Lectures 3 & 4 Health Policy, Outpatient Services and Emergency Care rev

Lectures 3 & 4 Health Policy, Outpatient Services and Emergency Care rev

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Health Policy, Outpatient Services, and Emergency Care Frankie Augustin
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Agenda for today… Roll Call All readings are posted. Also check out supplemental readings posted. Sicko due beginning of class! Lecture
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Review… Who are the major players in our health care delivery system? How is health policy defined? What is a safety net hospital? What is a moral hazard? Give an example. Name some health policy issues… What is the difference between market justice and social justice?
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4 Fee For Service Capitation Bundled charges (global fees) AKA “package pricing,” related services included in one price, eg. Eye exam, frames, corrective lenses, etc. For HMOs: Capitation reimbursement Medicare/Medicaid: From retrospective reimbursement to prospective reimbursement to force hospitals to control costs
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5 Reimbursement is simple: Doctor is paid for each individual service performed rather than as part of a comprehensive plan The bill is made out by the MD, and the bill usually gets paid FFS “results in distribution of payment on the basis of expenditure of resources” (Kongsvedt, 116). * Essentials of Managed Healthcare, Fifth Edition (2007)
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6 Used by HMOs to keep costs down Bundled charges (global fees) AKA “package pricing,” related services included in one price, eg. Eye exam, frames, corrective lenses, etc. Provider is paid a monthly fixed fee for each enrollee (Per Member Per Month-PMPM) by HMO Example: For 3 Patients +$10 + $10 +$10 = $30/mo or $360/yr or $120/yr per patient (3 patients above) The amount stays the same whether the patient comes in or not. MDs want to keep costs down. Many MDs are forced to spend less time with capitated patients and more time with non-capitated “paying” patients. MDs resent this position.
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Outpatient Services Outpatients- People who visit for care and return home the same day. No overnight stay is involved. Difference between “ambulatory” and “outpatient”….patient walks in as opposed to (for example) arriving by ambulance, or care brought to them. Many services shifted from stays in hospital to outpatient care.
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Primary Care Defined by IOM: The provision of integrated, accessible health care services by clinicians who are accountable for addressing a large majority of personal health care needs, developing a
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This note was uploaded on 04/12/2009 for the course PPD 230 taught by Professor Augustin during the Spring '05 term at USC.

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Lectures 3 & 4 Health Policy, Outpatient Services and Emergency Care rev

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