Health System Organization Session 8 – February 24, 2011 Health Care Processes, Service Delivery & the Continuum of Care Organization, Integration and New Strategies for Improving the System Group presentation #5: Race Against Time

Ambulatory/Outpatient Services: Scope and Definition By service: preventive, diagnostic, therapeutic, emergent By location: community, hospital By discipline: medicine, dental, vision, complementary By setting: surgi-centers, clinics, dialysis, psychiatric By level: primary, secondary, tertiary

Why the Growth in Outpatient Care? Outpatient Surgery New Diagnostic Tests Technology Reimbursement Specialized Treatment Centers/Physician Office Practices Social Factors Settings and Overall Increase in Demand

Growth in Outpatient Services: The Issue of Access E.D. Use by Patient Flow Time Period Percent of Visits 8 a.m. – 4 p.m. 44% 4 p.m. – 12 a.m. 37% 12 a.m. – 8 a.m. 19% E.D. Use by Frequency and Payer Insurance Status 1 ED Visit 2 ED Visits 3+ ED Visits Private Insurance 78% 14% 8% Medicaid 75% 16% 9% Medicare 72% 17% 11% Uninsured 86% 3%

Reasons for Seeking Care in the ED Contact with Medical Personnel Prior to Coming to ED 35% - yes 63% - no 2% - Tried, but unable Reason for Not Going to Usual Source of Care* 51% - Prefer ED because no appointment required, don’t have to wait 31% - Office/clinic closed 14% - Told to go to ED 4% - Financial/insurance reasons Medical 33% - fever, flu, cough, etc. 19% - pain 11% - injury 8% - gastro-intestinal 28% - other Duration of Medical Problem 21% - a few hours 23% - one day 21% - two or three days 19% - four to seven days 9% - more than a week 7% - more than a month *Does not include those without a usual source of care.

Inpatient Care and Institutions Social Welfare Role Care for the Sick Institutions for Medical Practice Institutions for Medical Training and Research Expansions, Consolidation & Expansion of Complex Health Systems

Inpatient Concepts Discharges, (In)patient days Average length of stay Capacity Average Daily Census Occupancy Rate

Does Ownership Matter? Public Non-Profit Investor Owned/Proprietary Rural Critical Access Teaching Religious Affiliation Osteopathic

Other Considerations Ownership & Governance Licensure, Certification & Accreditation Ethical & Legal Issues

Break When You Return: Group 5 Presentation