Component 1: Introduction to Health Care and Public Health in the U.S. 1.2: Unit 2: Delivering Healthcare 1.2 d: Health Care Settings: Hospitals, Post-Acute Care , Long Term Care, and Non-Traditional Settings

Health Care Settings: Hospitals Community Hospitals provide convenient, high quality health care at a reasonable cost Provide emergency room services for a community Community hospitals represent the backbone of the acute care delivery system. In Massachusetts, they all provide emergency room services and, depending upon their size, provide services that mirror what is expected for secondary care in an academic medical center. Recent studies that review key quality measures, such as maternal outcomes, cardiac procedures and other measures of secondary care quality, demonstrate that the overall quality of our community hospitals equals or exceeds that of academic medical centers, but at a significantly lower cost. The community hospital is an important stabilizing factor in the economic viability of the cities and towns where they are located. Often they are the largest employer in the area and have wage levels equal to or above the state average. The community hospital system is an asset and an important factor in the overall health of our citizens and the economic well-being of the Commonwealth. Component 1/Unit 2d Health IT Workforce Curriculum Version 1.0/Fall 2010

Health Care Settings: Hospitals Community Hospitals Usually the largest employer in the area with wages that are equal to or exceed the state average. Important factor in the overall health of a community Community hospitals represent the backbone of the acute care delivery system. In Massachusetts, they all provide emergency room services and, depending upon their size, provide services that mirror what is expected for secondary care in an academic medical center. Recent studies that review key quality measures, such as maternal outcomes, cardiac procedures and other measures of secondary care quality, demonstrate that the overall quality of our community hospitals equals or exceeds that of academic medical centers, but at a significantly lower cost. The community hospital is an important stabilizing factor in the economic viability of the cities and towns where they are located. Often they are the largest employer in the area and have wage levels equal to or above the state average. The community hospital system is an asset and an important factor in the overall health of our citizens and the economic well-being of the Commonwealth. Component 1/Unit 2d Health IT Workforce Curriculum Version 1.0/Fall 2010

Health Care Settings: Hospitals (cont’d) Critical Access Hospitals A hospital that is certified to receive cost-based reimbursement from Medicare. This is different than the normal prospective payment model of Medicare. This reimbursement was designed to help small hospitals improve their financial performance and reduce hospital closures. These are usually rural hospitals A Critical Access Hospital (CAH) is a hospital that is certified to receive cost-based reimbursement from Medicare. The reimbursement that CAHs receive is intended to improve their financial performance and thereby reduce hospital closures. Each hospital must review its own situation to determine if CAH status would be advantageous. CAHs are certified under a different set of Medicare Conditions of Participation (CoP) that are more flexible than the acute care hospital CoPs. Component 1/Unit 2d Health IT Workforce Curriculum Version 1.0/Fall 2010

Health Care Settings: Hospitals (cont’d) Federal Hospitals Hospitals operated by the Department of Defense, the Department of Health and Human Services, and the Veterans Health Administration. Component 1/Unit 2d Health IT Workforce Curriculum Version 1.0/Fall 2010

Health Care Settings: Hospitals (cont’d) Long-term Hospital Long-term care hospitals (LTCHs) furnish extended medical and rehabilitative care to individuals who are clinically complex and have multiple acute or chronic conditions. Component 1/Unit 2d Health IT Workforce Curriculum Version 1.0/Fall 2010

Health Care Settings: Hospitals (cont’d) Long-term Hospital An LTCH must be certified as an acute care hospital that meets criteria to participate in the Medicare program and has an average inpatient length of stay greater than 25 days. As of November 2001, Medicare recognized 270 facilities as LTCHs. Component 1/Unit 2d Health IT Workforce Curriculum Version 1.0/Fall 2010

Health Care Settings: Hospitals (cont’d) Psychiatric Hospital Psychiatric inpatient, outpatient, partial hospitalization, foster and/or home care, consultation, and education; Hospital-based community mental health centers. Component 1/Unit 2d Health IT Workforce Curriculum Version 1.0/Fall 2010

Health Care Settings: Hospitals (cont’d) Psychiatric Hospital Alcoholism/chemical dependency treatment inpatient, outpatient, and/or partial hospitalization;  Clinical psychology; Component 1/Unit 2d Health IT Workforce Curriculum Version 1.0/Fall 2010

Health Care Settings: Hospitals (cont’d) Specialties Hospital The facility provides specialized care services to patients who are critically ill, have multiple complications and/or failures that require continued hospitalization beyond the acute care setting. Long term intensive care can also be offered by a specialty hospital Component 1/Unit 2d Health IT Workforce Curriculum Version 1.0/Fall 2010

Health Care Settings: Hospitals (cont’d) Specialties Hospital (cont’d) Programs include ventilator care, coma emergence, traumatic brain injury, pulmonary rehabilitation and medically complex care. Health care professionals specialize in treating a variety of conditions, ranging from injuries to the brain and spinal cord to slow-healing wounds. Component 1/Unit 2d Health IT Workforce Curriculum Version 1.0/Fall 2010

Health Care Settings: Hospitals (cont’d) Private Hospital A hospital owned by a for-profit company or a non-profit organization and privately funded through payment for medical services by patients themselves, or by insurers. Component 1/Unit 2d Health IT Workforce Curriculum Version 1.0/Fall 2010

Health Care Settings: Hospitals (cont’d) Private Hospital The majority of hospitals that exist in the United States today are considered private hospitals. Conversely, the majority of hospitals that exist in the United Kingdom are run by the National Health Service. Component 1/Unit 2d Health IT Workforce Curriculum Version 1.0/Fall 2010

