Growth of Ambulatory Care
: an individual presenting for
personal health services, who is neither bedridden, nor
currently admitted to any health care institution.
Why has Amb. Cares expand over the past few years b/c
of the rapid growth of managed care and the greater
emphasis placed on outpatient hospital care.
Medicare Prospective Payment System (PPS)-
for inpatient hospitalizations. Purpose: more
Based on your review of tables, are you
familiar with some of the common disease states
that patients see their physician and their
Top Common Diseases: Essential Hypertension,
Infant checkup, Acute upper respiratory
infections, diabetes mellitus
In training high-quality health professionals,
should pharmacy schools emphasize education
on the common disease states?
Primary Care Providers
What types of physicians are known
as primary care providers? Physicians,
midwives, nurse practitioners, and
What non-physician health
professionals provide primary care?
Types of Medical Practices
2 major types in medical practice:
Private-Practice physicians in solo, partnership,
and private group practice settings on a fee for
Ambulatory Care: provided in organized settings
that have an identity independent of that of the
physicians practicing in it. This includes HMOs
Solo Practice: Is ↓ b/c managed care pressures
solo practice offers
an opp. To avoid organizational dependence
and to be self employed. PCP by Solo
Practioners= family practice, internal
medicine, pediatrics, and obstertrics and
SPPractitioners care for patients in office
space owned or leased by the physicians or
in the physicians home. For hospitalized
patients physicans seem @ provides care for
them in the hosp
is an affiliation of 3 or more providers
usually physicians who share income, expenses,
facilities, equipment, medical records, and support
personnel, and who provide
services thru a formal org.
**basically it’s a formal sharing of resources and
distribution of income.
successful non industrial group practice
ws the Mayo Clinic in Minnesota (single
specialty group 1887. It later became a mult-
from Physicains Perspective:
Shared operation, joint ownership, centralized
administrative fxns, & availability of
professional business manager. Financially the
group practice relieves the provider of having to
scare up large initial investment often req. to est.
Disadvantages from provider perspective:
Less individual freedom, less income,weak
provider-patient relationship, and greater
on referral practices
How has the trend of physicians in
solo practice and group practice changed
in the last 40 years?
What changes in health care have