical care facilities • Oldest and largest healthcare accrediting body • Independent nonprofit organization • Evaluates more than 18,000 US healthcare organizations and programs of all types • Goal is to improve effectiveness, safety, and value of healthcare • Organizations must undergo periodic site visits to identify and resolve problems Introduction to Healthcare and Public Health in the US Delivering Healthcare (part 1) Lecture c

13. Hospital Clinical Structure: Overview • Hospitals contain specialized areas • General inpatient care is provided in wards • Immediate care is provided in the ER • Surgery is performed in the operating room (OR) • Critical care is given in intensive care units (ICUs) and critical care units (CCUs) • Hospitals employ specialized personnel • Physicians and nurses provide healthcare • Ancillary personnel assist with technical tasks Introduction to Healthcare and Public Health in the US Delivering Healthcare (part 1) Lecture c

14. Hospital Setup: ER • ER is open 24 hours, 7 days a week • Treats various types of injuries • Ranging from ankle sprain to drug overdose • Severity is assessed by a process called triage • Patients are treated completely or sent to other hospital areas Introduction to Healthcare and Public Health in the US Delivering Healthcare (part 1) Lecture c

15. Hospital Setup: OR • Surgery is done in the OR • Sterile environment is required • Surgical team includes variety of healthcare workers (surgeons, nurses, anesthesiologists) • OR contains surgical instruments, monitoring equipment, emergency equipment • Surgery centers also function as ORs • Are freestanding, not part of a hospital • Perform operations on outpatient basis • Are subject to Joint Commission certification Introduction to Healthcare and Public Health in the US Delivering Healthcare (part 1) Lecture c

16. Hospital Setup: ICU/CCU • ICUs treat patients with severe disease or injury (e.g., pneumonia, traumatic injury) • CCUs are for cardiac (heart) disease • Patients come from ER, OR, or another hospital • Various interventions are performed • Sophisticated equipment is used Introduction to Healthcare and Public Health in the US Delivering Healthcare (part 1) Lecture c

17. Personnel Who ProvideSerious Acute Care • Emergency medicine • Goals: save lives of patients, provide short-term care • Patients receive care at the accident scene by emergency medical technicians (EMTs) or paramedics, who are more highly trained than EMTs • ER care is a physician specialty • Critical care • Goals: treat life-threatening conditions, provide longer-term care • ICU and CCU care are also physician specialties Introduction to Healthcare and Public Health in the US Delivering Healthcare (part 1) Lecture c

18. Other Hospital Personnel • Surgeons perform operations, sometimes special types (for example, orthopedic surgery, plastic surgery) • Anesthesiologists monitor patients in the OR and treat pain (for example, in the ICU or during childbirth) • Other physician specialties exist (for example, internal medicine, cardiology, obstetrics/gynecology, psychiatry) • Medical subspecialties also exist (for example, pediatric cardiology) • Registered nurses (RNs), licensed practical nurses (LPNs), and physician assistants (PAs) may also specialize • Pharmacists evaluate and dispense medications Introduction to Healthcare and Public Health in the US Delivering Healthcare (part 1) Lecture c

19. Ancillary Personnel • Nursing assistants work under the direction of RNs and LPNs • Technicians help with treatment or diagnosis (for example, phlebotomists, x-ray and ultrasound technicians, laboratory personnel) • Therapists facilitate rehabilitation (for example, physical, occupational, respiratory, or speech) • Other workers educate and counsel (for example, dietitians, nutritionists, diabetes educators, social workers) Introduction to Healthcare and Public Health in the US Delivering Healthcare (part 1) Lecture c

20. Hospital Corporate Structure • Governing board (board of directors) provides oversight • Chief executive officer is responsible for daily operations • Administration also includes chief officers, department heads, patient care managers • Medical staff and ancillary personnel provide healthcare and technical services • Nonmedical services are also critical (for example, cooks, laundry workers) • Business office does paperwork (for example, billing, scheduling) Introduction to Healthcare and Public Health in the US Delivering Healthcare (part 1) Lecture c

21. Hospital Financing • Ownership may be public or private • Public hospitals are funded by the government, may have limited resources • Private hospitals are run by private entities, may have greater resources (for example, finances, equipment) • Either type of hospital may be for-profit or nonprofit Introduction to Healthcare and Public Health in the US Delivering Healthcare (part 1) Lecture c

