第讲PracticeManagement.pptVIP

Chapter 22Practice Management Twenty years ago and now Ref P418 北京在职医生将可开私人诊所（2014年02月28日） 北京今年（5月）将鼓励社会资本进入健康服务业，医生将可获准开办私人诊所，并有望跨省多点执业。 医生开诊所审批流程简单 北京今年还将发布首都地区社会办医指南，把北京市卫生资源情况向社会发布，包括公立私立医院如何布局，人员、床位基本情况，以此帮助投资者决策，“比如什么地方可以办医疗机构，提供什么服务。”此外，还包括社会办医过程中需要提供什么样的材料、需要什么样的手续，政策法规等。 医生执业有望不受地点限制 将支持医疗机构开展全日制与非全日制医生区别聘用合同、薪酬待遇等改革探索，鼓励非全日制医生以固定时间到基层、其他医院兼职工作 护士将提供社会护理服务 Old management compare to the New OLD NEW ACUTE(severe,urgent,care) Nurse/doctor, same day, immediate PA(physical assistant)-decide what is the next,prescribtion/doctor CHRONIC(nonurgent,routine appointment) None None ROUTINE(wait in wait room,15 minutes) Prevention,telphone calls,PE E-mail, test results RETURN VISIT(every three months) Dependent on disease(hypertension) E-mail scheduling of next appointment depending on test results Payment Old New Fee for service A.H.A(affordable health care act) Insurance from employer insurance from individual Prepaid government Managed care(HMO,IPA,capitation) Gate keeper(a primary doctor or person who decides if patients need specialists or hospitalization) Not limited to the doctors. Needs Old New vital signs COPD-pneumococcal vac Targeting the Disability HPV immunizion for who sexual active Increasing migrant infectious disease Home visit Transportation to the clinic Flu shots Changing viral subtypes Psycho-social disease APA manual psychiatric disease 2013 Single patients More indigent health care Migrants Migrants w/o(without) care increasing PAP smears by doctor Done by PA,planned parenthood-type out patient clinics Patient’s demands Old New Telephone consultations internet medical information Office visits for acute conditions media drug promotion ( risk of radiation, cost) Request for home visits Office visits for prevention care Requests for repeat prescriptions care-givers Emergency and night calls informed consent Evaluation Old New A direct approach to the patient el ectronic records Periodic assessments of practice procedures SOAP aspects