1. Hospitals and Ambulatory Care H Edu 5100

2. History 1873 = 178 1909 = 4,300 1946 = 6,000 1970s = 7,200 2000s = 4,000

3. Growth and Decline Technology/war Financial incentives Costs

4. Capital Financing Hill-Burton Act (1946) Medicare and Medicaid Three factors…  Guaranteed revenues  Tax exemption  Cost reimbursement Hospital borrowing

5. Types of Ownership Voluntary, not-for-profit Investor-owned, for-profit Government

6. Legal Structure Governing board Medical staff Management

7. Operational Structure Medical division Nursing division (clinical services) Other Clinical and diagnostic Administrative “Hotel” Services

8. Patient Rights/Responsibilities Rights Responsibilities

9. Informed Consent Established legal practice Right to know…

10. Quality of Care JCAHO Structural reviews Process audits Results focus Indicators Fragmentation

11. Re-engineering New models vs incremental change Hospitals = one component vs hub Service orientation

12. Integration Horizontal Vertical

13. Role of Physicians Admissions What services are used Guest in hospital

14. Sources of Revenue Philanthropy Global budgets Charges (price) Cost reimbursement Per case (DRG) Capitation Managed care

15. Funds Out Payroll Professional fees Supplies and other Capital depreciation and interest

16. Who Gets the Profits? Physicians Hospitals For-profit vs non-profit

17. Competition Among Hospitals Good or bad?

18. Current Issues… Team-based care Hospitalists Patient Expectation

19. Magnet Hospitals Nursing leadership Standards for nurse administrators Protected feedback procedures Unfair labor practices Regulatory compliance Data collection

20. Ambulatory Care

21. Origins Private medical practices Indigent clinics ERs Public health clinics

22. Evolution of physician practices Solo Group Multi-specialty groups

23. Hospital Outpatient Activities Indigent clinics Outpatient services Outpatient departments Specialty clinics

24. The Emergency Room

25. Freestanding Centers Who owns? Who uses? Hospital concerns Surgical centers

26. Impact on triangle Access Quality Cost