Clinical Issues for Health Care Managers
The World of Medicine (Lecture 1)
Delivery of Health Care in the US
Inpatient versus outpatient
Community hospital versus tertiary care
Community hospital – serves the common medical needs of the community
Tertiary (academic) – addresses complex medical problems, training, and research (Hershey, Geisinger)
Teaching hospital
Specialty hospital (ortho, Meadows)
Rehab hospital
Prehospital versus hospital (healthcare starts before you get to the hospital)
Access to care issues – over 47 million uninsured
HIPAA – The Health Insurance Portability and Accountability Act of 1996 Privacy Rule
EMTALA – Emergency Medical Treatment and Active Labor Act
“Anti-dumping” law
Emergency department must provide a screening exam and treatment
Emergency – a condition manifesting itself by acute symptoms of sufficient severity (including severe pain) such that the absence of immediate medical attention could reasonably be expected to result in placing the individual’s health (or the health of an unborn child) in serious jeopardy, serious impairment to bodily functions, or serious dysfunction of bodily organs
Unfunded mandate that does not require health insurance, government, or individuals to pay for mandated services
Three hospital obligations
Screen
Treat
Accept transfers
Violations may result in monetary fines
Prehospital/EMS (Emergency Medical Services)
Paramedics are first responders
Advanced life support (ALS)
Basic life support (BLS)
Purpose is to stabilize and start treatment until definitive care is provided in the ED
Paramedics have protocols they must follow based on the chief complaint (CC)
May not deviate
May require physician medical command for certain medication/steps
Examples
CPR
IV pain or nausea medications
Respiratory therapy – nebulizers, intubations
IV hydration
Life flight/helicopters
Used to transport patients from the scene or form transfer from a hospital to tertiary care
Flight crew has very advanced skills
Delivery of Health Care in the US
Inpatient versus outpatient
Community hospital versus tertiary care
Community hospital – serves the common medical needs of the community
Tertiary (academic) – addresses complex medical problems, training, and research (Hershey, Geisinger)
Teaching hospital
Specialty hospital (ortho, Meadows)
Rehab hospital
Prehospital versus hospital (healthcare starts before you get to the hospital)
Access to care issues – over 47 million uninsured
HIPAA – The Health Insurance Portability and Accountability Act of 1996 Privacy Rule
EMTALA – Emergency Medical Treatment and Active Labor Act
“Anti-dumping” law
Emergency department must provide a screening exam and treatment
Emergency – a condition manifesting itself by acute symptoms of sufficient severity (including severe pain) such that the absence of immediate medical attention could reasonably be expected to result in placing the individual’s health (or the health of an unborn child) in serious jeopardy, serious impairment to bodily functions, or serious dysfunction of bodily organs
Unfunded mandate that does not require health insurance, government, or individuals to pay for mandated services
Three hospital obligations
Screen
Treat
Accept transfers
Violations may result in monetary fines
Prehospital/EMS (Emergency Medical Services)
Paramedics are first responders
Advanced life support (ALS)
Basic life support (BLS)
Purpose is to stabilize and start treatment until definitive care is provided in the ED
Paramedics have protocols they must follow based on the chief complaint (CC)
May not deviate
May require physician medical command for certain medication/steps
Examples
CPR
IV pain or nausea medications
Respiratory therapy – nebulizers, intubations
IV hydration
Life flight/helicopters
Used to transport patients from the scene or form transfer from a hospital to tertiary care
Flight crew has very advanced skills