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
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
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
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 taxes (MC, SS)
Philanthropy or charity
Self-pay US System - Payment : US System - Payment Fee-for-service
Specific group of providers
Choice of providers
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,
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
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
http://www.apta.org/AM/Template.cfm?Section=Professionalism1&Template=/TaggedPage/TaggedPageDisplay.cfm&TPLID=97&ContentID=21263 AOTA Core Values : AOTA Core Values Altruism
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.