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    41 views8 pages

    Type of Health Facilities

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    uploaded by lagan

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    CHAPTER i} Types of Health-Care Facilities Patricia Royal, EdD © EMERGENCY “4 Ambulance Learning Objectives [ter reaing this chapter, students should beable to: * Understand the diferonce between types of hosts + ldentty some ofthe services provides ay hosnitals + Recognize the various heatrcare fecties * Identity the populations who require the services + Understand the historical perspective that led to the development of various health-care faclitios Types of Hospitals and Health-Care Facilities “Thischaptr focuses on sei typesot heh-cre faites andthe tle they ply it keeping us heathy. Patents on recive testment in many types of hosts an ices as aminpaientor outpatient for skilled or unskilled neds and ttforprofitand not for pofifacites This chapter explores the iferences between these types of flies and the services they provide Hospitals Hospitals were established in the 16th centory, and since then, the development and types of hospitals have Key Terms + Not for profit + Genera hospitals + Teaching hospitals + Preceplors + Ambulatory + Residential care continually changed based on needs, location, and ser vices. Since the establishment of the first U.S. hospital, changes in population, diseases, and technology have contributed to the advancement of hospitals and services provided. The first section ofthis chapter explores some ‘of the types of hospitals in existence today and the types of services they provide. Hospital Structures TThe type of hospital determines the various internal struc tures, such as governing board and committees; however, ‘generally speaking, most hospitals have similar departments nd services Specialty hospitals may include additional treat- ‘ment options depending on the area of expertise, but overall, 2s Section The Stae ofthe Health-Care Environment there is atypical organization chert for most US. hospitals ‘These areas include the following! + Governing body: Typically, the governing body is the board of directors or board of trustees, The governing, body is responsible for hiring the chiof executive officer (CEO) oF hospital administrator and addressing the long-term goals of the hospital. The governing body is, responsible for establishing a mission for the hospital, ensuring adequate performance of the CEO, and ‘ensuring that quality care is provided, along with many other strategic operations Hospital administrator: The hospital administrator is somctimes referred to as the CEO or president and responsible for the day-to-day operations. The hospital administrator is directly responsible for supervision of the officers im the hospital, such aschiet financial officer (CFO), chiet operating officer (COO), chief information officer (CIO), and various other officers or vice presidents. The hospital administrator is responsible for risk management, development, and marketing Financial: This department is supervised by the CFO or vice president for finance and encompasses several offi including accounting, admitting, cashier, business, data processing, and credit and collections. ‘The financial department maintains the accounting systems for tracking, ‘of income and expenses, development and coordination, of the budget, preparation of financial reports and internal audits, as well as many and various other responsibilities. ‘Nursing: This department is supervised by the chief nursing officer (CNO) of vice president of nursing and ‘encompasses several offices or departments, including, Inpatient units, operating rooms, outpatient clinics, ‘emergency departments (EDs), aursing education, and, central supply. The nursing department is responsible for required educational training, stalling, reports, ‘equipment and supplies, patient care, and scheduling, along with a variety of other activities, Supports The support department is generally supervised, by the COO andis divided into two groups: administrative and environment + Administrative: ‘The administrative division may ‘encompass medical records, personnel and purchasing, social services, dietary, and discharge planning. The administrative division does not provide direct patient ‘care but is involved in the care of patients. Some responsibilities include keeping medical records up to date, assessing patients’ support systems, patient advocacy, meeting dietary requirements, and patient ‘transport «+ Eivironnen The environment division may encompass housekeeping and laundry, maintenance and plant ‘operations, security, and safety. Some responsibilities include maintenance of building andl machinery: hospital cleanliness; providing comfortable temperatures for patients and visitors: and overall safety for patients, employees, and visitors Ancillary:"The ancillary department is usually supervised, by the vice president of patient care services and encompasses services such as imaging, respiratory therapy, pharmacy, clinical laboratory, physical therapy, and electcocatdiography. The individuals working this department provide direct patient