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CH. 1 Today's Medical Assistant

CH. 1 Today's Medical Assistant

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Chapter 01 Chapter 01 Presentation Transcript

  • Chapter 1The Health Care System Elsevier items and derived items © 2009 by Saunders, an imprint of Elsevier Inc.
  • PretestTrue or False 1. Palliative treatment attempts to reduce symptoms but does not cure disease. 2. In the past 30 years there has been a trend to avoid admitting patients to the hospital if possible. 3. The first health insurance plans in the United States were provided by the federal government. 4. The managed care movement has put pressure on physicians to limit time spent with individual patients. 5. After graduating from medical school, a physician spends 2-5 years in postgraduate training called an internship. Elsevier items and derived items © 2009 by Saunders, 2 an imprint of Elsevier Inc.
  • Pretest, cont.True or False 1. If laboratory tests are done in the medical office, there is a specific room or area set aside for this. 2. Some medical offices use paper medical records, but other offices store patient records electronically. 3. The physician who provides general medical care to an adult is usually an internist or a family practitioner. 4. A group practice often consists of three or four physicians in the same specialty. 5. In addition to standard medical treatment, only a few patients also receive treatments that can be called complementary medicine. Elsevier items and derived items © 2009 by Saunders, 3 an imprint of Elsevier Inc.
  • Introduction to Health and the Health Care System 1. WHO (World Health Organization) definition of health: a. Absence of illness or disease b. Individual can carry out the daily functions of life with no difficulties and no pain Elsevier items and derived items © 2009 by Saunders, 4 an imprint of Elsevier Inc.
  • Introduction to Health and the Health Care System, cont. 1) Western medical health care delivery based on scientific study 2) Hippocrates (fourth century BC) credited as the first “scientific” physician Elsevier items and derived items © 2009 by Saunders, 5 an imprint of Elsevier Inc.
  • Shift from Hospital-Based to Community- Based Health Care 1. Designed to reduce costs of health care 2. More extensive outpatient care reduces hospitalization costs 3. People feel better if they can avoid hospitalization 4. Modern hospitals primarily provide acute care and diagnostic services Elsevier items and derived items © 2009 by Saunders, 6 an imprint of Elsevier Inc.
  • Managed Care versus Patient Care: Competing ForcesFee-for-Service Insurance Plans1. Traditional insurance paid for hospitalization only2. Each service provided was reimbursed3. Health insurance became an increasingly important job-related benefit in the 1950s and 1960s4. Cost of health insurance has increased more rapidly than other goods and services Elsevier items and derived items © 2009 by Saunders, 7 an imprint of Elsevier Inc.
  • Government Insurance Plans1. Federal insurance programs began in 1960s a. Medicaid • Began for low-income children without parental support • Now low-income population in general Elsevier items and derived items © 2009 by Saunders, 8 an imprint of Elsevier Inc.
  • Government Insurance Plans, cont. – Medicare—elderly, disabled, end-stage renal disease – CHAMPUS—families of those in the armed services – Included office visits for illness but not preventative Elsevier items and derived items © 2009 by Saunders, 9 an imprint of Elsevier Inc.
  • Managed Care1. HMO (health maintenance organization) movement a. Began as attempt to reduce cost of medical care b. Emphasis on routine and preventative care2. Utilization review of hospitalized patients a. Requires reason for continued hospital stay b. Means to shorten hospital stay Elsevier items and derived items © 2009 by Saunders, 10 an imprint of Elsevier Inc.
  • Managed Care, cont.1. Routine care became included in traditional insurance2. Managed care introduced as general term a. Care based on HMO model b. Includes utilization review of hospitalization c. May pay physician monthly amount (capitation) Elsevier items and derived items © 2009 by Saunders, 11 an imprint of Elsevier Inc.
  • Managed Care, cont.– Encourages use of less expensive generic medications– Controls access to diagnostic tests and additional services– Often based on a network of health care providers Elsevier items and derived items © 2009 by Saunders, 12 an imprint of Elsevier Inc.
  • Types of Ambulatory Care1. Private physician offices2. Staff HMO3. Multispecialty group practice4. Clinic at a hospital Elsevier items and derived items © 2009 by Saunders, 13 an imprint of Elsevier Inc.
