Health Care Management (Ambulatory Care Admin)
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week_1_1.pptxHCA 346 Ambulatory Care administration
Professor Haislip
What is the difference in Acute care & ambulatory care?
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Two myths about Outpatient care (in comparison to Acute Care)
Easy & Safe
Any provider can do it
Instead, rich with quality offerings, accrediting agencies, & leadership credentialing to promote excellence.
Overall, still needs more investment in mandatory licensing, standards across states, & outpatient service lines
But the hope is that consumers will use the information they receive to only choose the best, thus ridding the industry of subpar care
Preface
Apprehension, uncertainty, waiting, expectation, fear of surprise, do a patient more harm than any exertion. -Florence Nightingale
Easier to take the “Bad Apple” Approach- reacting only to errors & bad outcomes
Crisis Management
Poor Communication
Ostrich quality- burying head to avoid tough issues
Groupthink behavior
Apple Pie Strategy is using “Good Apples” (good qualities) to make the most desirable pie.
Prevention is practiced
Process oriented
Innovated, passionate, realistic
Huddles daily with staff
Benchmarks against the best of the best
Don’t waste time putting bad apples in your apple pie
Bad apples & apple pie
Outpatient Care
Growing rapidly
Movement of care from inpatient to outpatient
More than 1billion outpatient encounters every year (National Quality Forum)
Quality
Wide variation in quality practices
Inconsistent oversight by regulatory, licensing, accreditation & benchmarking agencies
Mostly rely on honor system
Economic prosperity depends on reducing variations, improving efficiencies, & implementing predictive models
Chapter 1: Defining outpatient healthcare
What are some outpatient services?
Consists of treatment performed without requiring an inpatient stay
Also known as ambulatory care
Settings:
Ambulatory Surgery Centers (ASCs)
Minute clinics
Urgent Care Facilities
Physician practices
Imaging centers
Oncology centers
Dialysis centers
Homecare
Freestanding emergency centers
Endoscopy centers
Chiropractors
Aesthetician and health spas
Emergency departments
outpatient services
Centers for Disease Control and Prevention (CDC) & National Center for Health Statistics (NCHS) conducts surveys of healthcare providers and facilities, including hospitals, ambulatory surgery centers, and physicians.
The results have shown the following:
Steady increase in ambulatory visits
Need for medication therapy (need for continuum of care)
Individuals can obtain in several sources. Can lead to drug interactions and overdoses
Increase by 300% in freestanding Ambulatory Surgery Centers since 1996
Due to demonstrated efficiencies, ease of access, and attractiveness to consumers
National health Statistics reports
| Ambulatory Medical Care Utilization | Results |
| Rate of Visits (annually in 2006) | 1.1 billion visits to physician offices, EDs, hospital outpatient depts |
| Visit rates to medical specialty offices | 29% increase from 1996-2006 |
| Hospital outpatient department visits | From 25.4 per 100 persons in 1996 to 34.7 in 2006 |
| Emergency Dept. Visits | Increased from 34.1 per 100 persons in 1996 to 40.4 in 2006 |
| Ambulatory Care Visits | 18.3% of all visits in 2006 were for conditions such as routine checkups & pregnancy exams |
| Medications | 7 of 10 ambulatory visits had at least one medication provided, prescribed, or continued in 2006. Amounted to 2.6billion overall |
National health Statistics reports
National health Statistics reports
| Ambulatory Surgery Utilization | Results |
| Rate of visits to freestanding ASCs | Increased 300% from 1996-2006 |
| Rate of visits to hospital-based surgery centers | Remained unchanged from 1996-2006 |
| 34.7million ASC visits w/53.3 million surgical & nonsurgical procedures performed in 2006 | Of those, 19.9million occurred in hospitals and 14.9 in freestanding ASCs |
| Gender | Females had significantly more ASC visits at 20million versus 14.7 million for males |
| Discharge disposition | 93.1% routine discharge w/.8% admitted as inpatients for 2006 |
| Payors | More than half of outpatient surgery visits were paid by private insurance 54% |
| Procedures | Procedures performed most often in an ASC: endoscopies of the large & small intestine |
Payors are pressuring for reduction of costs
Consumers are demanding more outlets
Technology & medications will continue to evolve
Hard to handle the above without improved quality measures!
Why?
Need for stronger quality programs
Outpatient programs are attractive to physicians and administrators because of:
Advanced technology, speed, improved medication options, shorter medical procedure duration, and cost effectiveness
But it’s not highly supported by payor sources
The goal is to demonstrate superb quality & financial outcomes. Then, it would be appealing to a wider provider and payor base.
Think about any situation where quality matters. You buy something at the store. Would you buy that item again if it was junk? If you had heard negative feedback or had a negative experience with a service provider would you go back?
Insurers are the same way. They don’t want to pay for outpatient services, if the person is just going to end up in the hospital for a medical error or “bad” job.
Quality begins at the facility level!
Outpatient quality initiatives
The Hospital Outpatient Quality Data Reporting Program ( HOP QDRP) includes 7 clinical performance and 4-MCR fee-for-service claims-based measures.
So that facilities can increase their payment rate from Outpatient Prospective Payment System (OPPS), hospitals must publically report this data using standardized measures to CMS.
Intent of CMS is to provide consumers with data so that better decisions can be made about healthcare choices and care at the hospital level
Doesn’t apply to freestanding clinics
Examples: Pg. 7
Cardiovascular disease
Aspirin at arrival
Median time to electrocardiogram (ECG)
Cms outpatient initiatives
Healthcare reform initiatives are looking at improving efficiency & effective care models for outpatient services
What is an ACO?
If successful, ACOs will push inpatient & outpatient entities together to share MCR reimbursement
Savings for MCR
Quality & safety is necessary to make outpatient programs affordable & accessible
Why????
Ambulatory care & health reform
Accountable Care organization- part of health reform 2010. A local network of providers that can manage the full continuum of care of patients, with the goal of improving health quality outcomes & reducing healthcare costs. It is believed by some that an ACO could change the healthcare system because ACO healthcare provider participants would receive payment for improving the quality of healthcare & reducing costs
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National Quality Forum endorsed 34-medical safe practices
Errors that create & contribute harm are due to:
Organizational system failures
Leadership failures
Predictable human behavioral failures
Must stop & think before doing!
Ex: foot in mouth when speaking
How can we cut down on errors?
Safe practices for better healthcare
Answers:
Creating & sustaining a culture of safety
Informed consent, life-sustaining treatment, disclosure, and care of caregiver
Facilitating information transfer & clear communication
Medication management
Prevention of healthcare-associated infections
Condition and site-specific practices
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Check out the website for the Kentucky Ambulatory Care licensing
Website located in Appendix I
Find and Read the Kentucky Regulation on Ambulatory Surgery Centers
101 Facility specifications; ambulatory surgical center
Assignment for next class:
