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74 Cards in this Set

  • Front
  • Back
THE RISING COST OF HEALTH CARE IS FUELED BY
-A GROWING AGING POPULATION
-INCREASED TECHNOLOGICAL ADVANCES
PHRASE THAT CHARACTERIZES MUCH OF THE HEALTH CARE DELIVERY IN THE U.S.
MANGED CARE
CARE THAT IS PROVIDED UNDER A FIXED OR PRESET BUDGET
MANGED CARE
ALLOWS FOR GREATER COST MANGEMENT AND COST CONTAINMENT
MANGED CARE
THE MANGED CARE ENVIRONMENT IS ENVIRONMENT CHARACTERIZED BY
MANGED COMPETITION
VARIOUS HEALTH CARE ORGANIZATIONS COMPETE WITH EACH OTHER IN TERMS OF COST AND THE QUALITY OF THE SERVICE
MANGED COMPETITION
PHYSICANS WORKING IN THIS TYPE OF CARE ARE ENCOURAGED TO PROVIDE THE MINIMUM AMOUNT OF CARE
MANGE CARE
HAS THE POWER TO DENY THE REQUEST FROM PHYISIANS OR TO PROVIDE A WRITTEN REQUEST FOR SERVICES THAT A PHYSICIAN RECOMMAND
PATIENT MANGER OR CASE MANGER
OFTEN SEEM TO BE AN INSURANCE COMPANY OR MANGED CARE ORGANIZATION REPRESENTATIVE THAT HAVE THE POWER TO DENY REQUESTS
PATIENT MANGER OR CASE MANGER
A NONPROFIT ASSOCIATION THAT EDUCATES NURSES ABOUT MANAGED HEALTH CARE
AMERICAN ASSOCIATION OF MANGED CARE NURSES
(AAMCN)
TO BE RECOGNIZED AS A RESOURCE IN MANGED HEALTH CARE STANDARDS
AMERICAN ASSOCIATION OF MANGED CARE NURSES (AAMCN)
ESTABLISH STANDARDS FOR MANGED CARE NURSING PRACTICE
AMERICAN ASSOCIATION OF MANGED CARE NURSES (AAMCN)
INFLUENCE PUBLIC POLICY REGARDING MANGED HEALTH CARE DELLIVERY
AMERICAN ASSOCIATION OF MANGED CARE NURSES (AAMCN)
ASSIST TO EDUCATE THE PUBLIC ON MANGED CARE
AMERICAN ASSOCIATION OF MANGED CARE NURSES (AAMCN)
WORK IN A VARIETY OF MANGED CARE SETTINGS TO COORDINATE CARE OF PATIENTS
CASE MANGEMENT
CASE MANGERS ARE TYPICALLY WHO
NURSES
A TYPE OF CASE MANGEMENT THAT FOCUS OF PEOPLE WITH COMPLEX CARE NEEDS
DISEASE MANGEMENT
PEOPLE THAT WORK WITH PATIENTS THAT ARE HIGH RISK FOR COMPLICATIONS FROM THIER DISEASE
DISEASE MANGEMENT
THEY COORDINATE HEALTH CARE OPTIONS AND EDUCATIONAL SERVICES FOR HIGH RISK PATIENTS
DISEASE MANGEMENT
DEVELOP AND IMPLEMENT CARE PLANS
DISEASE MANGEMENT
COORDINATE RESOURCES FOR PATIENTS
MAKE REFERRALS
DISEASE MANGEMENT
MONITOR AND EVALUATE PROGRESS
DISEASE MANGEMENT
THE GOAL OF PREVENTIVE SERVICES
TO KEEP PEOPLE IN THE COMMUNITY RATHER THAN IN HOSPITALS AND LONG-TERM CARE SETTINGS
ASSOCIATED WITH RESOURCE ALLOCATION OR THE FAILR DISTRIBUTION OF GOODS AND SERVICES
RATIONING
THE TRADITIONAL SYSTEM OF PAYMENT FOR HEALTH CARE IN THE U.S.
