outpatient services and primary health care heidi kinsell master of health administration (mha)...

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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