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chapter 5 health

Question	Answer
Almshouses or poorhouses were..	developed in the 1820s to primarily serve the poor. Early hospitals provided food and shelter to the poor and consequently treated the ill.
Pesthouses..	were operated by local governments, and they were used to quarantine people who had contagious diseases such as cholera
Initially, wealthy people did not want to go to hospitals because	the conditions were deplorable and the providers were not skilled, so hospitals, which were first built in urban areas, were used by the poor.
in 1789, the Public Hospital of Baltimore was	established for the indigent and, in 1889, it became Johns Hopkins Hospital, which exists today as one of the best hospitals in the world
In the 1850s, a hospital system was finally developed, but	the conditions were deplorable because of the staff of unskilled providers.
Hospitals were primarily owned by	the physicians who practiced in them.
The hospitals became more cohesive among providers because	the physicians had to rely on each other for referrals and access to hospitals, which gave them professional power
In the early 20th Century, with the establishment of	more standardized medical education. Hospitals became more accepted across socioeconomic classes and became the symbol of medicine
With the establishment of the American Medical Association (AMA)	who protected the interests of providers, the reputation of providers became more prestigious
In the 1920s, because of the development of medical technological advances, increases in the quality of medical training and specialization, and the economic development of the United States..	the establishment of hospitals became the symbol of the institutionalization of health care and the acknowledgment of the medical profession as a powerful presence.
During the 1930s and 1940s, the ownership of the hospitals changed from physician-owned to	church-related and government operated. Religious orders viewed hospitals as an opportunity to perform their spiritual good works so religion played a major role in the development of hospitals. Several religious orders established ones that still exist
in 1973, the first Patient Bill of Rights was introduced to	represent the healthcare consumer in hospital care. The AHA had all hospitals display a "Patients Bill of Rights" in their institutions
In 1974, the National Health Planning and Resources Development Act required...	states to have certificate of need (CON)laws to ensure the state approved any capital expenditures associated with hospital/medical facilities' construction and expansion. The Act was repealed in 1987, but 36 states still have some type of CON mechanism
Hospital Types by Ownership..There are 3 major types of hospitals by ownership: (1)public	Public hospitals are the oldest type of hospital and are owned by the federal, state, or local government.
County and city hospitals are open the the general public and..	are supported by taxes. Many of these hospitals are located in urban areas to serve the poor and the elderly. Larger public hospitals may be affiliated with medical schools and are involved in training medical students and other healthcare professionals.
Federal hospitals are a type of public hospital in that they are funded by taxes but	generally do not serve the general public but operate for federal beneficiaries such as military personnel, veterans, and Native Americans. The (VA)hospitals are the largest group of federal hospitals. They have high utilization rates by veterans.
Large public hospitals are primarily reimbursed..	by Medicare and Medicaid services and have a high utilization rate. In 2007 there were 1111 state and local hospitals
Hospital Types by Ownership..There are 3 major types of hospitals by ownership: (2) Voluntary hospitals are. This is the largest group of hospitals in 2007, there were 3000 not-for profit hospitals.	not government owned, private, and not-for-profit. They are considered voluntary because their financial support is the result of community efforts. Their focus is their community. Private, not-for-profit hospitals are the largest group of hospitals.
Hospital Types by Ownership..There are 3 major types of hospitals by ownership: (3)Proprietary hospitals	or investor-owned hospitals are for-profit institutions and are owned by corporations, individuals, or partnerships. Their primary goal is to generate a profit. They have the lowest utilization rates. In 2007, there were 873 proprietary hospitals
Hospitals are the foundation of our healthcare system. As our health insurance system evolved, the first type of health insurance was..	hospital insurance. As society's health needs increased, expansion of different medical facilities increased. There was more of a focus on ambulatory or outpatient services because US healthcare consumers prefer outpatient care.
US healthcare consumers prefer outpatient services and	they are more cost effective
in 1980, the AHA estimated that...	87% of hospitals offered outpatient surgery
"Hospitalists", created in 1996 are providers that..	focus specifically on the case of a patient when they are hospitalized. This new type of provider recognize the need of providing quality hospital care.