care either with hands- ‘on approaches, counseling, or testing of samples. This department is instrumental in helping the physician determine a diagnosis of disease ot illness. ‘Medical staff department: This department is supervised by the chiet medical officer (CMO) or medical director and includes medicine, surgery, house staff, obstetrics! sgynecology/pediatrics, and anesthesia. This department is sometimes separated fram the rest of the hospital because the board of trustees appoints the medical staff. This department formulates its own medical polices and rules and is responsible for quality care (o all patients Types For Profit Versus Not for Profit opt are first dtinguished by their profit status for profit ane nat for profit (lo known as nonprofit) has hw the money the hospital collects s payment for service is ued and dissin, For prot hospialscan be ome by corportions, investors individ or public sharsholl andar operated Similar to any other business that makes money and pays taxes, Theie profit is based on the money received for services provided minus the expenses expended to provide the services. For-profit hospitals are able to use the profit as they choose without any state and federal specifications. On the other hhand, not-for-profit hospitals are usually considered charities and provide certain community benefits in ageeement with sate and federal guidelines. Therefore, these hospitals donot pay state, local, property, or federal income taxes because of their designation by the Internal Revenue Service. The lack of paid taxes does not mean that the hospital cannot make a profit, The hospital is entitled to make money but is required to use it in accordance with the not-for-profit specifications, such as for reinvestments or the community. This type of hospital is usually governed by a board of trustees who serve without pay. The board members are generally selected from Number of Us. Hospitals In 2014 7000 6,000 5,000 4000 3,000 5 2,000 4,000 JLthee Ge, Ll ee a“ FIGURES-1 Number US. hospitals in 2014 |Souree: Hoan fou, LC, ‘an afflat of te American Hospital Associaton 2014] é Aes businessand civic leaders who have experience in finance, a ministration, and management activities + Community Hospitals Community hospitals are the most common type of hospital and are typically small in their number of beds. These hos pitals are established to provide routine medical and surgical needs fora gsographical location, hence the term commit. ‘These hospitals may also be called general hospitals because they are designed to meet the general acute-care needs of the local population, They are usually not-for-profit facilites and are supported by local funding, religious orgenizations, or cooperatives. These community hospitals went through some tough times in the 1980s, and many of the smaller ones were closed due to financial difficulties, Some of those that survived changed their tax status to become for-pr hospitals, and others joined larger hospital systems. Public Hospitals Public hospitals ae typically hought of as charity hospitals because oftheir tradition of providing services tothe poor population. These hospitals are funded by federal, state, or local governments. They are generally large hospitals and serve many roles within the comunity. Publi hospitalshave EDs, which some patients useto replace the physician's office isi because this type of hospital has to teat all patients re ards of ability to pay. Someor these hospitalsalso provide services for prisoners and ather vulnerable populations, such CChapter’3: Types of HealthCare Facies as individuals with AIDS, those with drug or alcohol adic tions, and the uninsured and underinsured. Public hospitals also provide outreach and community education programs and serve as home bases for local 911 systems, Because public hospitals treat all patients without reyard to payment souree, they depend on the money received from Medicare, Medicaid, and private insurance, and often the amount paid by these sources is not sufficient to pay for the fll cost ofthe services provided. The estimate of government support, including Medicare and Medicaid benefits is roughly 69%; the other 319% is billed to patients in hopes of payment. The unpaid expenses are often sent to a collection agency oF become tax write-off for the hospital. Another vital role for public hospitals is the training of medical personnel. Even with budgetary constraints, public hospitals train approxi- mately 15% of medical and dental residents.> Teaching Hospitals ‘Teaching hospitals ate usully the largest hospitals ia the system and are generally located within large cies. They are afilated with a medical school and have a commitment to graduate education to serveas preceptors for medical interns and residents completing their educational requirements Some of these hospitals are private, whereas others are gov: ‘ernment supported. Many of the physicians at a teaching. hospital also hold teaching positions with the affiliated ‘university. These hospitals usually have highly qualified physicians and the most advanced technology; therefore, patients with complex conditions or difficult diagnoses benetit {greatly from the medical experts and resources available. On. the flip side, some patients do not like multiple examinations performed by residents and students. Providing a hands-on approach to patient car, these hospitals serve a critical roe in the education of future health-care providers. Rural Hospitals ual hospitals also known as district hospitals, are located in smaller rural areas and have fewer than 100 beds. To be classified as a rural hospital the population of the cty of town typically must be under 50,000 residents. Ahough there has been a decline in rural hospitals over the lst few Years, they sil account for roughly 40% ofthe total number of hospitals located in the United States.’ Rural hospitals have always operated on small budget, but with changes in demographics, the budgets for many rural hospitals have been decreasing over the past decade. The problem has resulted from younger and healthier individuals moving 10 larger towns or cities. The remaining members of the pop lation are older, poorer, les healthy, and less abe 0 pay for services, Some rural communities have had an increase in 7 Section The Stae of the Health-Care Environment immigrant populations, who often have no health insurance or benefits to offset the costs of care. A problem in retaining skilled providers has contributed to the demise of some rural hospitals as well, For other facilities, admissions have been increasing over the past decade, and this has added to the burden of maintaining sufficient providers to care for the Increase, Often, rural hospitals depend on federal grants to help alleviate some of the costs associated with attracting and retaining health-care providers Specialized Hospitals Specialized hospitals are often affiliated with larger health systems, such as children's hospital located within the main organizational structure. However, ome children’s hospitals are private, government funded, or religious affliated. Other types of specialized hospitals include women's, veterans’, geriatric, psychiatec, rehabilitative, and cancer hospitals, Summary Many types hospitals xs an they canbe categorizedby ownership, umber ofbeds, services provided and length of stay. Hospitals are like anyother busines in that they may FIGURE 22 \icant Medical Center in Greemil, North Carolin, is large regional hel system ncorparating == umbrall, Photos ilsrato (A) te host, B) the chléee’s hospital (the cons emerganey depart, and () the heart inte 28 ‘open and close depending on community needs, resources, and financial assets. The same occurs with other types of hhcalth-care facilities, which is addressed in the next section, Ambulatory Care Facilities ‘The word ambulatory, in its most literal sense, means that patients are able to walk (ambulate) into the facility for ser vices; however, the term oupatien soften used interchange- ably with ambulatory, simply meaning that the patient does not stay all night, Ambulatory care can be provided by a va riety of health-care facilities, including hospitals, clinis, health departments, physician offices, and many other sys tems. The types of procedures under the ambulatory care ‘umbrella include same-day surgeries, emergency treatments, "urgent care, diagnostic tests, rehabilitative services, and im aging. One distinction worth noting isthe difference between, ambulatory care facilities and freestanding ambulatory care centers. Although the same types of services are provided, a freestanding ambulatory care center must deliver the care in| 2 facility that isnot located on hospital grounds. These types of facilities may be hospital sponsored or afiiated but are not directly located on the hospital grounds. Several different al types of faites unde the same types of freestanding ambulatory care centers are described after a brief history. History Ambulatory care centers became popularin the late 1980s and carly 1990s because ofthe rising costs ofhospital care. During ‘the 1960s to 1980s, health-care costs increased dramatically, ‘The challenges of delivering quality health care at lower costs were issues addressed by federal, state, and local governments 15 wellas the governing bodies atthe institutions themselves In addition to growing concerns regarding costs, health-care delivery was also challenged. For patients, it appeared that there was only one choice for hospital-based procedures such 18 minor surgeries, regardless of the distance between theit hhome and the hospital. These two forces helped to pave the ‘way for establishments of ambulatory care centers. Types Of the many types of ambulatory cre faites, one ofthe most popular and fastest growing the ambulatory surgical Center (ASC) The first freestanding ASC was established in 1970 by Dis John Ford and Wallace Reed in Phoenix, Arizona, The dramatic increase in health care had not reached fll intensity until around the 1880s, when others started the shift toward ambulatory centers. Although costs were an soe, the larger concern forthe establishment of the ‘ASC was based on palent? convenience and comfort? The growth of ASCs has been exceptional: In 2011, there were 5,300 faces performing more than 23 milion surgeries annually Another type of freestanding ambulatory care center is urgent care or