Allied health professionals and healthcare settings
As physicians made the switch from going to patients’ homes for treatment to having the patient come to their office, some physicians hired nurses to help in their practices. Gradually, the administrative part of running a practice became increasingly complicated and time consuming, and physicians realized that they needed an assistant with both administrative and clinical training. Nurses were likely to have training only in clinical skills; therefore, many physicians began training individuals-medical assistants-to assist with all the office duties.
The first medical assistants started working in individual physicians’ offices with on-the-job training to help out when an extra pair of hands was needed. Today, medical assisting is one of the most respected allied health fields in the industry, and training is readily available through community colleges, junior colleges, and private educational institutions throughout the United States.
With that background in place, the rest of this chapter turns from the origins of the profession to where a medical assistant fits today: the broader allied health team and the range of healthcare facilities and settings where that work is done.
Allied health professionals
In addition to doctors, nurse practitioners, and physician assistants, the healthcare team includes allied health professionals. The definition of an allied health professional can vary, but it loosely refers to those who can act only under the authority of a licensed medical practitioner.
Who are allied health professionals?
Allied health professionals include respiratory therapists, radiation therapists, occupational therapists, physical therapists, various types of technologists, dental hygienists, medical assistants, phlebotomists, and pharmacy technicians, all of whom provide direct or supportive patient care.
The allied health professions fall into two categories, technicians (assistants) and therapists. This includes, among others, physical therapy assistants, and medical assistants.
The educational process for nurses and therapists can be more intensive. These positions require a state-issued license and an advanced degree, showing that the individual is trained to evaluate patients, diagnose conditions, develop treatment plans, and understand the rationale behind various treatments.
Pharmacists and pharmacy technicians
A pharmacist is a licensed professional who holds a Doctor of Pharmacy (PharmD) degree and a state license to practice. Pharmacists dispense medications prescribed by a provider, and before doing so they review each prescription for drug interactions, allergies, and dosing problems. They also counsel patients on how to take their medications safely and effectively, including possible side effects. Many pharmacists are also trained and authorized to administer vaccinations.
A pharmacy technician works under a pharmacist’s direct supervision, preparing and packaging medications and assisting with inventory and insurance processing. Unlike a pharmacist, a pharmacy technician does not counsel patients about their medications.
Allied health professionals as part of the healthcare team
Allied health professionals typically work as part of a healthcare team, which is what will be done by you as a medical assistant. As a new medical assistant, you will be part of an ever-growing group of allied health professionals who provide a variety of services to patients in a variety of settings in today’s healthcare system.
Types of healthcare facilities
There are several different professions involved when providing healthcare. We also need to consider where that healthcare is provided. In this next section we will look at the various healthcare facilities.
Hospitals
Before looking at how hospitals are organized, it helps to distinguish two basic categories of care. Inpatient care means a patient is formally admitted to the hospital, usually staying overnight or longer so the healthcare team can monitor and treat them continuously. Outpatient (or ambulatory) care means a patient is treated and goes home the same day, without an overnight stay; this setting is covered in more detail later in this chapter under “Ambulatory care.”
Hospitals are classified according to the care and services they provide to patients and by the type of ownership. There are three levels of hospitalized care:
Levels of hospitalized care
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Primary level of care
- Smaller city or community hospitals
- Usually serve as the first level of contact between the community members and the hospital setting
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Secondary level of care
- Both PCP’s and specialists provide care
- Larger municipal or district hospitals that provide a wider variety of specialty care and departments
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Tertiary level of care
- Referral system for primary or secondary care facilities
- Provide care for complicated cases and trauma
- Medical centers, regional and specialty hospitals
Hospital ownership
Private hospitals are run by a corporation or other organization and usually are designed to produce a profit for the owners or stockholders.
Nonprofit hospitals exist to serve the community in which they are located and are normally run by a board of directors. The term nonprofit sometimes is misleading because “profit” is different from “making money”. A nonprofit hospital or organization may make money in a campaign or fundraiser, but all of the money is returned to the organization. Nonprofit hospitals and organizations must follow strict guidelines in the area of finance and must account to the government for the money brought in and the purposes for which it is used.
Hospital systems and integrated delivery systems
A hospital system is a group of facilities that are affiliated and work toward a common goal. Hospital systems may include a hospital and cancer center in a small community or may consist of a group of separate hospitals in a specific geographic region.
An integrated delivery system (IDS) is a network of providers and facilities that serves a defined population and is willing to be held clinically and fiscally accountable for the clinical outcomes and health status of that population. Services provided by an IDS can include a fully equipped community or tertiary hospital, home healthcare, and hospice services, primary and specialty outpatient care and surgery, social services, rehabilitation, preventive care, health education and financing, and community provider offices. An IDS can also be a training location for healthcare professionals, students, including physicians, nurses, and allied health professionals.
Accountable care organizations
An accountable care organization (ACO) is a group of doctors, hospitals, and other healthcare professionals who voluntarily work together to give patients high-quality, coordinated care. The goal is to improve health outcomes while managing the overall cost of care. Under Medicare’s Shared Savings Program, an ACO that meets quality standards and spends less than expected shares in the resulting savings, making the ACO a value-based arrangement rather than a traditional fee-for-service model, where providers are paid for each service regardless of outcome.
As a medical assistant working within an ACO, you play a direct role in care coordination. This includes closing gaps in preventive care, such as reminding patients about overdue screenings or immunizations, following up with patients after a hospital or emergency department visit, and documenting care completely and accurately so the whole care team has the information it needs.
