Transcript Trends in Health Care

Trends in Health Care
Technology in Health Care
 Health care is affected by science and
technology. Technology in the 21st century
has been “explosive.”
 Cell phones
 Geographic Information Systems (GIS)
 Cameras
 Scopes and Small Instruments
 Digital Imaging
 Electronic Health Records (EHR)
Preventive Medicine & Wellness
 Exercise
 Diet
 Screening Tests
 Drugs to prevent disease
Hospital Wellness Centers
 Offers programs that focus on older
populations and their therapeutic
needs; Clinical services are an
important component of hospital
wellness centers
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Cardiac Rehabilitation
Pulmonary Rehabilitation
Occupational Medicine
Sports Medicine
Clinical Weight Management
Physical Therapy
Cardiac Rehabilitation
 (Cardiac Rehab) - a professionally
supervised program to help people
recover from heart attacks, heart surgery
and percutaneous coronary intervention
(PCI) procedures. Usually provide
education and counseling services to
help heart patients increase physical
fitness, reduce cardiac symptoms,
improve health and reduce the risk of
future heart problems.
Pulmonary Rehabilitation
 (Pulmonary Rehab or PR) is a broad
program that helps improve the well-being
of people who have chronic (ongoing)
breathing problems. Can benefit people
who need lung surgery. It’s used with
medical therapy and may include:
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Exercise training
Nutritional counseling
Education
Energy-conserving techniques
Breathing strategies
Psychological counseling and/or group support
Occupational Medicine
 Attempts to maintain workers' health,
prevent disease, and treat the results
of occupational disease or accident
Sports Medicine
 A branch of medicine that deals with
physical fitness, treatment and
prevention of injuries related to sports
and exercises
Clinical Weight Management
 A physician directed long-term weight loss
program proven to be the healthiest way to
lose weight. This program is a complete
lifestyle transformation educating patients
on weight management, healthy eating
habits, and proper exercise, the patients
are less likely to gain back weight once
they have completed the program, making
it not only healthy but effective.
Physical Therapy
 (Often abbreviated PT), concerned with
the remediation of impairments and
disabilities and the promotion of mobility,
functional ability, quality of life and
movement potential through examination,
evaluation, diagnosis and physical
intervention carried out by physical
therapists and physical therapist
assistants (PTA)
Factors Related to Wellness
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Fitness
Preventive Care
Spiritual Health
Safety
Nutrition
Tackling Tobacco Addiction
Stress Management
Health Care Reform
 Health care costs are increasing in the United
States because of growing demand and more
costly procedures. Uninsured or underinsured
individuals also cause the cost of health care to
rise.
 Hospitals that are partially supported by taxes
provide care to uninsured people with low
incomes. Hospitals or health care providers
often pass on these costs to patients who have
insurance or can afford to pay full price. This
raises the prices charged by providers and
insurance companies.
Health Care Reform
 Outpatient Care – Many procedures from
diagnosis to treatment are done on an outpatient
basis. A patient may walk into a clinic in the
morning, have tests or surgery, and go home in
the afternoon. Procedures that once required
hospitalization now are done in outpatient
centers.
 Home Health Care
Health Care Reform
 Benefits of Home Health Care
 Patient exposed to less pathogens
 Stress and anxiety are also minimized at
home
 Nurses and therapists provide assessment,
treatment, and education
 Unlicensed workers assist with personal care
 Many frail or elderly people can remain at
home and can receive – meal delivery,
shopping help, transportation, etc.
Health Care Facilities
Hospitals (Inpatient Facilities)
 Hospitals run by Religious
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Organizations
Private Hospitals
Nonprofit Hospitals
Hospitals run by Government
Organizations
Specialized Hospitals
Long Term Care
 Provide care to people who need nursing or
other professional health care services on a
regular basis. These patients may not need
round-the-clock nursing services. A
physician usually reviews the care being
provided to the patient and sees the patient
on at least a monthly basis. May be
admitted for physical rehabilitation following
surgery, injury, or serious illness (stroke).
These patients may be called residents
instead of patients.
Long Term Care
 Nursing Home
 Rehabilitation Center – help patients regain
physical or mental abilities or teach them how
to live with disabilities. Focuses on physical,
occupational (job), mental or psychological,
and behavior modification therapies. Helps
patients regain function, independence, and,
as much as possible, the ability to take care
of themselves.
 Assisted-Living Center
 LTACH – Long Term Acute Care Hospital
Offices and Clinics
 Health care providers such as
physicians, nurse practitioners and
physician assistants provide
examination and diagnosis for acute
and sudden illnesses as well as
chronic illnesses, wellness exams,
counseling, etc. Dentists and dental
hygienists are included in this group.