emergency care units not affiliated with hospitals, In these facilities, patients are treated for non= life-threatening conditions such as minor cuts, broken bones, Increase in Number of Medicare- Certitied ASCs 5,600 5,200 5,000 4,200 4,800 4,400 4200 4000 SEES IRS SK FIGURE 3-3 Growth in Medicare catfied ambulatory surgical conte, (Source: MedPAC analsis of Provide of Services fs from CMS, 2012), umber of Mecieare-cenied ASCs CChapter3: Types of HealthCare Facilites viruses, or earaches. Many individuals do not want to wait tobe seen at the ED and would rather be treated at the urgent care center. Another reason for choosing these units is con venience. Criteria for classification of an urgent care center include the following’ + Able to provide on-site x-rays + Offers evening office hours Monday through Friday + Able to suture minor lacerations + Provides patient care primarily ona walk-in basis Most cities and towns now have several urgent care cen ters within their geographical areas, Urgent care centers are common today and represent a lange part ofthe health care system, In 2008, there were approximately 8,000 urgent care centers in the United States.* Other, similar facilities that ate popping up around the United States include so-called minute clinies or retail clinics, which provide services such as blood pressure, glucose, and cholesterol, screenings and flu vaccines, These facilities are often found in pharmacies and retail stores. Dialysis unite are also classified as ambulatory care centers Dialysis units treat patients who have end-stage renal disease (ESRD). People with ESRD need dialysis treatments to rid the toxins and excess fluids from their kidneys. The dialysis machine cleans the blood by Altering it theough an antficial kidney. These facilities are generally open 6 days a ‘week and have two or three shifts due to patient demand. Dialysis units have grown rapidly over the past 30 years with approximately 4,200 centers in the United States in 2013 (Currently, approximately 350,000 dialysis patients are being treated in centers across the United States. This number is expected to continue to increase at a rate of 3% to 5% annually. Other types of ambulatory care or outpatient centers include substance abuse centers, radiology centers, imaging centers, blood banks, and laboratory centers, Nursing and Residential Care Facilities Nursing and residential care facilities are distinguished based on the level of skill needed for the residents. Nursing homes provide inpatient services to patients who ace disabled ‘or sick and need constant care but are not required to stay in the hospital. The services provided include nursing, personal care, and rehabilitation services to patients on a short- and long-term care basis, Residential care facili provide some of the same types of services but offer around: the-clock services to children as well as to elderly individuals who have limited ability to care for themselves” After a brief history, the various types of facilities are discussed 29 Section The Stae ofthe Health-Care Environment History Before the 20th century, disabled or elderly individuals need ing care were sent to almshouses, which were dilapidated homes where limited care was provided. These homies were also known as poorhouses because the residents there were poor and had no money to pay for assistance. (This topic is addressed in more detail in Chapter 28. There were no fe eral monies or programs established yet for this population, +0 those who had no family members to take care of them ‘were placed in these facilities. With the Social Security Act in place and a growing elderly population, private old-age homes were being established by the late 1930s, Residents would live in the old-age home while collecting Social Security, which could help pay for the costs of the facility. By the mid 1950s, nursing homes were being built with federal grant money. For the next 6 decades, mursing homes’ standards and compliance were improved based on legisla tion reform, accreditation requirements, and payer source demands, such as Medicare and Medicaid."° Types Nursing homes were established predominantly for the elderly as a place to live out their final years. Over the years, the services provided and types of patients have changed along with the demographics. Today, nursing homes still provide the sick elderly who have need for skilled care with ‘place to lve, but in addition, nursing homes provide other services such as rehabil for short-term care. Long-term residents also can receive rehabilitative services from physical, occupational, and speech therapists. There are facilities specializing in Alzheimer patients, AIDS patients, and ventilator dependent patients. The nursing home staff consists of an administrator, nurses, registered dietitians, social workers, activity directors, nursing assistants, facility service workers, and housekeeping and laundry personnel. Nursing homes generally receive federal money (Medicare and Medicaid), in addition to private insurance or private pay. To receive federal funding the facility must achieve and maintain certain standards to be certified; approximately 80% are Medicare and Medicaid certfied.? With