Many medical services are provided both in hospital and community settings, such as physician offices and freestanding imaging or ambulatory surgical centers (ASCs). Services commonly provided in both settings include laboratory tests, physical therapy, outpatient surgery, routine and advanced imaging, physician visits, and noninvasive and invasive procedures, such as endoscopy or cardiac catheterization. When the Centers for Medicare & Medicaid Services (CMS) originally developed the hospital outpatient department (HOPD) designation to establish a higher reimbursement rate for hospital-based outpatient services, hospitals started purchasing physician practices, freestanding imaging centers, and ambulatory surgery centers and rebranding them as hospital outpatient departments to collect the higher Medicare payments.
Ambulatory Care
Shared Medical Appointments Are Becoming a New Outpatient Care Option
Most patients wait alone in a cramped exam room for a scheduled appointment as their physician rushes through back-to-back individual patient visits lasting an average of 22 minutes each. With the growing trend of shared medical appointments, a patient and his/her peers spend a full 90 minutes with their personal physician. Shared medical appointments are a small but growing part of primary care as well as for a variety of medical specialties. According to the American Academy of Family Physicians, the percentage of its members offering shared medical appointment more than doubled, to nearly 12 percent, between 2005 and 2012. At the Cleveland Clinic, nearly 10,000 group appointments were logged between 2002 and 2014. Promoted as the wave of the future in outpatient care, group appointments are changing the way physicians and patients view medical treatment.
Community Clinics, ACA Beneficiaries, Worry About Their Future
Community clinics are key providers of primary care services for the poor. Treating people for free or for very little money has been the role of community health centers — a type of community clinic — across the U.S. for decades. In 2015, 1 in 12 Americans sought care at one of these clinics; nearly 6 in 10 were women, and hundreds of thousands were veterans. With roughly 1,400 community clinics nationwide, they have also expanded in recent years to serve people who gained insurance under the Affordable Care Act (ACA) and these clinics have been the poster child of the positive impact of the landmark ACA.
New International Property Measurement Standard for Office Buildings
As the result of a global effort to establish a uniform method of measuring property worldwide, a new international property measurement standard for office buildings — IPMS for Office Buildings — has been created. The IPMS for Office Buildings is compatible with, and complements, Building Owners and Managers Association (BOMA) International’s current office standard Office Buildings: Standard Methods of Measurement (ANSI/BOMA Z65.1—2010). Historically, property has been measured differently throughout the world. According to research by global property firm JLL, depending on the standard used, the area quoted in different markets for an equivalent building could vary by as much as 24 percent. These inconsistencies have led to confusion in markets, and even led businesses to develop their own costly processes for measuring and benchmarking property assets. The work to create the IPMS for Office Buildings was spearheaded by a coalition of more than 50 professional organizations, including BOMA International, and was produced following global consultation by a team of 18 independent industry experts. The IPMS for Office Buildings document can be found at the IPMS website.
Psychiatrists Replace Talk Therapy With Drugs
Talk therapy has dominated the psychiatric profession since the days of Sigmund Freud. Because of changes in how much insurers will pay, most of the nations 48,000 psychiatrists are forced to prescribe medications instead, usually after only a brief consultation with the patient.
Historically, psychiatrists often saw patients ten or more times before arriving at a diagnosis. But things have changed ― now they must make a decision in the first 45-minute visit. Without a diagnosis, they cannot get paid. Their patients are referred to a less costly therapist to explore their personal crises. Psychologists and social workers ― who unlike psychiatrists do not attend medical school ― can often afford to charge less which has driven down the price of talk therapy. There is no evidence that psychiatrists provide higher quality talk therapy than psychologists or social workers.