History/Overview

By: Greg Aspenson

Outpatient care refers to any visit that is less than 24 hours. Outpatients are not required to spend the night in the hospital and are able to come and go on the same day.¹ Today outpatient care is referred to as ambulatory care. But unlike the term ambulatory care, outpatient care is more comprehensive because not all patients “walk” (ambulatory) to a care facility, but instead can arrive by air or land ambulance to a hospital ED that provides secondary and tertiary care. An essential part of outpatient care is primary care. The main services that primary care provides is, prevention, diagnostic and therapeutic services, health education, counseling, and minor surgery.

Outpatient care has been around for a long time and due to innovation in technology and medical services, many patients are now receiving their care same day without lengthy visits and overnight stays. Decades ago, many physicians would have patients visit their clinics, which were independent of hospital facilities, or they would visit their patients personally in the comfort of their own home. The patient-physician relationship in those days was very strong because in general the physician would take on many medical services. As medical technology advanced and services expanded, outpatient care began to shift to hospitals settings. With the increasing costs of inpatient care and the increasing innovation in medical technology, outpatient care became the dominant approach. Just a couple decades ago, chemotherapy and mastectomy patients were in the hospital for at least a week. Nowadays patients are receiving these type of treatments in outpatient care facilities.

An example of the shift from inpatient to outpatient care happened in the 1990's at the Nation Jewish Hospital. In 1995, the Nation Jewish hospital set up a day-treatment program in pediatrics that provided day treatment for children.² The reason for this shift was increasing technology and better services, as well as to control costs. According to Michael S. Ewer, M.D., special assistant to the vice president and chief medical officer at M.D. Anderson, “Much of the move toward outpatient care in this country has been driven by third-party payers in an effort to control expenses.”³ Michael S. Ewer also mentioned that it benefited patients by challenging health care providers to provide an effective and safe way to provide outpatient care. As well as driving down health care costs, 90 percent of patients according to Carmen P. Escalate, M.D., an associate professor in the Department of General Internal Medicine, Ambulatory Treatment, and Emergency Care, would rather come in daily then be admitted for the whole five days.

Outpatient care is most likely to endure as long as costs are kept down. It is also to the advantage of hospitals and other care facilities to treat patients quickly and send them on their way. Today there is a shortage of inpatient hospital beds throughout the country, which could lead to overcrowding. The best option would be to provide inpatient beds for the very sick. Unfortunately, the aging population is stuck with a higher co-payment through Medicare which is leading to less routine primary care doctor visits, resulting in more expensive care and worsening health down the road; according to a New York Times article.⁴ Hospital administrators are realizing that they need to keep a strong preference for outpatient care if they plan to keep their organization from crumbling. We as a group believe costs are crucial when it comes to outpatient/primary care. If Medicare co-payments increase then we agree that individuals will not seek the care they need until its to late and inpatient care will result, which in-turn will become more costly.

Shi, Leiyu and Douglas A. Singh. “Delivering Health Care inAmerica: A Systems

Approach.” 4^th Ed. Sudbury, MA: Joans and Barlett Publishers, 2008. (247,250-251)

¹ Jeffries, Melissa. "How Inpatient and Outpatient Benefits Work". .

² "Clinical History (3 of 3)". National Jewish Health. .

³ Meeting the Rising Demand for Outpatient Care 49.11 (2004). Outpatient Care. OncoLog. Web. 21 Feb. 2010. .

⁴ Rabin, Roni C. "Aging: Higher Co-Payments Tied to Costlier Care." New York Times - Health. New York Times, 1 Feb. 2010. Web. 21 Feb. 2010. .

Team Beliefs and Values

By: Cassandra DeHaro

I suffer no illusions that this will be an easy process. It will be hard. But I also know that nearly a century after Teddy Roosevelt first called for reform, the cost of our health care has weighed down our economy and the conscience of our nation long enough. So let there be no doubt: health care reform cannot wait, it must not wait, and it will not wait another year.

- President Barack Obama, February 24, 20091

Barack Obama’s words are powerful and strong and he is justified in saying we need reform. Americans need a better health care system in order to live the “American dream” to the best of their ability. Our group’s political stance is affiliated with moderate/independent ways of thinking. We have a wide spectrum of thoughts in our group that will help us to bring unique reform ideas to the table. We all agree that our health care system cannot operate the way it has been and that reform must occur, and, like Obama, we want to involve the best ideas from both parties. Though our beliefs range on the political spectrum, we all have some similar beliefs and values about what an exceptional health care system looks like. Because values are the foundations for beliefs, we have stated three values and three beliefs that we believe suit our specific topic best.

