Component 1: Introduction to Health Care and Public Health in the U.S.

1. Component 1: Introduction to Health Care and Public Health in the U.S. 1.1: Unit 2: Delivering Healthcare 1.2 c: Health Care Settings: Outpatient Clinics and Hospitals

2. Health Care Settings: Outpatient Clinics and Hospitals (Overview) • Types of Outpatient Clinics- Sole proprietership, group practice, corporate group practice, individual practice associations, preferred provider organizations, federal clinics, urgent/immediate care or walk-in clinics, multispecialty care center Health IT Workforce Curriculum Version 1.0/Fall 2010

3. Health Care Settings: Outpatient Clinics and Hospitals (Overview) • Types of Hospitals- Community Hospitals, Rural Critical Access Hospitals, Federal hospitals, Long-term Hospitals, Psychiatric hospitals, Specialty hospitals, Private hospitals, Multi-hospital systems, Inpatient rehabilitation centers Health IT Workforce Curriculum Version 1.0/Fall 2010

4. Health Care Settings: Outpatient Clinics • Sole Proprietorship • In this practice model, a physician owns his own business and provides health care services to patients. • Many physicians use this model, but this model is giving way to the newer group or corporate practices that allow physicians to be a more effective provider. Health IT Workforce Curriculum Version 1.0/Fall 2010

5. Health Care Settings: Outpatient Clinics • Sole Proprietorship (cont’d) • In this model, the physician will see patients in his office as well as once the patient is admitted to the hospital. The physician usually makes hospital visits before or after his regular practice. • The physician will also have to hire another physician to come and cover for this person when the physician goes on vacation. Health IT Workforce Curriculum Version 1.0/Fall 2010

6. Health Care Settings: Outpatient Clinics (cont’d) • Group Practice • In this practice model, two or more physicians enter into a partnership to provide health services to people. Health IT Workforce Curriculum Version 1.0/Fall 2010

7. Health Care Settings: Outpatient Clinics (cont’d) • Group Practice (cont’d) • The physicians can enter into arrangements where the partners will cover for another physician when on vacation or the physicians can take turns covering each other’s patients that are admitted to the hospital. It is a win-win situation for the physicians and the patients. Health IT Workforce Curriculum Version 1.0/Fall 2010

8. Health Care Settings: Outpatient Clinics (cont’d) • Corporate Group Practice • In this model, a hospital or a corporation own the practice and the physicians are employees. • The physician earns a salary. Health IT Workforce Curriculum Version 1.0/Fall 2010

9. Health Care Settings: Outpatient Clinics (cont’d) • Corporate Group Practice (cont’d) • The physicians are contracted to provide health services and the corporation takes care of the facilities, utilities, office staff, billing, and reimbursement issues. Many times the owners will also pay the physician’s malpractice insurance. Health IT Workforce Curriculum Version 1.0/Fall 2010

10. Health Care Settings: Outpatient Clinics (cont’d) • Individual Practice Associations (IPA) • An IPS is a legal entity where physicians remain individual practitioners and retain their individual identities and offices. • Each physician maintains his own medical records, offices, and support staff. Health IT Workforce Curriculum Version 1.0/Fall 2010

11. Health Care Settings: Outpatient Clinics (cont’d) • Individual Practice Associations (IPA) (cont’d) • IPA’s recruit physicians of all specialties so that they can provide a broad spectrum of services within their organization and referrals to outside providers are kept to a minimum. • The more specialties that are included in an IPA, the more attractive the IPA is to health plans and HMOS for providing a broad network for beneficiaries. Health IT Workforce Curriculum Version 1.0/Fall 2010

12. Health Care Settings: Outpatient Clinics (cont’d) • Preferred Provider Organizations • Entities that contract with health benefits plans and health insurers to purchase health services for covered beneficiaries. • PPO’s contract directly with hospitals, physicians, and other diagnostic facilities. Health IT Workforce Curriculum Version 1.0/Fall 2010

13. Health Care Settings: Outpatient Clinics (cont’d) • Preferred Provider Organizations (cont’d) • Negotiate payment rates • Rapid payment terms • Utilization management • Consumer choice Health IT Workforce Curriculum Version 1.0/Fall 2010

14. Health Care Settings: Outpatient Clinics (cont’d) • Federal Clinics • These clinics include VA clinics, military clinics, Indian Health Service clinics, Planned Parenthood, and grant-funded clinics. • Services are provided free of charge to the individuals who come to the clinic. Health IT Workforce Curriculum Version 1.0/Fall 2010

15. Health Care Settings: Outpatient Clinics (cont’d) • Federal Clinics (cont’d) • Aside from the VA, Military, and Indian Health Service clinics which serve a particular population, federally-funded clinics usually serve people with no health insurance, low incomes, or no income. Health IT Workforce Curriculum Version 1.0/Fall 2010

16. Health Care Settings: Outpatient Clinics (cont’d) • Urgent/Immediate Care Clinics • These clinics complement emergency rooms. • The urgent care clinic is a walk-in clinic where people can be seen for many conditions at a fraction of the cost of an emergency room visit. Health IT Workforce Curriculum Version 1.0/Fall 2010

17. Health Care Settings: Outpatient Clinics (cont’d) • Urgent/Immediate Care Clinics (cont’d) • With clinics and physicians’ office usually open from 8 – 5, Monday through Friday, people that wanted to be seen by a physician flocked to the emergency rooms of hospitals. Many conditions were not life-threatening, but these patients were using precious resources. Health IT Workforce Curriculum Version 1.0/Fall 2010

18. Health Care Settings: Outpatient Clinics (cont’d) • Multi-specialty Clinics • These are large clinics or groups that typically have providers with different specialty licenses who enter into a partnership. • The physicians pool their resources to create this large clinic. Health IT Workforce Curriculum Version 1.0/Fall 2010

19. Health Care Settings: Outpatient Clinics (cont’d) • Multi-specialty Clinics (cont’d) • An example would be a group like the Oregon Clinic that includes gastrointestional; pulmonary; ear, nose, and throat; and cardiology in the same building. Health IT Workforce Curriculum Version 1.0/Fall 2010

20. Health Care Settings: Outpatient Clinics (cont’d) • Point of Service (POS)- hybrid of HMO and PPO • Primary care physicians are reimbursed by a fixed payment per member per month (capitation) • Physicians are held accountable to make utilization targets by holding back a portion of their pay. Health IT Workforce Curriculum Version 1.0/Fall 2010

21. Health Care Settings: Outpatient Clinics (cont’d) • Point of Service (POS)- hybrid of HMO and PPO (cont’d) • The primary care physician is the gatekeeper for all services other than primary care. • The amount covered for nonparticipating physicians or non-authorized procedures is more than for authorized services. Health IT Workforce Curriculum Version 1.0/Fall 2010