Kathryn Ruis - C799 Task 2
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Western Governors University *
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C799
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Medicine
Date
Jan 9, 2024
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Kathryn Ruis
Student ID: 011624005
C799 – Healthcare Ecosystems
Task 2 – Trends in the Ecosystem
Evolution of Medicine
The Johns Hopkins School of Medicine opened in 1893 and helped medicine to evolve in
different ways. At the time of it’s creation Johns Hopkins did something no other medical school
was doing at that time, it established entrance requirements for students, developed a curriculum
with emphasis on the scientific method, and integrated the School of Medicine with the hospital.
One individual associated with the Johns Hopkins School of Medicine is Abraham Flexner, who
not only studied at Johns Hopkins University, but he also conducted a survey for the Council on
Medical Education that is now known as the Flexner report. The Flexner report called for a
complete restructuring of medical education, the consolidation of medical institutions, and a
standardization of curriculum in order to create a more scientific standard of medical education
and research. [ CITATION Wag20 \l 1033 ]
Roles of Healthcare Professionals
With the creation of Johns Hopkins School of Medicine, came the opportunity for women
to be admitted to a major medical school within the United States. This opened the door for
many women who were looking to become a medical professional. In later years, the Flexner
report would help not only women, but men as well with being able to attend a school that held
students to the highest standard when choosing to apply, attend and be educated at a medical
school. This report provided the framework and principles that modern medical education still
uses for teaching students to this day. [ CITATION Wag20 \l 1033 ]
Technology in Healthcare
Johns Hopkins School of Medicine was the first to do many things, including using
rubber gloves during surgery, performing renal dialysis, and performing cardiopulmonary
resuscitation. These firsts were later adopted and used by individuals such as the Mayo brothers.
Many of the advancements of Johns Hopkins were due to the individuals that were associated
with the school, namely one individual, Abraham Flexner, who as mentioned, created the Flexner
report. While Flexner was not a physician, he was educated at Johns Hopkins University and was
interested in medical education. Due to his report, medical schools became more rigorous in their
curriculum and strongly discouraged alternative forms of medicine such as homeopathy.
[ CITATION Wag20 \l 1033 ]
Components of a Healthcare Delivery System
The first component of the U.S. healthcare delivery system are inpatient facilities. These
facilities include hospitals, long-term care facilities, and rehabilitation facilities. The most known
of these facilities are hospitals, which come with a different categorization depending on the type
of care they provide. Hospitals can be categorized as for-profit, not-for-profit, public, multi-unit
affiliation, rural and urban, teaching, religious, osteopathic, specialty, and even Mini hospitals.
Hospitals, no matter which type, are available twenty-four hours a day, seven days a week, which
makes them a unique and vital component of the healthcare system. [ CITATION Wag20 \l
1033 ]
The second component of the U.S. healthcare delivery system are non-institutional, or
outpatient, facilities. There are many types of outpatient facilities including physician offices,
ambulatory surgery centers, emergency rooms, urgent care centers, laboratory or radiology
centers, or community health centers and mobile hospitals. Outpatient facilities are important for
hospital organizations as they can provide care to patients that was once only offered in an
inpatient setting and can now be done in a way that patients do not require overnight stays in the
hospital. These services are usually less costly and private and government payers, as well as
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physicians and patients, have more and more begun to favor outpatient services, which has
helped in the growth of the outpatient components of the healthcare system. [ CITATION
Wag20 \l 1033 ]
The third major component of the U.S. healthcare delivery system is the pharmaceutical,
insurance, and managed care components. These include pharmacy benefit managers, drug
stores, the biotech and medical devices industries, and complementary and alternative medicine.