In 2000, as a result of the Balanced budget Act cuts of 1997, the federal government...	authorized an outpatient Medicare reimbursement system, which has supported hospital outpatient service efforts.
In 2007, hospitals employed over..	5 million individuals, were the second largest source of private sector jobs, provided outpatient care to over 600 million patients, and performed 27 million surgeries.
Hospital Types by specialty	Specialty hospitals are hospitals that provide services for a specific disease or target population. Some examples are psychiatric, children's, women's, cardiac, cancer, reahabilitation and orthopedic hospitals.
Over 50% of urgent care centers are owned by...	physicians
Other terms related to "hospital" include...	hospitality, host, hotel, and hospice
Nearly 1 in 20 individuals in the United States relies on	community health centers for primary care
Women seek healthcare services more	frequently than men
Other Hospital Classifications...Hospitals can be classified by single or multiunit operations.	Two or more hospitals may be owned by a central corporation. Multiunit hospitals are the result of the merging or acquiring of other hospitals that have financial problems. These chains can be operated as for profit, not for profit, or government owned.
Hospitals often formed systems because	it was more cost-efficient. In 2007, there were over 2700 hospital systems.
Hospitals can also be classified by length of stay	a short stay or acute care hospital focuses on patients who stay on an average of less than 30 days. Community hospitals are short term.
A long-term care hospital focuses on patients who stay	on an average more than 30 days. Rehabilitation and chronic disease hospitals are examples of long-term care hospitals. More than 90% of hospitals are acute or short-term.
The Medicare Rural Hospital Flexibility Program (MRHFP)was..	created as part of the Balanced Budget Act of 1997,. The MRHFP allows some rural hospitals to be classified as critical access hospitals if they have no more than 25 acute care beds and provide emergency care.
Cost plus reimbursement allows for	capital costs, which enables some rural hospitals that provide emergency care to expand
Teaching hospitals...	are hospitals that have one or more graduate resident programs approved by the AMA
Academic medical centers..	are hospitals organized around a medical school. There are approximately 400 teaching hospitals including 64 VA medical centers that are members of the Council of Teaching Hospitals and Health Systems in the United States and Canada
Members of the Council of Teaching Hospitals and Health Systems offer..	substantial programs and are considered elite teaching and research institutions affiliated with large medical schools
church-related hospitals are...	developed as a way to perform spiritual work. The first church-affiliated hospitals were established by Catholic nuns. These hospitals are community general hospitals. The could be affiliated with a medical school.
Osteopathic hospitals focus on..	a holistic approach to care. They emphasize diet and environmental factors that influence health as well as the manipulation of the body. Their focus is PREVENTATIVE care. There are approximately 200 Osteopathic hospitals in the United States.
Historically, Osteopathic hospitals were developed as a result of...	the antagonism between the different approaches to medicine--traditional or allopathic medicine versus holistic. Current trends indicate that both branches of medicine now serve in each others' hospitals and respect the focus of each others' treatment.
Hospital Governance Hospitals are governed by...	A chief executive officer (CEO), a board of trustees or board of directors, and the chief of medical staff.
The CEO or president is ultimately responsible for...	the day-to-day operations of the hospital and is a board of trustees member. CEOs provide leadership to achieve their mission and vision.
The board of trustees is legally responsible for...	hospital operations. It approves strategic plans and budgets and has authority for appointing, evaluating, and terminating the CEO. Boards often form different committees such as quality assurance, finance and planning.
Boards often form different committees. There are two standing committees...	The executive committee that monitors the hospital activities and makes policy recommendations and the medical staff committee that is charged with medical staff relations.
The medical staff or medical director is in charge of...	the medical staff/physicians that provide clinical services to the hospital. The physicians may be in private practice and have admitting privileges to the hospital and are accountable to the board of trustees.
