Topics- UNIT 1-- outpatient

kms013's version from 2016-02-08 15:54

Section 1

Question Answer
ambulatory care refers to..outpaitnet services
what does ambulatory care include?care to MD offices, OP hospitals departments, diagnostic centers, specialty tx centers
ambulatory care is rendered in ...ccommunity helath centers
some services that are
categorical programspublic health programs specifically designed to address certain categories of disease or severely affected categories of persons
medically underserveddetermination by federal government; dearth of primary care providers & settings as well as poor health indicators of populace (medicaid recipients)
do PTs/OT viewed as primary care providers?no, the federal governement doesn't look at us this way; we are more of a "supplemental" thing
outpatient care settings: Private practice:office based; movement from individual & small practices to large group practices, limited examination and testing; use of "physician extenders" to expedite service delivery
outpatient care settings: hospital based OP services:located w/i or in close proximity to an acute care hspital; also owned by that hospital; enhances continuum of care for hospital, pt, and payer; may offer more sophisticated services tahn an office-based practice can achieve b/c of access to facilites, technology & specialists
outpatient care settings: free-standing facilites:proprietary,c ommunity-based locations; emphasize accessibility & convenience; walk-in clinics (Doc in the box); surgi-centers, urgi-centers; "rehabilitation organizations"
outpatient care settings: specialty tx centers:dialysis; chemotherapy
outpatient care settings: Mobile medical, diagnostic, & screeningemergency services (EMT, ambulance), preventive services (mammogram, well-baby checks, risk factor screening, etc) diagnostic services (MRI), medical services (lithotripsy---can break up kidney stones)
outpatient care settings: community health centers:public health service fx for the "medically underserved" (Medicaid, no insurance); private, non-profit: government & private subsidies; "primary care safetly net" ; rural and inner city
outpatient care settings: free clinicsserve the uninsured (working poor, homeless); staffed by medical & nursing students as well as licensed practioners, all of whom volunteer their time; priave funding-- no gov support
outpatient care settings: telemedicine:triage, diagnostic, & monitoring via information technology
outpatient care settings: alternative medicine:aka complementary/non-tradictional; herbal formulas, acupuncture, massage, meditation, yoga, crystals, magnets, chiropractic, homeopathy; 33.2% of adults and 11.6% of children in US who use these services to some extent; 33.9 billion $ annual out of pocket payment-- 12 billion to providers and 22 billion for products (11.2% of total health care expenditures)
outpatient care settings: alternative emdicine: how many adults and children use these services?33.2%, 11.6%
____ $ annual out of pocket payment for alternative medicine33.9 billion
___billion to provides adn ____ billion to products for alternative medicines?12, 22
growth in OP services: Reimursements:prospective payment (medicare), managed care
growth in OP services: technologydrugs, devices
retrospective vs. prospective paymentretro- you tx pt and send bill to payer and they pay; prospective--- payer says "hey, I will pay X amt for this kind of pt"
growth in OP services: Utlization controlprior authorization (permission); concurrent review for medical need
growth in OP services: social fxlocation; atmosphere, QOL
gatekeepers: Who?family practice, internal medicine, OB/GYN; pediatrician (these are pple that controlled whether or not the pt could get referral to another service provider)
gatekeepers: What?determine need for specialists and/or specialized procedures
community-based OT & PT services: outpatient (aka "ambulatory care")private practice, rehabilitation agency, OP hosptial departmnet, communtiy health centers/free clinic, MD offices
OP PT/POT services delivery challengesreferral requirements, 2. productivity requirements 3. payment rules 4. public awareness
community-based OT & PT services: Early intervention servicesPart C: individuals w disabilities education improvement act (IDEA)-- supportive, NOT mandatory; children from 0-3 yr old; individualized family service plan (IFSP); OT & PT may be only services needed --> focus on developmntal skills, miniizing or preventing future impairments, addressing fxl skills and/or motor skills, and assistive technology; variability in delivery models
community-based OT & PT services:: school systemPart B: individuals w disabilities education improvement act (IDEA); individualized education program (IEP)--> ID a student's educational needs and how these will be addressed; outlines directly involved team members along with, when, where, and how the needs will be addressed; outlines directly involved team members, along with, when, where, and how the nees will be addressed and ultimately met; therapy services minimize obstacles in the school setting but do not necessarily maximize all skills or fx
metnal health services: Institutionalacute hsopitalization, subacute hsopitalization, long term hospitalization, partial, and crisis hospitalization
mental helath services- comunity basedday rehab, adult day servvices, etc

Section 2