HAP CH-7 QUESTIONS AND ANSWERS.
What is Outpatient Care? - Answers-Any health care services that do not require an
overnight stay in an institution of health care delivery, such as a hospital or long-term
care facility
Outpatient Care : - Answers-In recent years, there has been enormous growth in:
volume of outpatient services
new types of outpatient settings
Outpatient Care : - Answers-As hospital occupancy rates have declined over the past
decade, hospital administrators now view outpatient care as an important part of their
health care services.
Outpatient Care : - Answers-The growth in non-hospital based outpatient services has
increased competition between hospitals and community-based providers
Examples: home health care and outpatient surgery
Key Factors: reasons for growth? - Answers-Several key factors have been significant
in changing the balance between inpatient and outpatient services
1) Reimbursement
2) Technological Factors
3) Utilization Control Factors
4) Social Factors
Reasons for Growth - Reimbursement - Answers-Public and private payers prefer
outpatient services because it costs less than inpatient care
*Changes in reimbursement
-Financial incentives to reimburse for outpatient care
-Hospitals developed outpatient services to offset declining inpatient income - earlier
discharges as a result of prospective reimbursement
Reasons for Growth - Technological Factors - Answers--New diagnostic and treatment
procedures and less invasive surgical methods make it possible to provide services on
an outpatient basis that previously required a hospital stay
- shorter acting anaesthetics
less invasive procedures
faster recovery times
Reasons for Growth - Utilization Controls - Answers-Inpatient hospital stays have been
discouraged by various payers
, To minimize length of stay prior authorization for admission and close monitoring during
hospitalization have been undertaken
Reasons for Growth - Social Factors - Answers-Patients have a preference for receiving
health care in their home and community-based settings
Most patients do not want to be institutionalized unless necessary
Patients gain sense of independence and control important for quality of life
Outpatient Care Settings and Methods of Delivery - Answers-Private Practice
Hospitals
Freestanding Facilities
Mobile Facilities for Medical, Diagnostic, and Screening Services
Telephone Triage
Outpatient Care Settings and Methods of Delivery cont - Answers-Home Health
Services
Hospice services
Outpatient long-term care services
Public health services
Community health centers and free clinics
Alternative medicine clinics
Private Practice - Answers-*Office based physicians
*Provide majority of primary care
*Limited examinations and testing, short duration
*Solo practices have merged into groups
-Uncertainties of health care delivery system
-Competition from large health organizations
-High cost of establishing new practice
-Complexity of billing and collections
-Increased external controls over private practice
Hospitals - Answers-Outpatient services provide a key source of profits for hospitals
* Hospitals have expanded their outpatient facilities
*Hospitals providing inpatient and outpatient services can refer cases to its affiliated
outpatient services and also from outpatient to inpatient services if necessary increasing
revenues
Hospitals cont - Answers-five main types of hospital-based outpatient services:
-Clinical-for uninsured or those in research studies
-Surgical-patient is discharged on day of surgery
-Home health care-post acute care and rehab
-Women's health
What is Outpatient Care? - Answers-Any health care services that do not require an
overnight stay in an institution of health care delivery, such as a hospital or long-term
care facility
Outpatient Care : - Answers-In recent years, there has been enormous growth in:
volume of outpatient services
new types of outpatient settings
Outpatient Care : - Answers-As hospital occupancy rates have declined over the past
decade, hospital administrators now view outpatient care as an important part of their
health care services.
Outpatient Care : - Answers-The growth in non-hospital based outpatient services has
increased competition between hospitals and community-based providers
Examples: home health care and outpatient surgery
Key Factors: reasons for growth? - Answers-Several key factors have been significant
in changing the balance between inpatient and outpatient services
1) Reimbursement
2) Technological Factors
3) Utilization Control Factors
4) Social Factors
Reasons for Growth - Reimbursement - Answers-Public and private payers prefer
outpatient services because it costs less than inpatient care
*Changes in reimbursement
-Financial incentives to reimburse for outpatient care
-Hospitals developed outpatient services to offset declining inpatient income - earlier
discharges as a result of prospective reimbursement
Reasons for Growth - Technological Factors - Answers--New diagnostic and treatment
procedures and less invasive surgical methods make it possible to provide services on
an outpatient basis that previously required a hospital stay
- shorter acting anaesthetics
less invasive procedures
faster recovery times
Reasons for Growth - Utilization Controls - Answers-Inpatient hospital stays have been
discouraged by various payers
, To minimize length of stay prior authorization for admission and close monitoring during
hospitalization have been undertaken
Reasons for Growth - Social Factors - Answers-Patients have a preference for receiving
health care in their home and community-based settings
Most patients do not want to be institutionalized unless necessary
Patients gain sense of independence and control important for quality of life
Outpatient Care Settings and Methods of Delivery - Answers-Private Practice
Hospitals
Freestanding Facilities
Mobile Facilities for Medical, Diagnostic, and Screening Services
Telephone Triage
Outpatient Care Settings and Methods of Delivery cont - Answers-Home Health
Services
Hospice services
Outpatient long-term care services
Public health services
Community health centers and free clinics
Alternative medicine clinics
Private Practice - Answers-*Office based physicians
*Provide majority of primary care
*Limited examinations and testing, short duration
*Solo practices have merged into groups
-Uncertainties of health care delivery system
-Competition from large health organizations
-High cost of establishing new practice
-Complexity of billing and collections
-Increased external controls over private practice
Hospitals - Answers-Outpatient services provide a key source of profits for hospitals
* Hospitals have expanded their outpatient facilities
*Hospitals providing inpatient and outpatient services can refer cases to its affiliated
outpatient services and also from outpatient to inpatient services if necessary increasing
revenues
Hospitals cont - Answers-five main types of hospital-based outpatient services:
-Clinical-for uninsured or those in research studies
-Surgical-patient is discharged on day of surgery
-Home health care-post acute care and rehab
-Women's health
