Health Care Systems Voice

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Health Care Systems : 

Health Care Systems Administration & Management in OT and PT

Objectives : 

Objectives Compare and contrast various health care systems around the world. Discuss the continuum of care in US healthcare. Compare and contrast different payment systems and types of organizations in US healthcare. Discuss different types of healthcare organizations. Compare and contrast the content and purposes of fundamental guiding documents of an organization.

What do you think? : 

What do you think? Who should receive health care? Who should pay for it? How much care should be provided?

Health Care Systems : 

Health Care Systems Socioeconomic philosophy Accessibility Organization Management Financing Satisfaction Health-related outcomes

Health Care Systems : 

Health Care Systems

What do you think? : 

What do you think? What are the implications for PTs and OTs now that there will be more federal government involvement in the payment for and delivery of health care in the US? Implications for patients?

US Health Care: A Unique Business : 

US Health Care: A Unique Business Like other businesses: finances, human resources, capital equipment needs, cost controls, generation of profits… Unique from other businesses: purpose is preventing, curing, managing disease and injury Basic unit is patient, provider, and insurer

US Health Care : 

US Health Care Continuum of Care Prevention Acute care Post-acute care

US Health Care : 

US Health Care Prevention Decrease injury or disease Increase early identification of injury or disease Decrease exacerbation of existing conditions Decrease secondary problems

US Health Care : 

US Health Care Acute Care Initial care for condition < 30 days Provided in multiple locations by variety of personnel Four levels: Primary – physician office Secondary – hospital Tertiary – specialty unit Quaternary – regional medical center

US Health Care : 

US Health Care Post-acute Care For conditions considered chronic Progressive or permanent condition Continuous or periodic care

US System - Ownership : 

US System - Ownership Government

US System - Ownership : 

US System - Ownership Private

US System - Payment : 

US System - Payment Commercial insurance Employment benefit Tax revenue Employment taxes (MC, SS) Philanthropy or charity Self-pay

US System - Payment : 

US System - Payment Fee-for-service Managed care HMO Gatekeeper Specific group of providers PPO Choice of providers Discounted FFS PPS Medicare Lump sum payment

US System - Payment : 

US System - Payment Tax-funded Tricare, USFHP, military rx centers CHAMPVA for veterans Prisons and schools Federal Employees Health Benefits Program Medicare and Medicaid Indian Health Service

What do you think? : 

What do you think? PTs and OTs have legal “direct access” in nearly every state, however very few third-party payers will pay for PT/OT services without a physician referral. What would be the advantages and disadvantages if this referral requirement was dropped?

Types of Organizations : 

Types of Organizations Sole Proprietorship Form of creation: owner individually owns all assets used in business Liability: unlimited liability of the owner, creditors may take personal assets Management: individual operates business, no BOD Length of existence: perpetual Transferability: all interests transferable Tax ramifications: reflected on owner’s tax return

Types of Organizations : 

Types of Organizations Partnership Form of creation: written agreement recommended, partnership owns assets Liability: unlimited of each partner, creditors may take personal assets Management: partners manage business Length of existence: limited, if partner leaves, partnership terminates Transferability: new partners upon consent of all partners Tax ramifications: individual tax rates

Types of Organizations : 

Types of Organizations Corporation (C and S) Form of creation: articles of incorporation must be filed, corporation owns assets Liability: limited personal liability Management: shareholders elect BOD, BOD elects officers Length of existence: perpetual Transferability: stockholders can transfer stock Tax ramifications: C double-tax (corp profits + owner income), S all profit passed to shareholders

Types of Organizations : 

Types of Organizations Limited Liability Company (LLC) Form of Creation: Articles of Organization must be filed, company owns assets Liability: limited, creditors may only go after company assets Management: members operate business, no BOD or officers Length of existence: If partner leaves, company terminates Transferability: New members upon consent of partners Tax ramifications: personal income tax

Types of Organizations : 

Types of Organizations Limited Liability Partnership (LLP) Form of creation: Certificate of LLP must be filed, partnership owns assets Liability: General Partner personally liable, partners proportionally liable Management: General Partner manages, all partners operate business Length of existence: Limited (like LLC) Transferability: new members upon consent of all members Tax ramifications: individual tax rate

Types of Organizations : 

Types of Organizations Professional Corporation (PC) aka Professional Association (PA) in some states

Tax Status : 

Tax Status For-profit business Provides goods and services to make money for its owners Pays taxes on profits Also subject to local taxes such as property and sales taxes

Tax Status : 

Tax Status Not-for-profit business Exempt from all forms of federal, state and local taxes, and sales tax Primary purpose is some form of community service May not provide financial benefit to any private individual or business Required to retain and reinvest revenue into the business to support its mission

What do you think? : 

What do you think? Why does a not-for-profit company have to make a profit? What would be some pros and cons of working as a PT/OT for a for-profit company? A not-for-profit company?

Organizational Structure : 

Organizational Structure Centralized Higher administration makes most of all of the decisions and policies Middle managers implement decisions and enforce policies Top-down structure Decentralized No formal chain-of-command from a single source Greater independence of departments, individuals More likely in well-established, more progressive companies

Organizational Chart : 

Organizational Chart

Organizational Chart : 

Organizational Chart

Organizational Culture : 

Organizational Culture Shared attitudes, experiences, beliefs, and values as a group “the way we do it here” “the rules of the game” Drives decision making about operations and relationships to the stakeholders

Fundamental Guiding Documents : 

Fundamental Guiding Documents Philosophy or Values Statement Values are hierarchical Philosophical principles help weight desirable values and the actions that further them Philosophy > Values > Actions

APTA Core Values : 

APTA Core Values Accountability Altruism Compassion/Caring Excellence Integrity Professional Duty Social Responsibility http://www.apta.org/AM/Template.cfm?Section=Professionalism1&Template=/TaggedPage/TaggedPageDisplay.cfm&TPLID=97&ContentID=21263

AOTA Core Values : 

AOTA Core Values Altruism Equality Freedom Justice Dignity Truth Prudence http://www.aota.org/Practitioners/Ethics/Docs/Standards/36526.aspx

Mission Statement : 

Mission Statement Each clinic, department, organization should have one States why an organization exists - purpose Serves as the overall frame of reference May evolve as the entity evolves

Mission Statement of USA : 

Mission Statement of USA The University of St Augustine for Health Sciences mission is the professional development of health care providers through innovative and individualized education.

Vision Statement : 

Vision Statement Deals with long-term future of the organization Identifies the desirable future state of the organization Long-term goal that drives current efforts Motivates, inspires toward an ideal

APTA Vision Sentence : 

APTA Vision Sentence By 2020, physical therapy will be provided by physical therapists who are doctors of physical therapy, recognized by consumers and other health care professionals as the practitioners of choice to whom consumers have direct access for the diagnosis of, interventions for, and prevention of impairments, functional limitations, and disabilities related to movement, function, and health.

AOTA Centennial (2017) Vision : 

AOTA Centennial (2017) Vision We envision that occupational therapy is a powerful, widely recognized, science-driven, and evidence-based profession with a globally connected and diverse workforce meeting society's occupational needs.

Think about it? : 

Think about it? Is the APTA/AOTA vision attainable and realistic? Does it give the reader a clear and vivid image of what the organization can become? What steps have been made toward making the vision reality? What challenges remain?

Walt Disney : 

Walt Disney If you can dream it, you can do it. It's kind of fun to do the impossible.