Introduction to Health Care and Public Health in the U.S. Delivering Health Care, Part 2 Welcome to Introduction to Health Care and Public Health in the U.S.: Delivering Health Care, Part 2. This is lecture e. The component, Introduction to Health Care and Public Health in the U.S., is a survey of how health care and public health are organized and how services are delivered in the U.S. It covers public policy, relevant organizations and their interrelationships, professional roles, legal and regulatory issues, and payment systems. It also addresses health reform initiatives in the U.S. Lecture e This material (Comp 1 Unit 3) was developed by Oregon Health & Science University, funded by the Department of Health and Human Services, Office of the National Coordinator for Health Information Technology under Award Number 90WT0001. This work is licensed under the Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License. To view a copy of this license, visit http://creativecommons.org/licenses/by-nc-sa/4.0/. Health IT Workforce Curriculum Version 4.0

Delivering Health Care - Part 2 Learning Objectives Describe the organization of clinical health care delivery in the outpatient setting, and the organization of outpatient health care (Lectures a-c) Describe the organization of ancillary health care delivery in the outpatient setting (Lecture d) Discuss the role of different health care providers, with an emphasis on the delivery of care in an interdisciplinary setting (Lecture e) The learning objectives for Delivering Health Care, Part 2 are to: Describe the organization of clinical health care delivery in the outpatient setting and the organization of outpatient health care. Describe the organization of ancillary health care delivery in the outpatient setting. Discuss the role of different health care providers, with an emphasis on the delivery of care in an interdisciplinary setting.

Organization of Primary Care Clinics Organization of primary care clinics usually revolves around two axes The provider Physician Nurse practitioner Physician’s assistant The patient This lecture will discuss the various types of health care providers. The organization of primary care clinics usually revolves around two axes. The first is the axis of the provider. A provider may be a physician or a mid-level staff member, such as a nurse practitioner or physician’s assistant. The second axis is the patient.

The Patient Experience - 1 The Front Office Receptionist: First point of contact Greeter: help patients find the appropriate area Scheduler: Makes appointments Patient Navigator: helps navigate medical care Clinic Manager: administrator for the office Clinic Supervisors: help run the clinic This slide reviews the organization of primary care clinics in the context of the patient experience. When the patient walks into the clinic, most likely he or she initially comes in contact with a member of the front office staff. Often the receptionist has multiple roles in the office, including checking in patients and triaging telephone calls. Some larger clinics have personnel called greeters who help patients find the appropriate areas for their care. The patient may also meet a scheduler, who makes appointments for patients. The patient may contact the scheduler by telephone, by email, or face-to-face at the end of a visit to set up the next appointment. Other members of the front office team may include a patient navigator, who helps patients find their way around the complex maze of medical care and helps advocate for patients, and the clinic manager, who is the administrator for the office and is responsible for clinic activities. Additional personnel such as clinic supervisors help run the clinic. The clinic manager may also actively problem-solve complaints and other issues with the patient.

The Patient Experience - 2 The Clinical Team Medical Assistant – certified health care assistant who performs minor clinical or clerical work First clinical point of contact for patients in outpatient offices Takes patients to exam room Obtains the vital signs and chief complaint After checking in, typically patients wait in a designated waiting area for a member of the clinical team to take them back into the examination room. This is usually done by a medical assistant, a certified health care assistant who performs minor clinical or clerical work. The medical assistant is usually the first clinical point of contact for patients in outpatient offices. Medical assistants direct patients to their rooms, obtain vital statistics, record the chief complaint or reason for the visit, and in some offices may obtain additional information.

The Patient Experience - 3 Provider Physician, physician assistants or nurse practitioner who address the patient’s clinical issues Providers typically have a predetermined schedule of appointments for their day May visit hospitalized patients Have additional work that is not patient facing After preliminary information has been obtained, the patient usually makes contact with the provider. In some offices, the provider obtains all the clinical information and may even walk the patient back from the reception area to the examination room or the clinician’s office. The clinical team is orchestrated by the health care provider, who may be a physician or a mid-level practitioner such as a nurse practitioner, or physician assistant. The provider addresses the patient’s clinical issues at the time of the visit. Providers typically have a predetermined schedule of appointments for their day. Providers may spend time performing administrative functions such as quality and financial management tasks and they may also spend time away from the clinic visiting patients in the hospital.

Additional Provider Activities What do physicians do when they are not seeing patients? Reviewing charts Fielding telephone calls Reviewing test results, correspondence Answering questions from staff about patient care Consulting with other physicians about patients Completing forms Other work So what do physicians do when they are not seeing patients? They may review charts, write or dictate notes, or field telephone calls from or to patients, their family members, or other physicians such as specialists. They may review test results, including laboratory results or radiographs, or read correspondence from consultants or patients. They may answer questions from staff members about patient care, patient telephone calls, or laboratory results. Sometimes they consult with other physicians about patients, and they spend time doing paperwork including visibility, insurance, and school physical forms. They may also make pharmacy calls, schedule patients, or provide instructions to staff.

