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INSTRUCTOR MANUAL
TODAY’S HIM, 3
RD ED
DANA C. MCWAY
Page 1 of 9
CHAPTER 1
Health Care Delivery Systems Curriculum Crosswalk HIA Program
Domain: Data Structure, Content, and Information Governance
Competency: Compare diverse stakeholder perspectives
through the delivery of health care services.
Curricular guidance: Stakeholders of the U.S. Health Care System
• Health care facilities (e.g., hospitals, alternate care settings) • Health care workforce, professionals, and professional associations • Public health organizations (federal, international, state, local, community) Health Care External Forces • Accreditation, regulation, and licensure • Accountable care organizations • Healthy People 20xx, Institutes of Medicine reports, Centers for Disease Control and Prevention, Patient-Centered Outcomes Research Institute, Precision Medicine Initiative, Centers for Medicare and Medicaid • Professional associations Health Care Internal Forces • Coordination of care and levels of care • Medical staff organization • Health care provider roles and responsibilities
Competency: Analyze strategies for the management of infor-
mation.
Curricular guidance: Policy Strategies
• Health care accreditation standards (e.g., American Osteopathic Association, the Joint Commission, Healthcare Facilities Accreditation Program, and Accreditation Association for Ambulatory Care, Det Norske Veritas) 1 / 4
INSTRUCTOR MANUAL
TODAY’S HIM, 3
RD ED
DANA C. MCWAY
Page 2 of 9
Domain: Health Law and Compliance
Competency: Analyze the impact of policy on health.
Curricular guidance: Impact of Policy on Health
• Health care delivery of accountable care organizations and medical homes
Domain: Organizational Management and Leadership
Competency: Facilitate fundamental leadership skills
Curricular guidance: Team Leadership
• Interprofessional– “when two or more professionals learn about, from, and with each other to enable effective collaboration and improve health outcomes” (WHO 2010); different professions working together (e.g., HIM working with physician or pharmacist)
HIT Program
Domain: Data Structure, Content, and Information Governance
Competency: Describe health care organizations from the
perspective of key stakeholders.
Curricular guidance: Stakeholders of the U.S. Health Care System
• Health care facilities (e.g., hospitals, alternate care settings) • Health care workforce, professionals, and professional associations • Public health organizations (e.g., federal, state, local) Health Care Delivery Forces • External forces (e.g., accreditation agencies, federal regulatory agencies, government programs and third-party payers, mobile-health technology, professional associations, quality and reimbursement initiatives, state departments of health) • Internal forces (e.g., clinical care, health information management department, continuum of care and levels of care, medical staff organization, patient registration and 2 / 4
INSTRUCTOR MANUAL
TODAY’S HIM, 3
RD ED
DANA C. MCWAY
Page 3 of 9
billing, provider roles and responsibilities)
Competency: Apply policies, regulations, and standards to the
management of information.
Curricular guidance: Policy Strategies
• Health care accreditation standards (e.g., The Joint Commission)
Competency: Determine compliance of health record content
within the health organization.
Curricular guidance: Continuum of Care–Impact on Health Record
Content • Primary care (e.g., acute care, preventive care, chronic care) • Secondary care (e.g., medical specialists) • Tertiary care (e.g., specialized hospitals, including level I through IV trauma centers) • Quaternary care (e.g., experimental medicine)
Domain: Organizational Management and Leadership
Competency: Demonstrate fundamental leadership skills.
Curricular guidance: Leadership Skills
• Team leadership (e.g., team roles, positions, functions)
Domain: Health Law and Compliance
Competency: Identify the impact of policy on health care.
Curricular guidance: Impact of Policy on Health Care
• Governmental policy-making process • Public health initiatives (e.g., Affordable Care Act, accountable care organizations, patient- centered home)
Special Notes Payment and reimbursement systems are covered in more detail in Chapter 16, “Reimbursement Methodologies.” HIPAA and ARRA are integrated throughout the text and also emphasized in Chapter 3, “Legal Issues,” as are accreditation standards. Chapter 2, “The Health Information Management Profession,” offers the health information management (HIM) perspective to the components and operation of health care organizations and certification requirements.
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INSTRUCTOR MANUAL
TODAY’S HIM, 3
RD ED
DANA C. MCWAY
Page 4 of 9
Summary and Explanation of Chapter The delivery of health care and the practice of medicine can be traced back several thousand years, beginning with the responses of primitive societies to the emergence of early physicians and hospitals. Health care in the United States has progressed through four stages, with 21st century developments such as the use of tracer methodology in the accreditation process, the use of outsourcing, changes in financing, and the rise of the consumer culture resulting in a cultural shift in health care delivery. New areas of concentration have emerged, including public health, mental health, and occupational health. Also emerging are new organizations, entities, and professionals who deliver health care services, and new settings in which they work, adding to the complexity of health care in the United States. One mainstay throughout these changes is the position of the physician, who provides care in multiple environments. When such care is provided in hospitals, those physicians are governed by medical staff organizations and their bylaws and rules addressing credentials and privileges.This chapter provides an understanding of the delivery of health care through an overview of the historical development of the health care delivery system, both in the United States and other regions of the world. Some focus is given to specified areas of health care, including public health, mental health, and occupational health. A discussion of the organizations, entities, and professionals who deliver health care services and the settings in which they work follows, allowing the learner to better understand the complexity of health care. A section concerning a hospital’s medical staff explains its organizations, its governing mechanisms, and the credentialing process. Integrated as appropriate within the entire chapter is a discussion of the influences of technology, financial concerns, and the role of the federal government in the health care delivery system.
Suggested Enrichment Activities
1. AHIMA level: Analyze (4)
Bloom’s Taxonomy level: Analyze
The stages in the delivery of health care help the reader understand how trends can develop. Ask the students to complete the Matching Chart found in Appendix A as a way to connect the stages in health care delivery with trends. The answer key is included immediately after the Matching Chart.
2. AHIMA level: Understand (2)
Bloom’s Taxonomy level: Comprehension
Ask the student to create a timeline with brief descriptions of the historical development of public health as described in this chapter.
Suggested answers:
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