Healthcare Delivery Systems

Chapter 1 – Health Care Delivery Systems There are many interesting and important points in this chapter. Some of them include: Pennsylvania Hospital founded by Ben Franklin was the 1st US hospital University of PA was the US first medical school The AMA was founded in Philadelphia in 1847. The Flexner Report was published in 1910 and impacted the status of medical school education. Hill-Burton Act of 1948 provided federal monies to update hospitals JCAH which is now JCAHO was created in 1951. JCAHO is an independent accreditation agency for health care facilities (all types).

Medicare and Medicaid were enacted by Congress in 1965 Privacy Act of 1974 – protect the privacy of information systems in federal health care facilities HCFA (now called CMS) was created in 1977 TEFRA in 1982 established the first Medicare prospective payment system EMTALA of 1985 protected patients against “dumping” HIPAA was passed in 1996 with components on standardization, simplication, privacy, and security SCHIP was established in 1997 to provide health insurance to infants and children not covered under Medicaid Notice all of the abbreviations used in chapter 1!

The use of abbreviations and acronyms is very prevalent in the health care and HIM field. Important Concepts in Chapter 1 Continuum of Care – primary care, secondary care, and tertiary care. Most of us are familiar with primary care, care sought by a patient with medical professionals for current problem or maintenance of a problem. Secondary care is seeing a specialist, dermatologist, neurologist, etc. for a problem, often referred by your primary care or family doctor. Tertiary care is often provided in specialty hospitals.

This can include specialty radiograph (PET scan, MRI), burn treatment, cancer treatment centers, etc. Health care facility ownership, there are three kinds of facility ownership in general; government, for profit, and not-for-profit non government (Faith-based hospitals for example). Hospitals are organized with a governing body at the top, sometimes referred to as a board of trustees. Within the hospital and most larger health care facilities (rehab, clinics) there will be an Health Information Management (HIM) or Medical Records Department.

However, Medical Records is an older term. Typical functions of an HIM department include, coding, chart abstraction, record processing, record storage and retrieval, medical transcription, release of information (ROI), cancer registry, and index complying and retrieving. The size of the HIM department staff will vary and is usually based on the bed size of the facility and/or annual visits processed (discharged, ED, Outpatient surgery etc. ). One of the most visible components of a health care facility and an HIM department is the coding function.

Coding is also seen in outpatient area for physician office and other types of non-hospital based healthcare. This is based partially on the fact the coding is tied to reimbursement and funding for the facility/provider. In the US there are two main coding systems used; ICD-9-CM and HCPCS. HCPCS contains CPT codes which are often thought of as a separate system but CPT is part of HCPCS. CPT codes are used to report physician services regardless of the place of service (hospital, office, ED, clinic, etc. ).

ICD-9-CM classification contains diagnoses codes which are used by all providers for coding. ICD-9-CM volume 3 is only used to report inpatient or acute care hospital procedures. Note: CPT does not have any diagnoses codes in it. If a physician uses CPT to code/bill for procedures, ICD-9-CM must also be used. A complete picture must be captured with the procedure and the diagnosis(ies) of the patient for coding/billing to be correct! Licensure and accreditation – your textbook makes a distinction between these wo. Licensure is often governed by state and can be for an individual or a facility. Licensure is most often required for a health care provider or facility to operate in that specific state. Accreditation is for a facility and is most often voluntary. JCAHO is one accreditation body, others include; AAAHC, AOA, CARF, NCQA, NCCHC. New Developments: When the implementation of more digital technology in the area of health care and specifically in the HIM area.

Electronic health records (EHR) are being discussed and used more and more in the US. With this type of record gathering and storage, methods of authentication have been updated for the digital age. These include electronic signature. Security measures have also been updated which include smart cards and biometrics. Your textbook also includes some excellent websites for concepts in this chapter. You may also want to refer to this list when you are looking for journal articles to complete lab assignment 2-5 which will be due next week.