22. Hospital Systems • A hospital system is 2 or more hospitals owned by a corporation, with a single board of directors • A network is a group of hospitals, physicians, and other entities that collaborate to provide care in a community • Example of a hospital system: Greenville Hospital System University Medical Center in South Carolina • Has multiple locations • Research and teaching organization Introduction to Healthcare and Public Health in the US Delivering Healthcare (part 1) Lecture c

23. Delivering Healthcare (Part 1)Summary – Lecture c • Medical facilities range from single-physician offices to large hospital systems • Most of the US population has a managed care plan • Community centers and clinics offer a range of services • Hospitals treat patients; also fill teaching, research, and charitable roles • All healthcare facilities must prove efficacy and safety • Healthcare providers work as a team to optimize medical care Introduction to Healthcare and Public Health in the US Delivering Healthcare (part 1) Lecture c

24. Delivering Healthcare (Part 1)References – Lecture c References Aetna. POS health insurance plan choices. http://healthinsurance.aetna.com/health-plans/point-of-service. Published 2011. Accessed April 6, 2011. American College of Emergency Physicians Foundation. Emergency care for you. http://www.emergencycareforyou.org/EmergencyManual/WhoTakesCare/Default.aspx. Accessed April 7, 2011. American Heart Association. Managed health care plans. http://www.americanheart.org/presenter.jhtml?identifier=4663. Published 2011. Accessed April 7, 2011. American Hospital Association. http://www.aha.org. Accessed April 6, 2011. AmericanHospitals.com. Hospital locator: all hospitals are not created equal. http://www.americanhospitals.com/hospitals/hospitalsequal.htm. Accessed April 5, 2011. Association of American Medical Colleges. Teaching hospitals. https://www.aamc.org/about/teachinghospitals. Accessed April 8, 2011. Centers for Medicare and Medicaid Services. Community mental health centers. https://www.cms.gov/CertificationandComplianc/03_CommunityHealthCenters.asp. Accessed April 8, 2011. Feigenbaum E. Organizational structure of hospitals. http://smallbusiness.chron.com/organizational-structure-hospitals-3811.html. Published 2011. Accessed April 7, 2011. Greenville Hospital System University Medical Center. http://www.ghs.org. Accessed April 8, 2011. Health Careers Center. http://www.mshealthcareers.com. Accessed April 8, 2011. Medline Plus. Emergency medical services. http://www.nlm.nih.gov/medlineplus/emergencymedicalservices.html. Updated August 10, 2010. Accessed April 7, 2011. National Association of Community Health Centers. http://www.nachc.org. Accessed April 7, 2011. Introduction to Healthcare and Public Health in the US Delivering Healthcare (part 1) Lecture c

25. Delivering Healthcare (Part 1)References – Lecture c (continued) References (continued) National Institute on Aging. AgePage: hospital hints. http://www.nia.nih.gov/HealthInformation/Publications/hospitalhints.htm. Updated April 20, 2010. Accessed April 7, 2011. Rural Assistance Center. CAH frequently asked questions. http://www.raconline.org/info_guides/hospitals/cahfaq.php#whatis. Updated October 26, 2010. Accessed April 7, 2011. Rust ME, Luepke EL. Practice organizations and joint ventures. In: American College of Legal Medicine. Legal Medicine. 6th ed. Philadelphia: Mosby; 2004. Society of Critical Care Medicine. MyICUCare.org. Critical care questions. http://www.myicucare.org/Critical_Care_Questions/Pages/default.aspx. Accessed April 7, 2011. The Joint Commission. http://www.jointcommission.org. Accessed April 8, 2011. Torpy JM. Intensive care units. JAMA. 2009;301(12):1304. United States Department of Labor. Bureau of Labor Statistics. Occupational outlook handbook, 2010-11 edition. http://www.bls.gov/oco. Accessed April 7, 2011. Urgent Care Association of America. http://www.ucaoa.org/index.php. Accessed April 6, 2011. Introduction to Healthcare and Public Health in the US Delivering Healthcare (part 1) Lecture c