NM 111 - Chapter 4 and Lecture: The Healthcare Delivery System

Modern day Healthcare Delivery System

• Application of common sense and supportive care

• Return of healthcare to preventive measures and natural treatments due to increasing costs and over-reliance on antibiotics/medication

Crisis intervention

Approach in which the patient or client seeks help only when unable to manage alone

Preventive healthcare system

• Attempts to promote well-being and avoid the need for medical intervention

• Encourages good self-care that avoids habits such as smoking and the use of drugs

Health promotion

Instead of focusing on treating the illness that occurs from being unhealthy, team focuses on keeping people healthy

Injury prevention

Instead of focusing on treating the injuries that occur from accidents, team focuses on preventing injuries

Primary prevention

• Seeks to avoid disease states through wellness activities

• “Use of seatbelts”

Secondary prevention

• Recognizes the presence of disease but seeks to reduce the impact of the condition by encouraging behaviors to promote health

• “Preemptive screenings”

Tertiary prevention

• Reducing further complications from a disease or disorder

• “Dietary teaching to diabetes patient to reduce risk of hyperglycemia”

Fee-for-Service

System where insurance companies reimburse patients for the costs of their health care within the limits of the policy, and the patient’s responsible for anything not covered

What were the benefits of choosing a fee-for-service care?

Patients were able to seek care from a desired physician or hospital of choice

Health Maintenance Organizations (HMO)

Made to deliver more affordable care by providing complete and comprehensive health care for the cost of the premium and a copayment for each visit

What are the patient expectation’s involved in choosing an HMO?

Expectation of the patient in being more involved in meeting their own needs

Managed care system

Systems allow private hospitals and physicians to provide private services while also providing care through insurance plans that operate as HMOs or PPOs

What was a benefit of choosing a managed care system?

Patient’s would save money by limiting access to expensive services when they weren’t needed

Preferred Provider Organization (PPO)

Offers care at reduced rates within an established network of providers

Urgent care or Surgicenters

System evolved to treat patients who need urgent care or minor surgery for conditions that are not immediately life-threatening

What was the benefit of a surgicenter?

Surgicenters are outpatient facilities where patient’s are seen in the early morning and released to home care that same evening

What level of care do low-income patient’s go to?

Low-income families turn to the ER for care of all kind of illnesses

Affordable Care Act (Obamacare)

• Act that came into law in 2010 to ensure that all Americans were covered by health insurance

• Employers required to provide health insurance for full-time employees

Medicare

Federal health insurance program, covers a portion of the medical care costs for 65 years and older in form of HMO, PPO, or fee-for-service

What is Part A of Medicare?

Covers portion of inpatient care costs in hospitals, skilled nursing, home health, and hospice

What is Part B of Medicare?

Cover other medically necessary services and preventive health care measures like doctor’s visits, radiology, and lab on outpatient basis

What is Part C of Medicare?

• Medicare Advantage offered by private companies to give both A and B insurance

• Sometimes includes Part D

What is Part D of Medicare?

Prescription drug coverage

If there are additional costs for Medicare patients, what happens?

Additional premium costs is deducted from patient’s social security payments

Medicaid

• Federal government funded program that assists the indigent

• Must fall within designated group, recognized by federal and state governments to be eligible

Mission statement

• Role of the hospital in relation to the community

• A declaration of institution’s basic philosophy and goals

• Gives guidance on decisions that oversees activities of the hospital

Patient’s Bill of Rights (1972)

Ensures that patient’s fundamental rights for treatment are done with dignity and compassion

Patient Care Partnership (2003)

Outlines how patients can expect to be treated during their hospital stay with regard to their rights and responsibilities

Referring physician

Doctor who sends patient to the hospital

Attending physician

• Doctor who oversees the direction of care for patient in hospital

• Responsible for assessing patient’s needs and prescribing therapeutic procedures to promote health

Interns

Recent medical school graduates gaining practical experience

Fellows

Licensed physicians receiving advanced training

Residents

Licensed physicians in an educational program to become certified in a specialty area

Hospitalist

Specialty where physician chooses to treat only hospitalized patients

Diagnostic services

Identification of patient problems

Therapeutic services

Devoted to treatment of patient problems

Support services

Departments that indirectly support patient’s care like purchasing, central supply, and laundry

Radiology department

Provides various diagnostic services that relate directly to the patient 

Radiologists

• Physicians who specialize in diagnostic imaging and serve as consultants in one or more imaging modalities

• Can perform many examinations with aid of radiographers 

• Must interpret each examination and provide a report for patient’s physician

Lead technologist

• Manages the day-to-day activities in the department

• Schedules the staff of radiographers and support personnel

• Often promoted from staff radiographers because of experience and supervisory capability

Professional behavior

Knowledge of the profession was handed down from master to student, and students honored their teachers by upholding the traditions as they had been taught

Modern day profession

Organized to govern itself – to set the standards for professional behavior, education, and qualification to practice and to enforce those standards 

American Society of Radiologic Technologists (ASRT)

• Professional organization that radiographers and other technologists work through

• Organization brought medical imaging technology to a professional level

What does the ASRT provide?

• Provides guidelines for the organization, correct operation, and curriculum design for programs 

• Reviews and approves educational programs for continuing education and maintains continuing education records for members

Consumer-Patient Radiation Health and Safety Act (CARE) of 1981

If enacted, law will impose mandatory education and credentialing standards for all who use ionizing radiation or magnetic resonance and those who plan/deliver radiation therapy

Practice Standards for Medical Imaging and Radiation Therapy

Defines the clinical practice, technical activities and professional responsibilities of imaging and therapeutic professionals

What can the Practice Standards for Medical Imaging and Radiation Therapy be used for?

• Can be used by radiology managers to develop job descriptions and performance standards

• Can also be used when there’s an incident of medical malpractice

Credentials

Registration, permits, certificates, and licenses all refer to documents that attest to the qualifications of an individual

American Registry of Radiologic Technologists (ARRT)

National organization of appointees from both the ASRT and American College of Radiology

What is the purpose of the organization, ARRT?

Establishes the minimum standards in imaging specialties and radiation therapy

What is the importance of the ARRT and a radiographers credentials?

• Radiographers must renew ARRT registration every year

• Must complete 24 credits of approved continuing education every 2 years 

What is the importance of continuing education for a radiographer?

• Essential to stay abreast of current trends and maintain competencies 

• Is needed in order to maintain license and ARRT certification

Accreditation

Process that applies to institutions and results in documentation attesting to the attainment of certain minimum standards

What organization is primarily accrediting facilities?

The Joint Commission

What does The Joint Commission look over during accreditation?

Indicates that hospital meets criteria for equipment, staff, safety, funding, management, and patient care

Why is accreditation by The Joint Commission so important?

Required for hospitals to receive Medicare payments and insurance payments from private carriers

Joint Review Committee on Education in Radiologic Technology (JRCERT)

Independent agency responsible for program accreditation in radiologic technology and radiation therapy

What is the significance of a program getting accredited by the JRCERT?

Accreditation determines the value of the diplomas granted and value of credits transferred from one institution to another