  • Flow of Activity in an Ambulatory Care Setting1. Patient checks in at the front desk2. Patient is seen by the physician3. Diagnostic tests are ordered and/or performed Elsevier items and derived items © 2009 by Saunders, 14 an imprint of Elsevier Inc.
  • Flow of Activity in an Ambulatory Care Setting, cont. (i) Follow-up a. New appointment, appointment for diagnostic tests, and/or referral b. Follow-up instructions 5. Billing process is begun Elsevier items and derived items © 2009 by Saunders, 15 an imprint of Elsevier Inc.
  • Members of the Health Care Team in the Medical Office 1. Physicians 2. Medical assistants 3. Nurses 4. Business manager Elsevier items and derived items © 2009 by Saunders, 16 an imprint of Elsevier Inc.
  • Members of the Health Care Team in the Medical Office, cont. i) Secretary/receptionist ii) Insurance specialist iii) Medical transcriptionist iv) File clerk Elsevier items and derived items © 2009 by Saunders, 17 an imprint of Elsevier Inc.
  • Physicians and Other Primary Care Providers1. Physician, may be MD or DO2. Physicians assistant (PA)3. Nurse practitioner (NP) Elsevier items and derived items © 2009 by Saunders, 18 an imprint of Elsevier Inc.
  • Effective Teamwork1. Teamwork is important to provide appropriate care to patients2. Medical assistant is an important team member but should not overstep his or her role3. Effective teamwork requires good communication Elsevier items and derived items © 2009 by Saunders, 19 an imprint of Elsevier Inc.
  • Effective Teamwork, cont.(i) Problems should be addressed without spending a lot of time assigning blame(ii) Different points of view should be accepted when trying to find solutions to problems Elsevier items and derived items © 2009 by Saunders, 20 an imprint of Elsevier Inc.
  • Parts of the Medical Office1. Areas to receive patients, examine patients, and perform administrative tasks2. Must meet requirements of regulatory agencies a. OSHA (Occupational Safety and Health Administration) b. Americans with Disabilities Act c. Local and state board of health Elsevier items and derived items © 2009 by Saunders, 21 an imprint of Elsevier Inc.
  • Waiting Room1. Should be clean with good lighting2. Furniture should be arranged neatly3. Up-to-date reading material should be available4. Seating should be adequate5. Colors should be muted and music should be soft Elsevier items and derived items © 2009 by Saunders, 22 an imprint of Elsevier Inc.
  • Reception Area1. Place where patient checks in2. May be separated from reception area by a glass window a. Prevents patients from overhearing office activities3. Appointments are made in this area or a separate area Elsevier items and derived items © 2009 by Saunders, 23 an imprint of Elsevier Inc.
  • Examination Rooms1. Designed for convenience of physician and staff2. Should be comfortable and calming for patients3. Reading material should be available Elsevier items and derived items © 2009 by Saunders, 24 an imprint of Elsevier Inc.
  • Laboratory1. Must meet requirements of CLIA ’88 a. Clinical Laboratory Improvement Act of 19882. CLIA-waived tests are most commonly performed a. Tests not regulated under CLIA ’88 Elsevier items and derived items © 2009 by Saunders, 25 an imprint of Elsevier Inc.
  • Medical Record Storage Area1. Medical record storage (if paper charts are used)2. Contains current patient charts3. Location should be accessible to business area4. Records of inactive patients may be stored elsewhere Elsevier items and derived items © 2009 by Saunders, 26 an imprint of Elsevier Inc.
  • Business Area or Business Office 1. May connect to reception area or be separate room 2. Place for entering patient charges and payments and billing Elsevier items and derived items © 2009 by Saunders, 27 an imprint of Elsevier Inc.
  • Billing and Insurance1. Billing and insurance may be done in several ways: a. In the office b. In a central billing office for several medical facilities c. Contracted to an outside firm Elsevier items and derived items © 2009 by Saunders, 28 an imprint of Elsevier Inc.
  • Additional Areas1. Physicians private office a. Often a reflection of the physicians personal taste b. For meeting privately with patients, patients family, and visitors2. Staff lunch and break room Elsevier items and derived items © 2009 by Saunders, 29 an imprint of Elsevier Inc.