We value health as a responsibility to the individual, provider, and government, not as a service to be taken advantage of. Like the Institute of Medicine (ION) Committee, we believe that all citizens and providers have certain levels of accountability. Providers are responsible for “providing quality care, [satisfying their patients], using resources efficiently, and behaving in an ethical manner”.2 Likewise patients also have a level of accountability for their own health. Patients are responsible for their health because they can influence it. We also recognize there are other determinants of health that patients and providers cannot control, like their genetic make-up, and some social and environmental factors. Therefore, we believe the government also has responsibility for the health and wellness of its citizens.

We value quality community-oriented primary care as it is central to the health care delivery system.2 Without primary care (annual doctor visits, patient education, mammograms, colonoscopies, etc.), our health care costs would sky rocket for things that could have been prevented in the first place. We believe that community-oriented primary care would lower costs, and allow the health system to run more efficiently because the use of epidemiological data would be used to help communities understand their specific needs.

We value out-patient care because according to an article in Hospital Review Magazine, out-patient care “lead[s] to quicker recovery times and an estimated $100 billion to $120 billion in savings due to shorter inpatient stays”. 2 We believe no one should be denied coverage for any reason including (but not limited to) age, health status, occupation, family history, and/or pre-existing conditions. Out-patient care typically allows patients to feel more comfortable in their own home. This way they are not paying for a stay in a hospital bed when they can just be given care at home. We also believe that a patient and a doctor should collaborate on which option is best (in-patient or out-patient care) and make the decision accordingly. Each patient will have their needs assessed and their coverage will not be based on cost or other limitations.

Our “premiums have been rising three times faster than wages over the past few years” and will continue to skyrocket.4 Our health care system is unsustainable for most Americans, businesses, and the federal government. Our plan will decrease administrative costs and also lower the cost to make health care more accessible to Americans. Not only will our reform make health care more accessible, we will also keep its quality level high by creating incentives, like bonuses to providers, for keeping people healthy.

We don’t necessarily think our plan is “better” than everyone else’s, but we do recognize our plan as an exceptional lot of ideas. Our team does not want to point fingers and say “this is right” and “this is wrong” but rather we want to find the shades of gray in between. We understand that this project is a journey and if we so desire to, we can change and make better our stance. Our values will not change but how we go about implementing them may. Our team recognizes that awareness and learning about health care reform is a journey, not a guilt trip.

Some Americans believe that we do not need health care reform in America and that it is not an imminent issue for Americans today. According to Joe Biden, about 14,000 Americans lose their health insurance everyday and thousands of people are denied insurance because of pre-existing conditions. The Declaration of Independence states that unalienable rights were given to us by the creator which include, “life, liberty, and the pursuit of happiness”. 3 We believe that when people are struggling with life, liberty, and their pursuit of happiness, that they cannot be the best and most productive members of society as possible. Therefore, for the sake of one’s friends, neighbors, family, community members etc., it is imperative that health care is obtainable by all.

1“Health Care: The Presidents Plan.” February 24, 2009. whitehouse.gov. February 13,

2010. <>.

2 Shi, Leiyu and Douglas A. Singh. “Delivering Health Care in America: A Systems

Approach.” 4^th Ed. Sudbury, MA: Joans and Barlett Publishers, 2008. (247,250-251)

3 “New Study Finds Out-patient Care is the Fastest Growing Segment of Healthcare”.

http://www.hospitalreviewmagazine.com/. January 5, 2009. Hospital Review Magazine. February 13, 2010. .

4Biden, Joe. “Vice President Biden Asks For Your Help: Why We Need Reform Now.” Q August 25, 2009. Online video clip. Whitehouse.gov. February 13, 3010. f <http://www.whitehouse.gov/realitycheck/771>.

5Jefferson, Thomas. “The Declaration of Independence.” http://www.ushistory.org. 2010. .

Welcome

Welcome to our team blog. We are excited to embark on this great journey to find a solution to a problem that has been reeking havoc on our nation: Health Care. Please feel free to comment on any or all of the ideas posted. We look forward to reading your comments! Thank you!