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Chapter 2

Chapter 2. The Healthcare Climate and Communication. Healthcare Delivery System Terms. Bottom line Beds Capitation CMS Cost/benefit ratio Formulary Heads Healthcare delivery system. HIPPA Managed Care Panel Preapproved perqs. Medicaid Concerns.

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Chapter 2

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  1. Chapter 2 The Healthcare Climate and Communication

  2. Healthcare Delivery System Terms • Bottom line • Beds • Capitation • CMS • Cost/benefit ratio • Formulary • Heads • Healthcare delivery system

  3. HIPPA • Managed Care • Panel • Preapproved • perqs

  4. Medicaid Concerns • Quality and range of services differ state to state • Due to contracts costs can’t be easily controlled • Increase in illegal immigration has caused burden for some states • Some groups are not covered

  5. Managed Care is characterized by • Prescribing according to a formulary • Preauthorization for treatment, procedures, surgeries and hospitalizations • Restricted hospital stays • Gate keeping by primary care providers in order to see specialists

  6. Advantages of Managed Care • Patients are consumers • Expansion of health care disciplines, including advanced practice nurses • Emphasis on efficiency and cost savings • Movement into ambulatory setting vs. hospital setting • Improved business practices

  7. Shortcomings of Managed Care • Health has not significantly improved • Costs have not been controlled • The public has lost trust in the health system • Healthcare as a business has been an uneasy fit • What was promised has not been kept • Tremendous profit was taken out of but patients did not necessarily benefit

  8. Types of HMOs • Kaiser Permanente • PPO • POS

  9. Boutique Practice have cropped up due to • Threats to income • Demands of paperwork, preauthorization, capitation, etc. • A desire to control one’s professional life

  10. Issues Facing Healthcare • Efficient use of resources • Fraud, abuse and waste • Joint Commission monopoly • Rural medicine • Aging population • Provider shortage • Controlling costs

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