The American Healthcare System Susan Haas, M.D, MSc. Northeastern University May 27, 2015
2
3
Provider Types Physician Nurse Pharmacist Dentist APC: NP, PA, CNM, NA 4
5
Internal Medicine Adolescent Medicine Adult Congenital Heart Disease2 Advanced Heart Failure and Transplant Cardiology Cardiovascular Disease Clinical Cardiac Electrophysiology Critical Care Medicine Endocrinology, Diabetes and Metabolism Gastroenterology Geriatric Medicine Hematology Hospice and Palliative Medicine Infectious Disease Interventional Cardiology Medical Oncology Nephrology Pulmonary Disease Rheumatology Sleep Medicine Sports Medicine Transplant Hepatology 6
What Kind of Doctors Are There/ What Do They Do? Osteo/allopathic Dx Rx injury disease by Hx PE order/perform/interpret tests Educational process 7
Nurses LPN RN NP, CNM, CRNA, CNS Educational process 8
Who Gives Authority? License scope Hospital Boards 9
More Provider Types Aide Counselor Audiologist Speech-language pathologist EMT Dietician Administrator Coder 10
Provider Types Cont. Administrator Optometrist Physical therapist Chiropractor Podiatrist Clinical psychologist Social worker Technician/technologist 11
Why Do People Interact With the Healthcare System? Wellness/prevention Symptom Care for diagnosed condition 12
Patient Types Well Latent Acute Chronic Premorbid 13
What happens when a patient receives care? Problem Information gathering Assessment/Diagnosis Treatment Evaluation of treatment continue, stop, change Same as engineering! 14
Health Literacy Health literacy is the ability to obtain, process and understand basic health information and services needed to make appropriate health decisions and follow instructions for treatment. 15
Health Literacy Individuals with limited health literacy incur medical expenses that are up to four times greater than patients with adequate literacy skills, because of unnecessary doctor visits and hospital stays. Affects people from all ages, races, income and education levels. Most patients hide their confusion from their doctors because they are too ashamed and intimidated to ask for help. 16
The System II Primary care Acute care Longterm care Behavioral health care Oral health care Public health Safety net 17
18
Physical Locations Inpatient General hospital Specialty hospital LTAC SNF Outpatient Office Surgicenter Lab Home. 19
Flow Through The System Home ambulatory inpatient SNF LTC Hospice 20
Trends To ambulatory Shortened LOS P4P 21
22
Why so complex and expensive? Shared responsibility: federal, state, local; public and private. No controlling legal authority. Organized for acute, reactive care Fragmented payment fragmented delivery. 23
Why so complex and expensive? Providers are organized and reimbursed around what we do, rather than what patients need. Multiple IT systems for specialties, scheduling, billing Not for care across a continuum; not for outcomes measurement 24
Overview of Problems Cost Quality Value Variation Waste 25
Health Literacy 10% of Americans can understand 27