1. 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

2. 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

3. 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

4. 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%

5. 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.

6. 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

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

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

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

10. Break
When You Return:
Group 5 Presentation