HOSPITALS - NOV13

Acute Care vs. Long-Term Care

  • Acute Care

    • Definition: Care provided in a hospital setting for a limited time.

    • Duration: Patients must stay for less than or equal to 30 days.

  • Long-Term Care

    • Definition: Care provided for an extended period, typically in facilities designed for longer stays.

    • Duration: Patients typically require care for more than 30 days.

    • Examples include nursing homes and skilled nursing facilities.

Types of Hospitals

  • General Hospitals

    • Definition: Hospitals that provide a range of services and specialties to treat various conditions.

    • Examples:

    • Massachusetts General Hospital (MGH)

    • Lowell General Hospital

    • Services include:

    • Neurology

    • Surgery

    • Dermatology

    • Cardiology

    • Adult care

  • Specialty Hospitals

    • Definition: Hospitals that specialize in specific types of health care or target populations.

    • Examples:

    • Boston Children's Hospital

      • Specializes in treating children

    • Dana-Farber Cancer Institute

      • Specializes in cancer care

    • Shriners Hospitals for Children

      • Specializes in the treatment of burn victims, specifically for children.

Hospital Distribution and Management

  • Hospital Count

    • Number of hospitals in Boston: Approximately 25 (according to Google search).

    • Comparison with other cities: Typically, smaller towns have only one or two hospitals.

  • Academic Medical Centers

    • Definition: Hospitals that are affiliated with universities and serve as teaching hospitals.

    • Examples of hospitals affiliated with Harvard:

    • Mass General

    • Brigham and Women's Hospital

    • Beth Israel Deaconess Medical Center

    • Joslin Diabetes Center

    • Example of a hospital affiliated with Tufts University:

    • Tufts Medical Center

    • Example of a hospital affiliated with Boston University:

    • Boston Medical Center

Hospital Ownership

  • Types of Hospital Ownership

    • Federal Government Hospitals

    • Definition: Hospitals owned and operated by the federal government.

    • Example: Veterans Affairs (VA) hospitals.

    • Other federal hospitals:

      • National Institutes of Health (NIH)

      • Military hospitals

    • Non-Federal Hospitals

    • Definition: Hospitals operated by state or local governments or private entities.

    • Types include city hospitals and county hospitals.

    • Example: Boston City Hospital (now consolidated).

Nonprofit vs. For-Profit Hospitals

  • Nonprofit Hospitals

    • Definition: Hospitals that do not operate to make a profit; any profit is reinvested into community services.

    • Characteristics:

    • Example: Most hospitals discussed earlier are nonprofit, e.g., Mass General.

  • For-Profit Hospitals

    • Definition: Hospitals that operate to generate profit for owners or shareholders.

    • Examples:

    • Tenet Healthcare System (Framingham, Saint Vincent's in Worcester).

Community Hospitals

  • Community Hospitals

    • Definition: Smaller hospitals that provide basic services at a community level and serve as a step-down from larger medical centers.

    • Example: Emerson Hospital (part of the Mass General Brigham Alliance).

Hospital Types and Operations

  • Teaching Hospitals

    • Definition: Hospitals that serve as training centers for medical students, residents, nursing students, and pharmacy students.

  • Multihospital Chains

    • Definition: Organizations that operate multiple hospitals under a single management structure.

    • Relevant Issues: These chains frequently face news coverage due to hospital closings and consolidations.

Hospital Management Structure

  • Types of Management

    • Board of Directors

    • Responsible for the leadership in for-profit hospitals.

    • Board of Trustees

    • Responsible for the leadership in nonprofit hospitals.

    • Hospital Administration

    • Involved in the overall management of hospital operations.

    • Medical Staff

    • Includes physicians, nurses, pharmacists, and other health professionals.

    • Definition of Attending Physician: An attending is sometimes referred to as a generalist or hospitalist responsible for patient care once admitted.

Accreditation of Hospitals

  • Accrediting Bodies

    • The Joint Commission

    • National organization responsible for accrediting hospitals.

    • Importance: Accreditation affects a hospital's ability to bill Medicare and Medicaid.

    • Unannounced Site Visits: Hospitals prepare extensively for visits from The Joint Commission to ensure compliance with standards.

Role of Pharmacists in Hospitals

  • Types of Pharmacists

    • Staff Pharmacists

    • Clinical Pharmacists

    • Pharmacy Technicians

  • Drug Distribution Methods

    • Floor Stock Distribution

    • Unit Dose Distribution

Hospital Formulary Management

  • Hospital Formulary

    • Definition: A list of medications that are regularly stocked and available in a hospital.

    • Importance: Helps manage drug costs and facilitates drug therapy decisions.

    • Development: Drugs are reviewed by the Pharmacy and Therapeutics (P&T) Committee before being added to the formulary.

Medicare and Medicaid Overview

  • Medicare

    • Part A: Covers inpatient hospital care, skilled nursing facility care, hospice, and some home health care services.

    • Part B: Covers physician services and outpatient hospital care.

    • Part C: Known as Medicare Advantage, combines Parts A and B and sometimes includes Part D coverage.

    • Part D: Provides prescription drug coverage.

    • Eligibility Criteria: Must be 65 years or older or have specific conditions, including a certain number of quarters of coverage.

  • Medicaid

    • Definition: A joint federal-state program that provides health coverage for qualifying individuals.

    • Coverage Flexibility: States can set their own eligibility criteria within federal guidelines.

    • Services Covered May Include:

    • Inpatient hospital services

    • Outpatient hospital services

    • Labs and X-rays

    • Outpatient prescription drugs (optional)