Component 2: Health Care Settings

3.1: Unit 3: Health Care Settings-

Where Care is Delivered

3.1 a: Outpatient Care

 Objectives Of This Unit
• Differentiate the range of care delivery
organizations, including primary care, specialty care,
tertiary care, inpatient and outpatient facilities, long-
term care hospitals, and long-term care facilities
• Analyze the organization of Healthcare delivery from
the perspective of a “continuum of care”, such as
ambulatory services, in-patient care, long term care,
and end of life care.

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 Objectives of this Unit (cont’d)
• Evaluate the similarities and differences of
community hospitals, teaching hospitals, and
community health clinics
• Describe the predicted workforce needs and
shortages for various healthcare professions.
• Describe the various departments and
services offered in a typical U. S. Healthcare
delivery organization.

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 Objectives for this Unit (cont’d)
• Explain the ways in which these department
interact and the services relate.
• Speculate on the data and information that
are created and used by the people in these
departments
• Describe ways in which medical and/or
information technology has improved inter-
departmental communication and how that
has improved the patient experience
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 Overview of Healthcare Settings
• Outpatient clinics
• Organizational Chart
• Clinic Personnel
• Health information generated in a clinic
• Hospitals
• Organizational Chart
• Descriptions of individuals associated with a
hospital
• Hospital departments and their functions

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 Outpatient Clinics
• Outpatient Clinics
– Also known as ambulatory care clinics.
Ambulatory is to walk, so basically they are walk-
in clinics.
– Most prevalent type of outpatient service
provider.

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 Outpatient Clinics (cont’d)
• Most outpatient clinics are privately owned, but
healthcare systems are introducing more corporate
owned clinics
• Some outpatient clinics can be owned by health
insurance plans (i.e. Kaiser)
• Outpatient clinics have an organizational structure
that is quite different from the hospital
organizational structure.

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 Outpatient Clinics (cont’d)
• Other types of facilities include those that provide
diagnostic testing, radiation therapy or physical
therapy.
• Outpatient clinics have organizational charts
that are very different from hospitals.

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 Outpatient Clinic Organizational Chart

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 Clinic Personnel
• Healthcare Provider/Physician
• Own the clinic
• Can be a physical therapist, occupational
therapist, a physician or a group of physicians.
• If a group of physician owns the practice, it may
be called a group practice.
• Provide care
• Ensure quality
• Manage the clinic/business
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 Clinic Personnel (cont’d)
• Nurse Practitioners and Physician Assistants
• Nurse Practitioners and Physician Assistants- have
master’s degree and can specialize
• Licensed to provide care to patients under the
supervision of a licensed physician
• They have a certain scope of practice which is
more limited than that of a physician.
• They are paid less than a physician and they
deliver quality healthcare at a low cost
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 Clinic Personnel (cont’d)
• Medical Officer Manager
• Top supervisory position in the clinic
• Wears many hats.
• Supervises scheduling, coding, billing, collections,
patient relations, and acts as a liaison between
the healthcare providers and the non-clinical staff

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 Clinic Personnel (cont’d)
• Reception and front office staff
• Front line personnel that are the first to interact with
patients
• Education- includes high school diplomas, certificates
(one year or less training) or an associate’s degree
• Functions-managing the reception desk, processing
patient information, scheduling appointments, pulling
medical records, and filing medical records.

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 Clinic Personnel (cont’d)
• Coding and billing staff
– Do not have direct patient contact and deal with
the business functions of the clinic
– Education- high school diploma, certificate (less
than one year), and associate’s degree
– Functions-
• Coders: check medical charts for accuracy and
completion, verify signatures, verify medical data in
computers, assign appropriate diagnosis and
procedural codes.
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 Clinic Personnel (cont’d)
• Billers- management of healthcare billing-processing,
adjusting and resubmitting of claims, adherence to
current healthcare industry regulations and policies,
and compliance with insurance procedures and allotted
benefit coverage.

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 Clinic Personnel (cont’d)
• Medical transcription and medical records
workers
– Many times the medical transcription work is
outsourced to a company to perform this task.
Medical records work is always done in-house.
– Education- high school diploma, certificate (less
than 1 year), associate’s degree

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 Clinic Personnel (cont’d)
– Functions-
• Medical transcriptionist- transform spoken words into
comprehensive written records
• Medical Records technicians- manage health records by
ensuring all associated paperwork (chart notes and test
results) are filed in the medical record (if it is a paper
record), or enter medical records data into computer
systems and validate their accuracy and completeness
(if it is an electronic health record)

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 Clinic Personnel
• Housekeeping and Maintenance
– These folks are responsible for the upkeep and
appearance of the facility.
– Education- some high school, high school diploma,
craftsmen—electricians, plumbers, etc.
– Functions- removing waste (hazardous and
regular), cleaning the facility, keeping all the
aspects of the facility running properly

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 Clinic Personnel
• Nurses and Medical Assistants
– RNs, LPNs, and Medical Assistants can work in the
clinical area of the clinic.
• RNs- licensed to perform RN duties in a particular state
– can have a two year associate’s degree or a bachelor’s
degree
– Highest paid nurse level
– Usually only one or two per practice. Physician decides how
many will be employed.

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 Clinic Personnel (cont’d)
• LPNs- licensed to perform LPN duties in a particular
state
– Can have a diploma or certificate—usually 1 year of less of
training
• Medical Assistants
– Specially trained individuals to help the nurses with some
tasks.
– Education- Certificate (less than one year) or associate’s
degree
– Performs administrative and clinical tasks, works directly with
patients to ensure that patients receive the care they need,
while providing health practitioners with vital patient
information

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 Health Information
• Health information generated in a clinic
– This will vary according to the size of the clinic.
Generally speaking, the information is generated:
• Chart notes
• Lab results
• Other test results
• Patient’s personal, financial, and social data

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