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Medical Practice Strategies:  Systems Based Practice - Business Laws Ethics

Janet Lerman, J.D.

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CME test - Class 1
Relevant Terms
History
Definition
Current Status
Effect on Providers
HMO vs. PPO
Payment Evolution
Perspectives
Considerations
Required Readings
Suggested Readings
New News Class 1

 

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Class Description - Class 1

OVERVIEW OF Systems-Based Practice

This class will give some terms commonly used in systems-based practice. Also, this class will identify six perspectives in which to analyze systems-based practice: (1) Consumers; (2) Patients; (3) Providers (the term "providers" is an all inclusive term for providers of medical care including physicians, hospitals and others); (4) Payors such as  Government (such as Medicare and Medicaid), Employer Groups, and individuals purchasing health care benefits; (5) Health Plans such as Health Maintenance Organizations (HMOs)/ Preferred Provider Organizations (PPOs), Managed Care Organizations (MCOs), and Insurers; and (6) Laws and Public Policies encompassing all of the previously listed perspectives.

Framework for Analysis:
bulletConsumer
bulletPatient
bulletProvider
bulletHealth Plan such as HMO/PPO/Managed Care Organizations (MCOs)/Insurers
bulletPayor such as companies purchasing health care benefits on behalf of their employees, governmental sponsored programs such as Medicare and Medicaid
bulletLaws and Public Policies encompassing  above listed perspectives

Systems care practice is dynamic. New laws on a local, state and federal level are continually in the making, the systems-based practice is changing with various mergers, acquisitions, and new types of health care companies. This course gives physicians and other healthcare providers a framework for analyzing how systems-based practice affects providers.

Class 1 Topics:    OVERVIEW OF Systems Based Practice

I.     BRIEF HISTORY OF Systems Based Practice
II.     WHAT IS Systems Based Practice
III.     REASONS SYSTEMS-BASED PRACTICE CONTINUES TO GROW IN THE UNITED STATES
IV.     WHAT SYSTEMS BASED PRACTICE MEANS TO PROVIDERS
V.     CONTRAST HEALTH MAINTENANCE ORGANIZATION ("HMO") AND PREFERRED PROVIDER ORGANIZATION ("PPO")

VI.     EVOLUTION OF HEALTH CARE PAYMENT METHODS

A.     FEE-FOR-SERVICE

B.     DISCOUNTED FEE-FOR-SERVICE 

C.     CAPITATION

D.    PAY FOR PERFORMANCE

VII.     PERSPECTIVES

Key Objectives

bullet1.     Summarize the goals of systems-based practice according to Affordable Care Act.
 

 

bullet2.     Examine specific terms used in the systems-based practice according to Affordable Care Act.
 

 

bullet3.     Identify how systems-based practice effects the following groups: (1) Consumers; (2) Patients; (3) Providers (the term "providers" is an all inclusive term for providers of medical care including physicians, hospitals and others); (4) Payors such as  Government (such as Medicare and Medicaid), Employer Groups, and individuals purchasing health care benefits; (5) Health Plans such as Health Maintenance Organizations (HMOs)/ Preferred Provider Organizations (PPOs), Managed Care Organizations (MCOs), and Insurers; and (6) Laws and Public Policies encompassing all of the previously listed perspectives.

Review 

bullet1.    Analyze the current status of systems-based practice in the United States and how systems-based practice effects hospitals, physicians, and other healthcare providers.  

 

Consider:  What's happening with systems-based practice now?

 
bullet2.     Define/compare and contrast: Electronic Medical Records (EMRs), Electronic Health Records (EHRs), Personal Health Records ("PHRs"), Meaningful use of certifed Electronic Health Record technology, Capitation and Fee-for-Service.  

 

Know what these terms mean and how they impact you:

bullet

EMR

bullet

EHR

bullet

PHR

bullet

Meaningful Use of certified EHR technology

bullet

Capitation

bullet

Fee-For-Service

 
bullet3.     Describe how systems-based practice effects the following groups: (1) Consumers; (2) Patients; (3) Providers (the term "providers" is an all inclusive term for providers of medical care including physicians, hospitals and others); (4) Payors such as  Government (such as Medicare and Medicaid), Employer Groups, and individuals purchasing health care benefits; (5) Health Plans such as Health Maintenance Organizations (HMOs)/ Preferred Provider Organizations (PPOs), Managed Care Organizations (MCOs), and Insurers; and (6) Laws and Public Policies encompassing all of the previously listed perspectives.

 

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