Accreditation and quality standards
It indicates to the public that the facility is concerned with providing high-quality care, and it also provides professional liability insurance benefits, and plays a role in regulatory agency licensure and certification efforts.
Hospitals and other healthcare facilities are accredited by the Joint Commission, an organization that promotes and evaluates the quality of care in healthcare facilities. Standards or indicators have been developed to help determine when patients are receiving high-quality care.
The term quality refers to much more than whether the patient liked the food served or had to wait to have a procedure or test performed.
Categories of compliance include the following:
- Assessment and care of patients
- Use of medication
- Plant, technology, and safety management
- Orientation, education, and training of staff
- Medical staff qualifications
- Patient’s rights
National patient safety goals
Accreditation by the Joint Commission is one way a facility can show that it meets Medicare requirements for reimbursement; a facility can also be certified through a state survey. Many managed care organizations and insurance companies also look for accreditation.
Besides accrediting healthcare facilities, the Joint Commission carefully evaluates patient safety. It has established the National Patient Safety Goals, which must be addressed by member facilities.
The Joint Commission reviews its goals every year. Its National Patient Safety Goals for ambulatory health care organizations include the following:
- Identify patients correctly: use at least two identifiers, such as name and date of birth.
- Use medicines safely: label medicines that are not labeled before a procedure, take extra care with patients on blood thinners, and record and pass along correct information about a patient’s medicines.
- Prevent infection: follow CDC or WHO hand-hygiene guidelines.
- Improve health outcomes for all: identify health care disparities in the patient population and have a written plan to reduce them.
- Prevent mistakes in surgery: make sure the correct surgery is done on the correct patient and at the correct site, mark the correct site, and pause before surgery to check for mistakes.
Ambulatory care
Ambulatory care centers include a wide range of facilities that offer healthcare services to patients who seek outpatient health services. Physician’s offices, group practices, and multispecialty group practices are common types of ambulatory care facilities, and medical assistants can be employed in all of these practices.
Group practices may involve a single specialty, such as pediatrics or may be multispecialty. A multispecialty practice might consist of an internal medicine physician, an oncologist, a cardiologist, and an endocrinologist.
The providers of the practice refer patients to each other when indicated. This is therefore more convenient for the patients and tends to be more profitable for the members of the practice.
Most providers charge new patients more than established patients due to the extent of the physical examination, the levels of decision-making, and the complexity of the medical history. New patient’s medical history may require more time.
Example: New or established patient?
A patient last saw a physician in her family practice group 2.5 years ago. Today she has an appointment with a different physician in that same group who shares the same specialty. Is she a new or established patient?
Answer: Established. She was seen within the past 3 years by a provider of the same specialty in the same group practice, so she counts as established even though today’s physician isn’t the one she originally saw.
Specialized ambulatory care facilities
Occupational health centers are committed to helping patients return to work and productive activity. Often, physical therapy is used in conjunction with rehabilitation services to assist the patient in regaining as much of his or her previous level of abilities.
Pain management centers can help patients deal with discomfort associated with their condition.
Sleep centers diagnose and treat patients with sleep conditions.
Urgent or emergency care centers provide patients with an alternative to hospital emergency departments (EDs) and are often open when traditional providers’ offices may be closed.
Ambulatory surgical centers
Surgery has become more convenient because of the number of ambulatory surgical centers that exist today. Many insurance companies now prefer day surgery because it is more cost-effective.
A wide variety of outpatient surgical facilities are available, offering procedures in ophthalmology, plastic surgery, and gastrointestinal concerns, including colonoscopies and endoscopies.
Additional ambulatory care facilities
Dialysis centers offer services to patients with severe kidney disorders, and many of the larger cities across the country have cancer centers for patients needing treatment by an oncologist.
Other types of ambulatory care facilities are centers that provide magnetic resonance imaging (MRI), student health clinics, dental clinics, community health centers, and women’s health centers.
Other healthcare facilities
Several other healthcare facilities deserve attention in the broad overview of a healthcare industry.
Laboratories
Laboratories offer testing services for patients referred by providers.
The enactment of CLIA in 1967 and its amendment in 1988 set federal standards for every laboratory that tests human specimens, including a physician’s office lab. The lab’s CLIA certificate determines which tests it may perform. A Certificate of Waiver allows only tests designated as CLIA (Clinical laboratory improvement amendments) waived, while a Certificate of Compliance or Accreditation allows moderate- and high-complexity testing.
You will learn how to perform a variety of CLIA-waived tests in your medical assistant program.
Smaller or independent practices typically have to send non-CLIA-waived tests to an outside diagnostic facility.
Tests that can be performed in a physician’s office are known as point-of-care testing (POCT).
Mobile health units
A mobile health unit, or mobile clinic, is a vehicle, such as a van or bus, that’s been equipped to deliver healthcare services directly in the community rather than in a fixed facility. Services commonly offered on a mobile unit include health screenings, immunizations, primary care visits, dental care, and mammograms.
Mobile health units are especially valuable for reaching rural, underserved, and homeless populations, since they remove common barriers to care, such as a lack of transportation or distance from the nearest clinic.
Home healthcare and hospice care
Home health agencies or hospital-affiliated home healthcare organizations provide crucial services to patients who may require medical follow-up but are not in a hospital setting.
Home healthcare includes therapy services, administration of and assistance with medications, wound care, and other services so that the patient may remain at home, yet still obtain consistent medical attention.
Hospice care is a type of home health service that provides medical care and support for patients facing end-of-life issues and their families.
Some communities have inpatient hospice services available either in a special unit in a hospital or in an independent hospice center.