Chapter 2

©2013 Delmar, Cengage Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part.©2013 Delmar, Cengage Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part.

Chapter 2The Health Care Environment:

Past, Present, and Future

©2013 Delmar, Cengage Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part.

Objectives

• Review the learning and performance objectives for this chapter

• By the end of this chapter, demonstrate the procedures in the textbook and the job skills in the workbook

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Heart of the Health Care Professional

• Service– With cheerfulness and patience, you will be

helping the medical practice and serving patients at the same time

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History of Medicine

• Medicine/Religion Connection

• Ancient Egypt– First prescription

• Discovered in tomb of Egyptian pharaoh

– Imhotep • Known as God of healing• Physician to the pharaohs• First written medical record

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History of Medicine

• Ancient Greece– Hippocrates

• “The father of medicine”• First to describe diseases• The Oath of Hippocrates

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History of Medicine

• Ancient Greece– Aesculapius

• Greek legend• God of healing• Caduceus

• Middle Ages– France and England began medical schools

• See Table 2-1: Highlights of Medical History

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Changes in Health Care

• Physicians traded services for goods

• Families paid for services monthly

• Cost of medical education increased

• Insurance companies emerge

• Third-party reimbursement system

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Changes in Health Care

• Medicine advanced

• Life expectancy rose

• Lawsuits increased

• Malpractice insurance soared

• Healthcare facilities started competing

• Baby Boomers aged

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Today’s Health Care Delivery System

• Utilization Review

• Traditional Care– Choice of physician, specialist, and facility– Fee-for-service

• Managed Care– Manage cost, quality, and delivery– Co-payments– Authorizations

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Today’s Health Care Delivery System

• Types of Managed Care Organizations– Health Maintenance Organization (HMO)– Preferred Provider Organization (PPO)– Independent Practice Association (IPA)– Exclusive Provider Organization (EPO)– Point-of-Service (POS) Plan– Concierge Medical Care

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The Medical Practice Setting

• Solo Physician Practice

• Associate Practice

• Group Practice

• Partnership

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Figure 2-4: Example of physician and staff interactions in a small medical group.

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• Professional Corporation

• Urgent Care Center

• Clinic

• In-Store Clinic

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• Hospital– Categories

• Government owned • Subsidized by federal, state, county, city

– Example: Federal VA Hospital– Example: State facility for the developmentally disabled

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• Hospital– Categories

• Nongovernment owned– For-profit– Not-for-profit

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• Hospital– Types

• Acute care hospital• Specialty hospital• Mental health hospital• Substance abuse hospital• Convalescent hospital• Rehabilitation hospital

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• Hospital– Administrative Departments (Figure 2-5A)– Adjunct Departments (Figure 2-5B)– Organization Chart (Figure 2-6)

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• Medical Center

• Hospital Owned Physician Practice

• Specialized Care Center

• Laboratory

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• Managed Care Organization

• Holistic Health Environment

• Telemedicine

• Patient-Centered Medical Home (PCMH)– Patient advocate

• Promote and support patients’ interests

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The Physician Specialist

• See Table 2-3: Medical Specialists and Administrative Medical Assisting Job Requirements– Variety of:

• Specialty practices• Patient types• Job responsibilities

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• What practice would you choose?

• What patients do you want to work with?

• Which job responsibilities interest you?

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• Nonphysician Providers (NPP)

• Physician Assistant (PA)

• Nurse Practitioner (NP)

• Clinical Nurse Specialist (CNS)

• Nurse Midwife (NMW)

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Health CareProfessional Abbreviations

• See Table 2-4: Abbreviations for Physician Specialists and Health Care Professionals– Be familiar with these abbreviations

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Stop and ThinkCase Scenarios

• Review the scenario “Traditional versus Managed Care”– What type of Medicare plan is Granny on?– What type of Medicare plan is Nana on?– What type of MCO does the physician belong

to that enables him/her to see both of these types of patients in his/her office?

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Stop and ThinkCase Scenarios

• Review the five scenarios at the end of Chapter 2 “Types of Medical Practice Settings”– What type of practice setting will you look for?– Why would you make that choice?

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Chapter 2

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