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Outpatient Services andOutpatient Services andPrimary Health CarePrimary Health Care
Heidi KinsellMaster of Health Administration (MHA)Health Services Research, Management and Policy
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Overview for TodayOverview for Today
Outpatient CarePrimary CareKey Issues
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DefinitionsDefinitionsOutpatient = 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.
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WhereWhere is Outpatient Care is Outpatient Care Provided?Provided?
Physician officesHospital outpatient departments
◦Diagnostic (e.g. lab, radiology)◦Therapeutic (e.g. PT, chemotherapy)
Hospital EDsNursing homes, Home health,
HospiceAmbulatory Surgery CentersPublic Health CentersRetail Clinic/Convenient Care Clinic
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Outpatient Care = Outpatient Care = Growth!Growth!All trend lines are up, up, upReimbursement changes
◦Payments◦Utilization controls
New technologiesPatient preferences
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Important ConsiderationsImportant ConsiderationsOutpatient services are
delivered….◦In a variety of settings◦By various types of providers◦For various conditions Acute Chronic Preventive Primary, secondary, tertiary
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The Health Services The Health Services SystemSystemPreventive CarePrimary CareSecondary CareTertiary CareRestorative CareContinuing Care
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Understanding Primary Understanding Primary CareCare
Primary Care◦ Main health care provider in non-emergency
situationsSecondary 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)
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Two Dimensions to Two Dimensions to ConsiderConsiderType 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)
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Primary CarePrimary CareThree key elements
◦Point of Entry◦Coordination of Care◦Essential Care
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Point of EntryPoint of EntryFirst contact with health care
systemGatekeepers
◦Patients come “through” primary care physicians to hospitals and specialists Con: Limits care? Pro: Prevents unnecessary care?
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Coordination of CareCoordination of CarePCPs coordinate delivery of care
from many sourcesPatient advisors, patient
advocatesEnsure continuity and
comprehensivenessThe Evidence
◦this works (better health outcomes)◦people prefer it (patient satisfaction)
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IdealIdeal Attributes of Primary Attributes of Primary CareCare
IntegratedCoordinating Continuity of careAccessibilityAccountability
◦For both patients and providers
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Primary Care ToolsPrimary Care Tools
Clinical guidelinesDisease managementCase managementPharmacy care managementOthers
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Who Provides Primary Who Provides Primary Care?Care?PhysiciansExtendersNursesAncillaryAlternative providers
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PhysiciansPhysicians
PCPs (Primary Care Physicians)Typically…
◦Family Practice◦General Internal Medicine◦General Pediatrics◦Obstetrics & Gynecology
Controversy◦Who?◦Specialized primary care training?
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Extenders & Non-physician Extenders & Non-physician Practitioners Practitioners
Nurse PractitionersPhysician AssistantsNurse Midwives Other Health Care
Providers
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TrendsTrendsHistorically
◦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
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HC Reform & Primary CareHC Reform & Primary CarePatient Centered Medical Home
(PCMH)Community Health FocusMore grant funding & payments
for PC trainingIncreased Medicare
reimbursements for PCPs
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ConclusionConclusionWill 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
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Master of Health Administration, MHA
Health Management & Policy Concentration of MPH
PhD in Health Services Researchhttp://hsrmp.phhp.ufl.edu
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