Laboratories
 Perform tests on blood, other body
fluids, tissues, etc. to assist
physicians or other practitioners in
making diagnosis.
Emergency Medical Services
 (EMS) Extends medical care form the
emergency room of a hospital into the
community. The EMS system is
designed to provide care to ill and
injured people as quickly as possible.
Home Health Care
 Provided in the home for short
periods after hospitalizations or for
longer periods for patients who have
chronic diseases or disabilities.
Hospice
 A special form of care for patients
who have terminal illness. Focus on
the ill person and the family, not the
disease. The goal is to give support
to patients who are near death.
Therapy is designed to improve the
quality of life, use pain medications
effectively, relieve symptoms, prepare
the person and their family for death.
Health Care Agencies
Government Agencies
 Paid for by taxes; may provide care,
but mainly they conduct research,
oversee programs providing care to
the elderly and children, and establish
health care policies.
 Local Health Departments
Government Agencies
 U.S. Department of Health & Human
Services
 CDC – Center for Disease Control &
Prevention
 FDA – Food & Drug Administration
 NIH – National Institutes of Health
 World Health Organization (WHO)
Volunteer & Nonprofit Agencies
 Provide funding for research and
promote education based on
information learned through research.
They may also provide special
services to victims of disease by
purchasing equipment or providing
treatment centers.
 What are some examples of these
agencies?
Health Care Funding
Programs
Paying for Health Care
 Most people rely on health insurance to pay for
health care. A subscriber pays a premium to an
insurance company. The subscriber is often an
employer, but subscribers can also be individuals.
The insurance company decides what services
will be covered. If the service is covered, the
insurance company pays for that service. Many
plans limit the amount they will pay for a service
and also sets deductibles, or the amount an
insured person must pay before the insurance
company begins to pay.
Paying for Health Care
 Employers often offer insurance
coverage to employees, this is group
insurance. The employer may pay part
or all of the premium as an
employment benefit.
Paying for Health Care
 In 2010, Obama signed the Patient
Protection and Affordable Care Act,
extending coverage to 32 million previously
uninsured Americans. The act also bans
lifetime limits on coverage, exclusions for
preexisting conditions, and policy
cancellations when a person becomes ill,
parents can also keep their children on a
family policy until age 26.
Medicare (1966)
 A federally funded and administered
national health insurance program for
citizens age 65 years and older , disabled,
chronic renal failure, regardless of age.
Paid for through payroll taxes of all workers
and through monthly premiums paid by
recipients.
Medicare (cont.)
 In 1983, the federal government instituted
major changes in the way hospitals were
reimbursed, hospitals receive compensation
on a prospective basis, hospitals are paid
one predetermined sum for a given
diagnosis (DRG’s – diagnosis-related
groups)
Medicaid
 A joint federal and state program administered by
the state government. This insurance program
provides limited funding for hospital and medical
care costs of low-income citizens. Each state sets
the income levels that determine eligibility. As a
result, some states provide more services than
others. The state must budget money from its
own revenues for the program matched by the
government. The federal portion is always larger
than the state portion.
Blue Cross / Blue Shield
 Private not-for-profit health insurance
companies set up through special
legislation in the 1930’s. The “blues”
are the largest single insurer outside
the federal government from shish
businesses and industry can purchase
health insurance for employees. Both
hospital and medical care
insurance are available.
Commercial Insurance
 For-profit businesses (ie: Traveler’s,
Metropolitan Life, etc.) – these
agencies usually sell a host of
insurance packages.
Military Health Care
 U.S. Government provides health care
benefits for families of current military
personnel and veterans through the
CHAMPUS/TRICARE program.
Self Insurance
 Businesses that develop their own
insurance programs for employees.
More companies are setting aside
funds to cover the risk of their selfinsurance programs. The company
may hire BC/BS or a commercial
insurer to administer the program,
including, reviewing, and paying
claims.
Workers’ Compensation
 A federally mandated, state-funded
and state-administered insurance
program available to workers injured
on the job. Each employer is
assessed a payroll tax, which funds
the plan.
Managed Care
 designed specifically to control costs.
Managed care organizations manage,
negotiate, and contract for healthcare
with the primary goal of keeping health
care costs down.
 HMO – Health Maintenance Organization
 PPO – Preferred Provider Organization
Private Pay
 Clients who have no insurance and
who must pay the entire health care bill
Uncompensated Care
 Health care delivered that is not paid for by an
insurance program or by clients themselves.
Many private pay clients contribute to the amount
of uncompensated care when they cannot pay the
high costs of health care. Other sources of
uncompensated care include the differences
between what the care costs and what Medicare
or Medicaid pays the provider. By law, providers
cannot bill anyone for the differences and must
absorb the loss of revenue.