Clinical Roles - 1 Care management coordinator Pharmacist Helps with referrals, tests, insurance pre-approvals Pharmacist Acts as a pharmacological resource for patients Manage medications for chronic illnesses or dosing protocols for blood thinners In addition to the provider, the patient may interact with other members of the clinical team. The care management coordinator helps the patient with referrals, tests, or insurance preapprovals for diagnostic testing or procedures. The patient may also visit the pharmacist, who acts as a resource for pharmacological information. In some clinics, pharmacists manage medications for chronic illnesses, such as diabetes or high blood pressure, or dosing protocols, such as for the blood thinner Warfarin.

Clinical Roles - 2 Dietician / Diabetes educator Social Worker Helps patients with specific dietary interventions Social Worker Assists with social issues Goal to enhance human well-being Counselor Mental health issues, also assists with patients’ psychosocial issues There is an acute shortage of mental health services Other members of the clinical team include a dietician or a diabetes educator, who helps patients with specific dietary interventions such as low-cholesterol or calorie-control diets. The social worker assists with social issues. According to the National Association of Social Workers, the goal is enhancing human well-being and helping to meet the basic human needs of all people, with particular attention to the needs and empowerment of people who are vulnerable, oppressed, and living in poverty. The patient may also visit with a counselor, usually for mental health issues, but also for other psychosocial issues. In many communities today, there is a huge shortage of mental health services. Counselors may coordinate care with the primary care provider rather than with a mental health specialist.

Clinical Roles - 3 Triage Nurse Back-office Medical Assistants Takes phone calls Problem-solves issues Refers complex issues to physician Arrange referrals Back-office Medical Assistants Telephone triage Referral coordination Point-of-care procedures In addition to meeting the front-office clinical team, the patient may also make contact with the back office. Members of this cohort include the triage nurse, who takes telephone calls, problem solves issues for patients, and refers complex cases to the physician. The triage nurse may also advise the patient to go to an urgent care center or to an emergency department. The triage nurse may also arrange referrals for the patient. Back-office medical assistants may take on multiple roles, including telephone triage, referral coordination, or point-of-care procedures such as ear washes, capillary blood glucose monitoring, or urinalysis. The difference between a triage nurse and a medical assistant is that the nurse has a higher level of training.

Clinical Roles - 4 Coders and billers Interpret codes that delineate diagnoses and levels of care Insurance Specialists / Referral Coordinators Simplify the referrals process Housekeeping Services Disposal of sensitive patient-related information and medical wastes There are some members of the back office that patients may not see during their office visit. In order to bill for the visit, health care providers use specific codes to delineate diagnoses and levels of care, and these codes are interpreted by billers and coders. Insurance specialists or referral coordinators simplify the referral process for patients and deal with paperwork from insurance companies. They may also arrange for appointments with specialists and other providers. Housekeeping services not only maintain the hygiene of the primary care clinic by disposing of medical waste and ensuring cleanliness, but they may also be responsible for the disposal of sensitive patient-related information.

Ancillary Roles Specialized ancillary staff Radiology and laboratory technicians Nuclear medicine technicians Sonographers Other ancillary service providers Physical and occupational therapists Speech therapists Emergency medical technicians and paramedics The patient may require diagnostic testing and therefore need the services of specialized ancillary staff such as radiology and laboratory technicians, nuclear medicine technicians, and sonographers. Other ancillary service providers include physical therapists, occupational therapists, and speech therapists. Emergency medical technicians and paramedics may make contact with patients outside of the primary care clinic or help transport them from the primary care clinic to the emergency room if their condition is deemed to be serious enough.

Delivering Health Care, Part 2 Summary – 1 – Lecture e Discussed the role of different health care providers. Patient experience includes an interdisciplinary team with multiple roles. May include ancillary providers. This concludes lecture e of Delivering Health Care, Part 2. This lecture discussed the roles of different health care providers. The patient interacts with an interdisciplinary team that involves the front office, the clinical staff, ancillary providers, and perhaps members of the back office.

Delivering Health Care, Part 2 Summary – 2 – Lecture e Described the organization of clinical health care delivery in the outpatient setting, and the organization of outpatient health care Described the organization of ancillary health care delivery in the outpatient setting Discussed the role of different health care providers, with an emphasis on the delivery of care in an interdisciplinary setting This also concludes the unit Delivering Health Care, Part 2. In summary, this unit described the organization of clinical health care delivery in the outpatient setting, and the organization of ancillary health care delivery. Also discussed were the roles of different health care providers, with an emphasis on the delivery of care in an interdisciplinary setting.

Delivering Health Care, Part 2 References – Lecture e Time Spent in Face-to-Face Patient Care and Work Outside the Examination Room. (2005). Annals of Family Medicine, 3(6), 488-493. doi:10.1370/afm.404 No audio Health IT Workforce Curriculum Version 4.0

Introduction to Health Care and Public Health in the U. S Introduction to Health Care and Public Health in the U.S. Delivering Health Care, Part 2 Lecture e This material was developed by Oregon Health & Science University, funded by the Department of Health and Human Services, Office of the National Coordinator for Health Information Technology under Award Number 90WT0001. No audio Health IT Workforce Curriculum Version 4.0