  • Additional Areas, cont.1. Treatment/diagnostic test room a. Best if located in separate room b. Should be fully stocked for procedures(iv) Special procedures room or surgery room a. Depends on specialty of the office Elsevier items and derived items © 2009 by Saunders, 30 an imprint of Elsevier Inc.
  • Medical Specialties1. Usually have their own residency programs2. Subspecialties require additional training (fellowship)3. Based on patient age, body system, and/or type of treatment Elsevier items and derived items © 2009 by Saunders, 31 an imprint of Elsevier Inc.
  • Medical Specialties, cont.(i) May focus on medical treatment a. Example: neurologyiii) May focus on surgical treatment a. Example: neurologic surgery (neurosurgery)v. May include both medical and surgical treatment a. Example: ophthalmology Elsevier items and derived items © 2009 by Saunders, 32 an imprint of Elsevier Inc.
  • Primary Care1. Provides general care for patients a. Internal medicine—adults b. Pediatrics—children c. Family medicine—all ages d. Sometimes OB/GYN—female adults Elsevier items and derived items © 2009 by Saunders, 33 an imprint of Elsevier Inc.
  • Osteopathy1. Takes a holistic approach to primary care2. DO (doctor of osteopathy) licensed by the state to practice medicine3. Manipulates bones and muscles to balance the body Elsevier items and derived items © 2009 by Saunders, 34 an imprint of Elsevier Inc.
  • Podiatry1. Treatment of the foot and ankle2. Both medical and surgical treatment provided Elsevier items and derived items © 2009 by Saunders, 35 an imprint of Elsevier Inc.
  • Chiropractic1. Spinal manipulation to treat musculoskeletal disorders2. Practitioner is licensed by the state3. More limited role than an osteopathic physician Elsevier items and derived items © 2009 by Saunders, 36 an imprint of Elsevier Inc.
  • Practice TypesSolo Practice2. Limited in size3. Medical assistant usually responsible for administrative and clinical duties4. Physicians share evening and weekend responsibility with other physicians Elsevier items and derived items © 2009 by Saunders, 37 an imprint of Elsevier Inc.
  • Practice Types, cont.Group Practice2. Several physicians share office space, personnel, equipment, etc.3. Medical assistants usually specialize a. Administrative b. Clinical3. Patients can be seen by any physician for urgent treatment Elsevier items and derived items © 2009 by Saunders, 38 an imprint of Elsevier Inc.
  • Practice Types, cont.Group Practice, cont.(ii) Types of group practice a. Single medical specialty b. Multispecialty (several specialties within one facility) c. Satellite offices in two or more locations Elsevier items and derived items © 2009 by Saunders, 39 an imprint of Elsevier Inc.
  • Practice Types, cont.Clinic1. Traditionally, an ambulatory care facility that provides free or low-cost care2. Physicians employed by the clinic a. May be physicians (MDs) b. May be in a residency program (residents) Elsevier items and derived items © 2009 by Saunders, 40 an imprint of Elsevier Inc.
  • Complementary and Traditional Medicine1. Used in addition to standard therapies2. If studied scientifically, may be widely accepted (e.g., acupuncture)3. Patients must often cover costs Elsevier items and derived items © 2009 by Saunders, 41 an imprint of Elsevier Inc.
  • PosttestTrue or False 1. In order to be hospitalized, a patient’s condition must be very unstable or require regulation of therapy. 2. Managed care insurance is another name for fee-for-service insurance. 3. A nurse practitioner manages routine patient care and can write prescriptions in most states. 4. When a patient enters the office, he or she is immediately taken to a treatment room. 5. The government agency that provides for health and safety in the workplace is CLIA. Elsevier items and derived items © 2009 by Saunders, 42 an imprint of Elsevier Inc.
  • Posttest, cont.True or False 6. Medical records for all patients who have been seen in the past 10 years are kept in the medical office. 7. The medical office may have a special room just for treatments or procedures. 8. An osteopathic physician (DO) provides primary care and has the same legal status as a physician with an MD degree. 9. The physician who specializes in diseases of the nervous system is a neurologist. 10. Acupuncture is considered to be a standard medical treatment. Elsevier items and derived items © 2009 by Saunders, 43 an imprint of Elsevier Inc.