The medical staff is divided according to specialty or department such as:	obstetrics, cardiology, radiology, etc. There may be a chief of service that leads each of these specialties.
There is also the operational staff that is..	a parallel line of staff with the medical staff. They are responsible for managing nonmedical staff and performing non-clinical, administrative, and service work.
It is in the best interest of the institution that both the..	operational staff and medical staff collaborate to ensure smooth management of the facility.
The medical staff also have committees such as...	credential committee that reviews and grants admitting privileges to physicians, a medical records committee that oversees patients records, a utilization review committee that ensures inpatient stays are clinically appropriate.
The medical staff also have these committees...	an infection control committee that focuses on minimizing infections in the hospital, and a quality improvement committee that is responsible for quality improvement programs.
State governments oversee the licensure of healthcare facilities including hospitals. States set..	their own standards. It is important to note that all facilities MUST BE LICENSED but do not have to be accredited. State licensure focuses on building codes, sanitation, equipment, and personnel.
Hospitals must be licensed to...	operate with a certain number of beds.
Certification of hospitals enables them to obtain..	Medicare and Medicaid reimbursement. This type of certification is mandated by the Department of Health and Human Services (HHS).
All hospitals that receive Medicare and Medicaid reimbursement must adhere...	to conditions of participation that emphasize patient health and safety.
Accreditation is a private standard developed by accepted organizations as a way to meet certain standards. For example...	accreditation of a hospital by The Joint Commission (TJC) means that hospitals have met Medicare and Medicaid standards and do not have to be certified.
Medicare and Medicaid have also authorized the...	American Osteopathic Organization to jointly accept their types of hospitals with TJC
it is important to mention that TJC has had tremendous impact on...	how healthcare organizations are accredited. Since its formation in 1951, TJC has expanded its accreditation beyond hospitals, laboratory services, long-term hospital care, and office-based surgery centers.
Accreditation of managed care organizations such as preferred providers..	and managed behavioral organizations ended in 2006
Established in 1947 in Geneva, Switzerland, the International Organization for Standardization (ISO) is a...	worldwide organization that promotes standards from different countries. Although this is not an accrediting organization, those organizations that register with the ISO are promoted as having higher standards.
The ISO 9000 (quality management focus) and ISO 14000 (environmental management focus) are...	management standards that are applicable to any organization, including healthcare organizations, and many healthcare organizations are registered with the ISO
The Patient Self-determination Act of 1990 requires...	hospitals and other facilities that participate in the Medicare and Medicaid programs to provide patients on admission, with information on their rights and is referred to as the Patient Bill of Rights.
If you enter any hospital you will see>>	the Bill of Rights posted on their walls. This law requires that the hospital maintains confidentiality of their personal and medical information. The patient also has the right to be provided accurate and easy-to-understand information.
The patient has the right to be provided accurate and easy-to-understand information about...	their medical condition so they may give informed consent for any of their medical care
Current status of hospitals--many hospitals have become dinosaurs of the healthcare industry. nearly 2/3 of hospitals have financial problems. As a result of...	increased competition of outpatient services (which are often more cost-effective, efficient, and consumer friendly) and reduced reimbursement from Medicare and Medicaid, many hospitals are developing strategies to increase their financial stability.
In the 1990s, many hospitals merges with other...	hospitals, were acquired by other hospitals, or became part of a hospital chain. These strategies were an attempt to become more cost efficient in the management of these organizations.
Current status of hospitals, Many hospitals have become...	dinosaurs of the healthcare industry. Nearly 2/3 of hospitals have financial problems. As a result of teh increased competition of outpatient services and reduced reimbursement from Medicare and Medicaid.
Many hospitals are developing strategies to...	increase their financial stability. In the 1990s, many hospitals merged with other hospitals, or became part of a hospital chain. These strategies were an attempt to become more cost efficient in the management of these organizations
Interestingly, outpatient services have become..	the major competitors of hospitals. Advanced technology has enabled more ambulatory surgeries and testing, which has resulted in the development of many specialty centers for radiology, & imaging, chemotherapy treatment, kidney dialysis, etc.