Some of the largest U.S. healthcare companies are payers and pharmaceutical firms and have
normally been considered outside the scope of the healthcare system, however, these companies
are quickly becoming more aligned. [ CITATION Wag20 \l 1033 ]
Patient Care Access
Healthcare delivery plays a positive role in improving patient access to care by
establishing various facilities, such as emergency departments, primary care offices, urgent care
centers, and hospitals, that are convenient for patients in both rural and urban areas. Having
adequate funding is crucial to ensure that these facilities have the necessary resources and
technology to provide high-quality healthcare services, as insufficient resources can have a
detrimental effect on patient care within a community. The organizational component of the
delivery system is also significant, as many rural hospitals form affiliations with larger
organizations in metropolitan areas, which allows them to effectively manage the challenges
associated with serving a higher number of elderly and disadvantaged patients, adapting to
demographic changes, acquiring specialized equipment, and attracting specialized medical staff
to meet the needs of the community. [ CITATION Wag20 \l 1033 ]
Patient Care Cost
The financing component of the American healthcare system plays a crucial role in
providing patient access to services and supporting the expansion of medical and healthcare
services. It incorporates various funding models, including publicly funded healthcare and
private insurance companies. Medicare covers healthcare costs through taxes and premiums,
while Medicaid is funded by state and federal taxes and private funds are used to cover
employer-based insurance. Cost sharing is implemented to make healthcare more affordable for
patients, and this is why individuals without insurance or Medicare often resort to using
emergency rooms only in dire situations. Medicare, Medicaid, and other public and private
payers have different billing policies and requirements for medical services. As new plan
structures and payment systems emerge, the complexity of health plans and financial
arrangements continue to increase. [ CITATION Oac20 \l 1033 ]
Quality of Patient Care
The Hospital Value-Based Purchasing (VBP) Program is designed to reward acute care
hospitals with incentive payments for the quality of care that is provided to inpatients and adjusts
payments to those hospitals based on the quality of care that they provide. This program rewards
based on the quality of care and the experience the patient receives during an inpatient stay, as it
encourages hospitals to improve quality, efficiency, patient experience and safety of care that
Medicare beneficiaries receive during acute care inpatient stays. This program works by
withholding Medicare payments by a specified percentage, using the total amount of that
reduction to fund value-based incentive payments to hospitals based on performance, and apply
the net result of the reduction and the incentive as a claim-by-claim adjustment factor to the base
Medicare severity diagnosis-related group payment amount for fee-for-service claims in the
fiscal year of the performance period. [ CITATION The23 \l 1033 ]
The Merit-based Incentive Payment System is a way to participate in the Quality
Payment Program by changing how it reimburses eligible clinicians for Medicare Part B covered
services and then rewards them for improving the quality of patient care and outcomes. Providers
performance is evaluated across four categories that lead to quality and value in the healthcare
system. To be eligible for the Merit-based Incentive Payment System providers must submit data
for the quality, improvement activities, and Promoting Interoperability performance categories,
which will be calculated and given a final score between zero and one hundred points. This score
will determine whether the provider receives a negative, neutral, or positive payment adjustment.
[ CITATION Mer21 \l 1033 ]
Federal Government Initiative
Health informatics is a field of information science that focuses on the interaction
between technology, clinical practice, and business operations in healthcare. It involves the use
of health information technology to gather and maintain patient records, collaborate with
colleagues, stay updated with medical literature, make decisions about patient care, interpret
laboratory data, and test results, and conduct research. The use of information technologies in
healthcare began to rise in the early 1990s and has continued to grow with the help of reports,
initiatives, and legislation. One notable federal government initiative in health informatics is the
Health Information and Technology for Economic Clinical Health Act (HITECH), which was
part of the American Recovery and Reinvestment Act signed into law by President Obama in
2009. The objective of this legislation was to explore innovations in reimbursement, establish
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standards and certification for health information technology, promote interoperability, and
provide incentives for healthcare providers to adopt electronic health record systems. The aim
was to launch initiatives that would demonstrate the benefits of information technology in
improving healthcare delivery and coordination of services for patients. [ CITATION Oac20 \l
1033 ]
Emerging Technology
Technological advancements have revolutionized the healthcare industry, making
previously unthinkable possibilities a reality. Healthcare Information Management experts are
examining innovative technologies that support healthcare delivery, data management, and
information sharing. Telemedicine, facilitated by interactive media video conferences,
communication tools, and remote-controlled biomedical technologies, allows patients to
schedule appointments and have face-to-face interactions with doctors without physically
visiting a clinic. Through telemedicine sessions, providers can offer guidance and consultation
on various aspects of patient care, including psychosocial/cognitive behavioral therapy, social
support, data collection and monitoring, and clinical care delivery. The COVID-19 pandemic has
further accelerated the adoption of telemedicine, providing virtual avenues for treatment,
medication, and non-emergency consultations for patients who are unable to visit healthcare
facilities. These emerging technologies are expanding the scope of medical practice and enabling
secure care delivery to patients, even when they are confined to their homes. [ CITATION Oac20
\l 1033 ]
Bibliography
Merit-Based Incentive Payment System (MIPS).
(2021, 06 21). Retrieved from HHS.gov:
https://www.hhs.gov/guidance/sites/default/files/hhs-guidance-
documents/2020%20Promoting%20Interoperability%20Quick%20Start%20Guide_1.pdf
Oachs, P., & Watters, A. (2020).
Health Information Management: Concepts, Principles, and
Practice (6th ed.).
American Health Information Management Association (AHIMA).
The Hospital Value-Based Purchasing (VBP) Program
. (2023, 09 06). Retrieved from CMS.gov:
https://www.cms.gov/medicare/quality/value-based-programs/hospital-purchasing
Wagner, S. L. (2020).
The United States Healthcare System: Overview, Driving Forces, and
Outlook for the Future.
Health Administration Press.