Health Care Management (Ambulatory Care Admin)
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week_3_hca_346_1.pptxHca 346 ambulatory care administration
Professor Haislip
Ambulatory services, for the “walking patient”, have the most contact with patients
Part of the evolution of the health care system reflects changes in the role of the physician. Used to be a supporter and occasionally effective curative interventions. Today, role is to treat symptoms and cure diseases
With the dramatic changes in diseases over time, doctors are no longer able to carry their supplies in a little “black bag” and move from home to home. Rather, they need advanced institutional support to cure disease
Overview of Ambulatory care:
Ambulatory care encompasses all services used by the noninstitutionalized patient
Central role is the initial and continuing point of contact with the health care system
Continuing= follow-up, routine, ongoing care, and referral source for specialized services
Especially important component= primary care
Serves to provide coordination, rationalization, and rationing of healthcare (gatekeeper)
Important for managed care
Don’t want you to go directly to a specialist
Overview of Ambulatory care:
Group Practice- affiliation of providers, usually physicians, who share incomes, expenses, facilities, equipment, medical records, and support through a formal, legally constituted organization
Group practice came about due to :
Increased specialization in medicine (one person couldn’t be specialized in all areas)
Formal structure for sharing costs
Promote high-quality care, because group members able to discuss patient problems
Physician advantages (more flexible hours, less financial risk)
Growth in HMOs since the 1980s also impacted
Managed care works with contracts. Easier to contract with groups than individuals
Overview of Ambulatory care:
Hospital moved throughout history to a provider of full range health services, from primary to tertiary care (services have expanded and multiplied)
This increased demands on hospital and lowered their ability respond with the resources they possessed
Thus, most have responded by expanding outpatient services and hiring full-time providers to staff redesigned hospital ambulatory facilities
Also, ambulatory surgery centers developed for one-day surgical care
Patients are screened by surgeons then assigned a date for surgery
Patient is discharged 1-3hrs after surgery when anesthesia recovery is complete
Some physicians used to do surgery in their office, but stopped after malpractice suits (oral, plastic, and ophthalmology surgeons still do)
Furthers the need for group management practice
Overview of Ambulatory care:
-What characteristics should a healthcare executive possess?
- How important is patient safety from a healthcare executive perspective?
- Why should staff engagement start at the top?
Discuss last week’s article:
Measuring what matters is fundamental because success, failure, and mediocrity are identified only when using a measurement program
Necessary for formation & continuation of effective and high performance quality & safety program
Scorecard measures need to be aligned with mission, vision, and values of organization
What is learned from data helps leaders with their future strategies
Some data is not numerical
Ex: customer murmurs (“It would make my life easier if you were open on Saturdays.” “Why does it take so long to get an appt?”)
Murmurs are an example of very valuable feedback
Chapter 6- measuring quality & safety
Induction and deduction are both needed for critical thinking and logic
A scientific method consists of the collection of data through observation and experimentation, and the formulation and testing of hypotheses
Common method in healthcare:
PDCA cycle (plan, do, check, and act)
Figure 6.1 & Figure 6.2
Induction, deduction, & scientific method
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Figure 6.3-6.8 show the results of a study initiated by staff members to reduce patient cancellations.
Figure 6.8- shows significance because the p value is less than .05
Figures 6.5 &6.7 lend important information regarding the days of the week which cancellations occurred most frequently, helping to point improvement efforts in the right direction
Case study
When creating a scorecard, think about what’s important from financial, operations, salaries & benefits, clinical, customer feedback, benchmarking, regulatory, licensing, and safety perspectives
All are important, but keep it streamlined and consistent
Figure 6.9- sample scorecard
Once collect data, reuse but input a timeframe (months or weeks) so you can compare results within an organization
Lists of example measures on pgs. 88-92
Sample: Financial measures:
Profitability
Revenue per patient
Rate per case by specialty and procedure type
Cost per case by physician
Payor mix
Supply cost
Collections as a percent of billings
Scorecards for outpatient services
Many times in healthcare, practices, leaders, employees, physicians, and shareholders are rewarded based on results of the measures put into place.
Thus, if scorecard results are used to financially reward, its important to develop a nonbiased approach
Also needs to include some type of audit approach
Weave in checks and balances and do not leave in the hands of one
Rewarding based on performance
Next week: Chapters 3 & 5