an aging population, nursing home needsare expected to rise, offering ample jobs in this arena, Assisted-living facilities re: milar to nursing homes in that they are also inpatient residential facilites. The main dilference between the two is thatthe asssted-living facility does not mee! the skilled need requirements, Residents who their live im assisted-iving facilites must be able to complet activities of daily living (ADIs) with limited assistance from stall, ADLs include their personal needs such as dressing, brushing their teeth or hair, and toiletry habits. There are no 20 nurses a this type of facility; however, there are medicine technicians (med techs) who distribute residents’ medica tions. The facility is managed by an administrator and resi dent coordinators manage patient medical needs such as doctor visits, medicines, supplies, and annual vaccines such as the fu and pneumonia vaccines, ‘Other residential care facilites include group homes, drug, ‘rehabilitation centers, and adult family homes. These facilites lo not employ nursing staf and their medical eare is not the ‘main focus. The focus is on ADL such as bathing, dressing, and brushing of hair and teeth. Medical issues are handlled by appointments tothe physician's office. In these facilities, pa tients are grouped together according to their health condi- tions or ages, Some group homes house mentally disturbed youth, whereas others may provide care for disabled seniors. Physician and Dental Offices Another type of heslth-care structure is private oF group Physician practices and dental ofices, Physician or surgeon practices can he privately owned o grouped together with, thesame or different specials. Group practices can some times be more enticing because ofthe backup coverage and reduced overhead expense. These physicians sce patients at their locations but may also be able to make hospital visit, dlepending on the individual hospital policy oF privileges granted Dental offices are commonly found in most towns or cities, They are generally small operations with few employees, however, some larger practices are grouped together, sch as ‘many physicians’ offices, Dental offices make up about 20% cofhealth-vare organizations? Home Health and Hospice Home health agencies provide care for patients in their own, homes. ‘The services are under the inditect supervision of a medical director of the agency or the patients own physician, ‘The types of services provided by home health nurses and certified nursing assistants include dressing changes, med. ication refills and vital sign and diabetic monitoring. Home health agencies employ nurses, nursing assistants, case -managets, social workers, and administrative staff Typiealy, hhome health agencies contract with physical and occupa tional therapists rather than having them on stafé Therapists help to rehabilitate the patient after some illnesses or accidents. A physician's orders dictate the service requested, bbut the service is usually for short-term care. Home health agencies can be for-profit or not-for-profit, hospital-based, or privately owned facilities, They must be Medicare and ‘Medicaid certified to be reimbursed for services Hospices can be affiliated with a home health facility oF hospital, or they can be freestanding facilities. Hospice care is provided for the terminally ill individual who has a life expectancy of 6 months or less. Similar to home health agencies, the hospice team treats patients in their home, but they can also provide services in a nursing home environ ‘ment. The hospice team is made up of medical directors, administrative staff, nurses, nurse assistants, social workers, bereavement counselo , and volunteers. ike home health agencies, they must be Medicare and Medicaid certified to receive reimbursement. spiritual support personn Medical and Diagnostic Laboratories “The last type of structure discussed inthis chapter is medical and diagnostic laborator This group is one ofthe smaller employers in the health-care system, Theit roe is to provide snalytic or diagnostic services based on physician orders. The types of services provided include blood analysis, x-rays, scans, and other clinical tests? These facilities are common Jn most cities and towns, but they are often overlooked be- «cause oftheir smal ize and theie small numberof employees SUMMARY Many types of healthcare fecilities provide care for patients depending on need, ebiity to pay, and location, among other factors. though facilities vary greatly in size, specialization, and focus, the one thing they all have in common is their benefit of providing prevention, diagnosis, and treatment of individuals nooding services, Review Questions 1. Hospitals that make profits and reinvest the profits into the hospital or community are known as: A. For profit B. Community C. Not for profit D. Community health centers 2. Atype of hospital afiiated with an academic center is known as a A Rural hospital B. Public hospital ©. Teaching hospital D. All of the above 3. In the 19th century, elderly or disabled individuals needing care were sent to nursing homes, A Tue 8. False CChapter’3: Types of Heolth

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