Ambulatory Care Test Questions

Ambulatory Care Test Questions What characterizes Inpatient Care stays? - ✔✔They are at least one overnight stay "ambul" means - ✔✔walking Three interrelated trends regarding inpatient care and ambulatory care: - ✔✔Be ...

Ambulatory Care Test Questions What characterizes Inpatient Care stays? - ✔✔They are at least one overnight stay "ambul" means - ✔✔walking Three interrelated trends regarding inpatient care and ambulatory care: - ✔✔Because inpatient care is so expensive, payers won't pay for an overnight stay if it isn't medically necessary Hospital based outpatient care is more expensive than non-hospital based outpatient care Busy people demand convenient care Hospitals must maintain all the expensive services and technology in order to: - ✔✔Be properly accredited and licensed, as well as attract various insurers, patients, and good physicians What does this high overhead do resulting in competition? - ✔✔It puts them at a competitive cost disadvantage relative to free-standing, single focus ambulatory facilities, including even surgical centers or imaging centers 7 Types of Ambulatory Care Settings: - ✔✔1) Hospital emergency departments (EDs) 2) Hospital-based outpatient departments (OPDs) 3) Outpatient offices; physician private practices 4) Urgent Care Centers 5) Retail clinics 6) Concierge medicine 7) Complimentary and Alternative Medicine What is EMTALA (1986), and what does it require? - ✔✔Emergency Medical Treatment and Labor Act. It requires hospitals and ambulances to provide care to anyone needing it regardless of ability to pay, citizenship, and legal status. A functional safety net. What was one issue with the act in terms of financing? - ✔✔It provided no money to accomplish this; classic "unfunded mandate" What did the act try to counteract? - ✔✔"dumping" of uninsured or unprofitable patients From 1997-2007, the amount of emergency room visits ______ by ___%, however the annual visit rate ______ by ___% - ✔✔Increased, 23% (116.8 million visits) Increased, 11% Visit rate for nursing home residents was ___x that of those living at home. Visit rate for homeless was ___x that of those with homes. Visit rate for blacks was ____x that of whites. - ✔✔4x 2x 2x What percent of people are admitted to hospitals from emergency rooms? - ✔✔12% What are the leading diagnoses for those admitted? - ✔✔Heart disease, chest pain, pneumonia, and cerebrovascular disease (stroke) What percent of visits are by uninsured patients? - ✔✔15.3% Historically, general practitioners provided first contact care in US, however now, only ___% of annual visits for acute care (treatment for newly arising health problems) are made to patients' personal physicians. The rest are made to: - ✔✔42% Emergency departments, specialists, or outpatient departments In the US, the number of emergency departments is ________, the number of hospitals is _______, and the number of emergency room visits is _______. - ✔✔Decreasing Decreasing Increasing True/False: When visiting an emergency room for care, patients are granted a follow-up visit - ✔✔False What percent of the time are urban hospitals at or over capacity? - ✔✔50% Overcrowding in hospitals leads to: - ✔✔Long waits for inpatient beds, ambulance diversions, errors, adverse outcomes Other elements of ED crisis: - ✔✔Nursing shortages, physician shortages (surgeons and specialty care physicians related to legal liability), uncompensated care What are some reasons ED is used more often than primary care? - ✔✔Busy primary care offices, Difficulty providing after hours and weekend care, Patient-Centered Medical Home and other measures in the ACA may help improve access to office care, Discussion of Accountable Care Organizations (ACOs) and retail clinics Hospital Based Outpatient Departments (OPDs) - ✔✔Historically primarily serve inner city/country hospitals. Important part of a safety net. Include many services, such as primary care, cancer center, ambulatory surgery center, diagnostic services How are outpatient clinics a source of profit for hospitals? - ✔✔They can compete with private physicians for the privately insured, cross referral with hospital inpatient facilities, send non urgent ED visitors to ambulatory care center, and better manage patients under managed care Hospital Outpatient visits per 1,000 people are ______ from 1992-2012 - ✔✔Increasing Urgent Care Centers: - ✔✔Treat patients who have illness/injury that requires immediate care but not require ED. (Should be treated within 24 hours) How do urgent care centers fill in gaps and offer advantages compared with other options? - ✔✔Unscheduled, walk in basis, Extended hours (fills in the gap after private offices are closed), More services than primary care practice (X-Ray, defibrillator, oxygen, lab), Can be freestanding or within hospitals Compared to emergency rooms, urgent care centers are: - ✔✔Cheaper, often have shorter wait times, and often have lower copay for insurance than ER Urgent care centers are not really connected to PCPs, so they have: - ✔✔Fragmented, poorly connected care Retail Clinics are: - ✔✔Clinics located in retail stores (Grocery stores, drug stores). Convenient, walk-in care for minor problems, usually staffed by non-physicians, night-time and weekend hours often From 2007 to 2009, retail clinics grew ____x - ✔✔4x Retail clinic for low acuity conditions represents ______ utilization, and that retail clinic use was associated with a modest ______ in spending; retail clinics do not ________ health care spending - ✔✔Increased Increase Decrease What is Concierge Medicine? - ✔✔Pay a retainers of $1k-5k and get a variety of additional services including cell phone access to MD 24/7, same day visits, longer visits, and PCP accompanies you to specialty visits What are some of the pros of concierge medicine? - ✔✔Why not allow people pay more to get more? Physicians argue that it allows them to practice the kind of medicine that they think is right What are some of the cons of concierge medicine? - ✔✔It's 2 tier medicine, better care for the wealthy, takes physicians away from those who need them Concierge medicine ______ have a huge impact yet - ✔✔Does not What is Direct Primary Care? - ✔✔Concierge care for the rest of us. Pay a monthly retainer, but way less money (~$50), and get all the office-based primary care you need. Couple with a high deductible plan What is the benefit of direct primary care from the MD perspective? - ✔✔Don't have the hassle of reimbursement; focus on patient care What is the benefit of direct primary care from the PT perspective? - ✔✔Better, easier access A poorly functioning system creates niches for services such as concierge medicine and direct primary care because: - ✔✔Patients are not getting what they need and physicians are constrained in how they can meet these needs What is Complementary and Alternative Medicine (CAM)? - ✔✔Group of diverse medical and healthcare systems therapies and products that are not presently considered to be part of conventional medicine Top 10 CAM therapies used: - ✔✔Prayer specifically for one's own health, Prayer for another person's health, Natural products, Deep breathing exercises, Prayer group, Meditation, Chiropractic care, Yoga, Massage, Diet based Yoga is ________ as a CAM - ✔✔Increasing CAM makes up about ____% of Out of Pocket Spending on all healthcare - ✔✔11% For 20 years, care has been moving to the _________ setting - ✔✔Ambulatory The inefficiencies and less than optimal service quality in office setting is creating: - ✔✔Opportunities for new markets and new care settings (urgent care centers and retail clinics) The tradeoffs in these new settings, convenience vs detailed patient knowledge, leads to: - ✔✔Potentially poor communication with primary care providers What are the leading diagnoses for those admitted? - ✔✔