Instructor – Cindy Quisenberry

Trends 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)

Technology in Health Care

Exercise Diet

Screening Tests Drugs to prevent disease

Preventive Medicine & Wellness

Offers programs that focus on older populations and their therapeutic needs; Clinical services are an important component of hospital wellness centers Cardiac Rehabilitation Pulmonary Rehabilitation Occupational Medicine Sports Medicine Clinical Weight Management Physical Therapy

Hospital Wellness Centers

(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.

Cardiac 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: Exercise training Nutritional counseling Education Energy-conserving techniques Breathing strategies Psychological counseling and/or group support

Pulmonary Rehabilitation

Attempts to maintain workers' health, prevent disease, and treat the results of occupational disease or accident

Occupational Medicine

A branch of medicine that deals with physical fitness, treatment and prevention of injuries related to sports and exercises

Sports Medicine

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.

Clinical Weight Management

(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)

Physical Therapy

Fitness Preventive Care Spiritual Health Safety Nutrition Tackling Tobacco Addiction Stress Management

Factors Related to Wellness

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 Reform

Health Care Facilities

Hospitals run by Religious Organizations

Private Hospitals Nonprofit Hospitals Hospitals run by Government

Organizations Specialized Hospitals

Hospitals (Inpatient Facilities)

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

Long Term Care

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.

Offices and Clinics

Perform tests on blood, other body fluids, tissues, etc. to assist physicians or other practitioners in making diagnosis.

Laboratories

(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.

Emergency Medical Services

Provided in the home for short periods after hospitalizations or for longer periods for patients who have chronic diseases or disabilities.

Home Health Care

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.

Hospice

Health Care 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 ServicesCDC – Center for Disease Control &

PreventionFDA – Food & Drug AdministrationNIH – National Institutes of Health

World Health Organization (WHO)

Government 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?

Volunteer & Nonprofit Agencies

Health Care Funding Programs

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.

Paying for Health Care

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 (1966)

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)

Medicare (cont.)

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.

Medicaid

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.

Blue Cross / Blue Shield

For-profit businesses (ie: Traveler’s, Metropolitan Life, etc.) – these agencies usually sell a host of insurance packages.

Commercial Insurance

U.S. Government provides health care benefits for families of current military personnel and veterans through the CHAMPUS/TRICARE program.

Military Health Care

Businesses that develop their own insurance programs for employees. More companies are setting aside funds to cover the risk of their self-insurance programs. The company may hire BC/BS or a commercial insurer to administer the program, including, reviewing, and paying claims.

Self Insurance

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.

Workers’ Compensation

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

Managed Care

Clients who have no insurance and who must pay the entire health care bill

Private Pay

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.

Uncompensated Care