SPEA-H 124 1st EditionExam # 2 Study Guide Hospitals and health Systems Character of American HospitalsExam is 45 multiple choice and true or false questionsRe-watch lectures to help you remember what he says, because a lot of his questions are directly what he saysAppreciated: resources for community; subject of criticism, idea of charitable, now very aggressive collecting payment Maligned: malpractice Poor understanding of hospitals: “magical place,” where a patient always gets better in theory Place of: 1. Treatment 2. Research 3. Education 4. Employment a. Usually the largest employer in areas with an average salary of 56-60k Not-for-Profit What it actually means: hospital isn’t taxed on value of property or profit; part of the private hospital network; voluntary and can be faith-based Early History 1700s: hospitals weren’t a place to get cured, they were a place for the sick to be contained, especially the poor -the elite were called the “polite” society and had resources of their own to keep them out of hospitals Hospitals used to be called “Poorhouses” and warehoused roughly 6,000 people; NOW, most hospitals contain about 1800 beds. *Hospitals had tighter visiting hours usually 7-9pm; limited public/family to how bad conditions actually were NOW, visits by loved ones are considered to aid in the healing process.Hospitals started by physicians going to wealthy for funds: driven by a desire for the community wellness (1800s) Religious Order (1800s-1910): the wave of church organizations starting churches - Churches headed by nuns/sisters until 1960s-1980s o Helped keep decisions based on religious beliefs and guidelines Nurse training was done by hospitals; all hospitals had a nursing school and housed their nursing studentsFactors Shaping Industry - Private health insurance : created “business of medicine” - Medical specializations and advances encouraged uses to go to a hospital - Hill-Burton Act (1946-just know general time period) Access went up, so did cost; biggest reasons costs went up o Gave federal funds for hospital expansion and improvements o Funding was to be used for charity use for 20 years o “A bed built is a bed filled.” –Roemer’s law - Medicare/Medicaid fueling costs and utilization Growth and Decline in Number of Hospitals Numbers of hospitals: 1873: 178  1909: 4300  1946: 6,000  1970: 7,200  1980-present: 5,700 33% decline in inpatient days Business of medicine reason for decrease in numbers; consolidation of hospitals Types of Hospitals (know each kind) Acute care: <30 days Sub-acute care: rehabilitation hospitals Specialty hospitals: Behavioral/mental; an orthopedic hospital-started by single physicians Average length of stay is about 3 days Ownerships: Not-for-profit (“voluntary”)-gives value to the community in ways that paying tax moneycouldn’t do; has to prove they can do this and maintain not-for-profit - 51% of hospitals non-government and not for profit; can be teaching and non-teaching For-profit (“proprietary”)- 18% investor-owned-for-profit - Majority of for-profit hospitals located in Tennessee) Government (“public”)- 21% state and local governmentTeaching or non-teaching; medical school affiliations --teaching hospitals are not-for-profit; they are expensive to run because they must havethe most technologically advanced to teahing hospitals are not-for-profit; they are expensive to run because they must have the most technologically advanced to teach from 2 parts to teaching hospitals 1. Residents teaching doctors 2. Applied health professionals (every other profession aside from doctors, i.e. physical therapist, technicians, dieticians) Physician-owned and specialty hospitals - Limited to minor surgeries, orthopedics, ENT or gynecologic procedures - Patient friendly and upscale - Produces competition for community hospitals by taking away profit for hospital; takes away “hosptial’s” patient because they think its “their patient” - Good nurse-to-patient ratio - PROBLEMSo “Cream Skimming” when specialty hospitals take patients who wont cost them money and give the hospital the patients who would cause a loss in profit; o Borrows equipment from hospitals; they don’t have an emergency room, so if a patient needs emergency care, they must go over to the hospital to use their rooms Forces the hospital to maintain a civil relationship with the physician because it is best for the patient Primary: physicians, primary careSecondary: somewhere between primary and tertiary; not used very commonly Tertiary: most sophisticated; found in big cities usually Federal System of the Department of Veterans Affairs (VA Clinics) The largest health care system in the U.S; owned and operated by the government --provides all veterans with free health care for life *Government is provider in this system whereas in Medicare/Medicaid government is payor Exempt from budget cuts; actually get more than asked for; a source for the governmentto show appreciation for veterans Structure and Organization of Hospitals The typical organization is the not-for-profit hospital 3 legged stool platform1. Board of directors: volunteers form the community responsible for the overall success of the hospital2. Administration: chief officers, vice presidents; paid positions 3. Medical staff (doctors); insurance company pays doctors, hospitals do not pay doctors a. Headed by physician “Chief of Staff”b. Reports directly to the Board c. Responsible for overseeing quality of care; only physicians can evaluate quality of care given d. Hospital staff is the rest of the hospital excluding doctors Major Operating Divisions: - Nursing: largest personnel component; - Clinical support serviceso Diagnosis (lab, imaging) o Patient support (pharmacy, respiratory therapy, rehab) - Administrative and Fiscal - Human Resources - Hotel services: housekeeping, food services - Community relations **”line” vs “staff” Line: directly doing patient care of supportStaff: supporting roles i.e. marketing for hospital Hospital Complexity Employer of about 1,000 people“Full time employment” gotten by adding together full-time employees, plus part-time employees that would equal a full-time employee No one person is in charge of a patient, which leads to a complex communication system; patient doesn’t know who to ask about their personal health information and appointments