Outpatient services were often performed in a hospital. What is even more interesting is that...	many physicians or physician groups own these centers. They are receiving revenue that used to be hospital revenue
although hospitals have operated outpatient clinics since the 19th century, these clinics were used to...	care for the indigent population. As revenues continued to fall, these clinics gradually generated revenue by offering more hospital services.
in 2003, outpatient services accounted for nearly..	40% of the total hospital revenue. Hospitals have to continue to focus on revenue generation by operating more outpatient service opportunities.
unfortunately, as a result of the economic recession...	there are less insured citizens and therefore less inpatient care and fewer patients who can pay for their care.
a 2008 AHA survey of 736 hospitals from 30 states indicated that...	40% of the respondents reported a drop in overall admissions
Hospitals also offer outpatient services in...	their emergency departments and their outpatient clinics
the basic form of an outpatient service is..	a patient seeing their physician in the physician's office. Both general practitioners and specialists offer ambulatory care. They offer ambulatory care as either a solitary practitioner or in a group practice.
Traditionally, physicians established solitary practices but...	the cost of running a practice became to expensive so more physicians are forming group practices. Approximately two thirds of physicians now operate as a group practice.
approximately 70% of group practices are..	single specialty groups while the remaining 30% are multispecialty group practices
hospital emergency and outpatient services...hospitals traditionally provide inpatient services although...	nearly all community hospitals provide emergency services that are considered outpatient services. Although emergency departments have the technology to treat emergency situations, many emergency rooms are used for nonemergency issues.
individuals who are 75 years or older use and emergency room..	66% more frequently than the general population
Many outpatient clinics are found in...	teaching hospitals. They use outpatient clinics as an opportunity to teach and perform research..The clinics are categorized as surgical, medical, and other. Larger teaching hospitals may have 100 specialty and subspecialty clinics.
Nonhospital-based freestanding ambulatory or outpatient facilities may...	be owned or operated by hospitals, hospital systems, or hospital chains; physicians; or for profit or not-for-profit organizations. These facilities may provide several different types of services that used to be offered as inpatient services
as a result of advanced technology..	surgery can be performed as an outpatient service. also, any type of rehabilitation service, elective surgery such as cosmetic procedures, kidney dialysis, substance abuse treatment, sports medicine, and other services are offered as ambulatory services
Urgent/Emergent Care Centers were first established in the 1970s. they are used for...	consumers who need medical care but their situation is not life-threatening. This would take the place of the hospital emergency room visit. The medical issue usually occurs outside the traditional physician office hours.
Many managed care organizations will reimburse member visits to Urgent/Emergent care centers because..	they are less expensive than an emergency room visit. The urgent care centers relieve the emergency departments from seeing patients who do not have life threatening situations. It is anticipated that there will be an increased need for these centers
Ambulatory Surgery Centers (ASCs) are for...	surgeries that do not require an overnight stay. Advances in technology an newer anesthesia drugs that enable patients to recover more quickly from grogginess have enabled more surgeries to be performed on an outpatient basis
specialized surgical centers focus on..	orthopedic surgery, plastic surgery, and gynecologic surgery. some centers offer a combination of both general and specialized surgeries
Approximately 8 million surgeries are performed in 4000 ASCs annually. THe most common procedures...	include ophthamology; gastroenterology; orthopedic; ear, nose, and throat; gynecology; and plastic surgery. Procedures at ASCs cost nearly 50% less than inpatient surgeries
community health centers (CHCs) which originated in the 1960s as part of the war on poverty, are organizations that provide healthcare services to..	the unisured or indigent population such as minorities, infants, patients with HIV, substance abusers, and the homeless. There focus is on primary care.
home health agencies and visiting nurse agencies provide medical services in ta patients home. This care is often provided to...	the elderly, disabled, or a patient who is too weak to come to the hospital or physician's office or has just been released from the hospital.

Created by: deana63

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