Health Care Settings: Hospitals (cont’d) Multi-hospital systems In 1940, the Catholic Church operated 183 hospitals in 42 systems! The model has growth tremendous since 1940 because healthcare has changed with reimbursement models, Medicare, Medicaid, etc. Component 1/Unit 2d Health IT Workforce Curriculum Version 1.0/Fall 2010

Health Care Settings: Hospitals (cont’d) Multi-hospital systems Benefits include reduction of duplication of services, economies of scale, access to management expertise, improved productivity and operating efficiencies….. Component 1/Unit 2d Health IT Workforce Curriculum Version 1.0/Fall 2010

Health Care Settings: Hospitals (cont’d) Inpatient rehabilitation centers In a broad sense, rehabilitation services are measures taken to promote optimum attainable levels of physical, cognitive, emotional, psychological, social, and economic usefulness, and thereafter to maintain the individual at the maximal functional level.   Component 1/Unit 2d Health IT Workforce Curriculum Version 1.0/Fall 2010

Health Care Settings: Hospitals (cont’d) Inpatient rehabilitation centers (cont’d) The term is used to denote services provided in inpatient and outpatient settings, ranging from comprehensive coordinated medically based programs in specialized hospital settings to therapies offered in units of hospitals, nursing facilities, or ambulatory centers.  Resources found on this site mainly focus on Medicare payment and related implementation issues.  Component 1/Unit 2d Health IT Workforce Curriculum Version 1.0/Fall 2010

Health IT Workforce Curriculum Version 1.0/Fall 2010 Health Care Settings: Non-Traditional Centers- School-Based Health Center Primarily located in areas with limited access to health care services, a SBHC is like a doctor’s office inside a school. They are usually located in areas with limited access to health care services. School-Based Health Centers are usually staffed by a multi-disciplinary team, which may include a Health Aide, Nurse Practitioner/Physician Assistant, Mental Health Professional, Physician, and Medical Assistant. A Medical Assistant acts as an aide to the Nurse Practitioner/Physician Assistant. Some SBHCs provide additional services such as mental health care, optometry services, and dental care. Often, SBHC staff participate in their school’s health education programs. If a service is not directly provided by the SBHC, the staff may refer students to outside specialists when needed. The SBHC can serve as a student's Primary Care Provider (PCP) or complement services provided by an outside PCP. It provides scheduled and walk-in services when school is in session and 24-hour telephone coverage to assist with problems that may arise when the SBHC is closed. Many SBHCs are opened during holiday periods and over the summer. SBHCs can provide care only for students who are enrolled; therefore, it is important for every student in the school to be registered at the SBHC. To receive SBHC services, parents must sign a Parental Consent Form . Component 1/Unit 2d Health IT Workforce Curriculum Version 1.0/Fall 2010

Health IT Workforce Curriculum Version 1.0/Fall 2010 Health Care Settings: Non-Traditional Centers- School-Based Health Center A SBHC fulfills three functions in a school: 1.   Primary care and preventive health services including (a) comprehensive physical examinations; (b) immunizations; (c) TB testing; and d) screening, diagnosis, and treatment of medical conditions. 2.    First aid care to all students registered in the building 3.    Emergency care to anyone in need on school premises. School-Based Health Centers are usually staffed by a multi-disciplinary team, which may include a Health Aide, Nurse Practitioner/Physician Assistant, Mental Health Professional, Physician, and Medical Assistant. A Medical Assistant acts as an aide to the Nurse Practitioner/Physician Assistant. Some SBHCs provide additional services such as mental health care, optometry services, and dental care. Often, SBHC staff participate in their school’s health education programs. If a service is not directly provided by the SBHC, the staff may refer students to outside specialists when needed. The SBHC can serve as a student's Primary Care Provider (PCP) or complement services provided by an outside PCP. It provides scheduled and walk-in services when school is in session and 24-hour telephone coverage to assist with problems that may arise when the SBHC is closed. Many SBHCs are opened during holiday periods and over the summer. SBHCs can provide care only for students who are enrolled; therefore, it is important for every student in the school to be registered at the SBHC. To receive SBHC services, parents must sign a Parental Consent Form . This form is available at the SBHC and also as a download: Component 1/Unit 2d Health IT Workforce Curriculum Version 1.0/Fall 2010

Health Care Settings: Non-Traditional Centers- Day Hospitals (cont’d) Day hospitals provide a broad range of skilled-nursing services, including injections, chemotherapy, and intensive rehabilitation. Most day hospital programs are housed in chronic-care hospitals or rehabilitation centers. This allows the health care provider to take advantage of in-house professional expertise and resources, while allowing the patient to return home for the evening. Services are covered under Medicare, with requirements similar to those of home health care. Day hospitals are most often used for two groups of patients: those needing rehabilitation in multiple areas and those with psychiatric illnesses. A systematic review of day-hospital care found that day hospitals compared favorably with other sources of care for many traditional health outcomes (eg, death, disability, etc.). In fact, those receiving care in day hospitals tend to have less functional decline and less hospital and institutional care. Component 1/Unit 2d Health IT Workforce Curriculum Version 1.0/Fall 2010

Health IT Workforce Curriculum Version 1.0/Fall 2010 Summary There are many types of facilities that provide health care services to people These facilities range from outpatient clinics to hospitals to non-traditional types of institutions. The institutions mentioned in this section is a sampling of the types of institutions providing health care, but is not an exhaustive listing. Contrary to the popular belief that there is no national healthcare in the US, the federal government spends billions of dollars providing “free” healthcare to specific populations. Component 1/Unit 2d Health IT Workforce Curriculum Version 1.0/Fall 2010

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