FEE FOR SERVICE (FFS)
A FEE IS CHARGED FOR EACH SERVICE DELIVERED BY A PROVIDER
FEE FOR SERVICE (FFS)
FEDERAL GOVERNMENT HEALTH INSURANCE PROGRAM
MEDICARE
WHO IS RESPONSIBLE FOR REGULATING AND ADMINSTERING MEDICARE
CENTERS FOR MEDICARE AND MEDICAID SERVICES (CMS)
COVERAGE THAT IS THE SAME IN ALL STATES
MEDICARE
FOR PEOPLE 65 YRS OR OLDER AND SOME YOUNGER WITH DISABILITIES
MEDICARE
MEDICARE CONSTIST OF WHAT PARTS
PART A
PART B
MEDICARE HOSPITAL INSURANCE
PART A
MEDICARE SUPPLEMENTAL MEDICAL INSURANCE
PART B
FEDERAL PROGRAM THAT IS THE 3RD LARGEST SOURCE OF HEALTH INSURANCE IN THE U.S.
MEDICAID
DESIGNED TO ASSIST PEOPLE IF LOW INCOME AND THOSE THAT RECEIVE OTHER FORMS OF PUBLIC ASSISTANCE
MEDICAID
PROVIDES COMPREHENSIVE MEDICAL CARE AND MEDICALLY RELATED SERVICES TO VULNERABLE POPULATIONS
MEDICAID
COVERS BOTH IN PATIENT AND OUT PATIENT CARE
MEDICAID
INJURY ON THE JOB OR MAY REQUIRE A WORK RELATED ILLNESS AND BE UNABLE TO WORK FOR AN EXTENDED AMOUNT OF TIME IS
WORKMAN'S COMPENSATION
CLAIM TO RECEIVE MONETARY COMPENSATION FROM AN EMPLOYER UNDER A FEDERAL PROGRAM
WORKMAN'S COMPENSATION
A MONTHY PAYMENT IS MADE TO A PROVIDER OF HEALTH CARE
CAPITATION PROGRAM
A PROVIDER IS PAID IN ADVANCE FOR THE DELIVERY OF SERVICE WHETHER THE MEMBER USES THAT SERVICES OR NOT
CAPITATION PROGRAM
THE PRIMARY GOAL OF THE CAPITATION PROGRAM
TO LOWER COST OF CARE BY ENCOURAGING MORE PREVENTIVE SERVICES BY PROVIDERS
EXAMPLES OF CAPITATION PROGRAM
-HEALTH MAINTENANCE ORGANIZATION (HMO)
-PREFERRED PROVIDER ORGANIZATION (PPO)
LEGAL CORPORATIONS THAT OFFER HEALTH INSURANCE AND A RANGE OF HEALTH SERVICES AT A FIXED PRICE
HEALTH MAINTENANCE ORGANIZATION (HMO)
PRIMARY GOAL OF HEALTH MAINTENANCE ORGANIZATIONS (HMO)
TO HELP PEOPLE PREVENT DISEASE AND MAINTAIN HEALTH
COVERS ACUTE HOSPITAL STAYS
HEALTH MAINTENANCE ORGANIZATION (HMO)
HEALTH MAINTAINANCE ORGANIZATION ARE A TYPE OF WHAT KIND OF CARE
MANGED CARE
WELL KNOWN HMO
LARGEST IN THE U.S.
KAISER PERMANENTE
AN ORGANIZATION NEGOTIATES LOWER RATES WITH CERTAIN HEALTH CARE INSTITUTIONS
PREFERRED PROVIDER ORGANIZATION (PPO)
MEMBERS ARE ENCOURAGED TO USE THE PROVIDERS WHO ARE WILLING TO GIVE LESS COSTLY SERVICES
PREFFERED PROVIDERS ORGANIZATION (PPO)
PROVIDERS BENEFIT BECAUSE THEY ARE GUARANTEED A CERTAIN NUMBER OF PATIENTS AND ARE PAID QUICKLY
PREFFERED PROVIDER ORGANIZATION (PPO)
A PROVIDER WILL BE REIMBURSED FOR A SERVICE BASED ON A PREETERMINED AND FIXED REIMBURSEMENT AMOUNT FOR THAT SERVICE
PROSPECTIVE PAYMENT PLAN
TYPES OF PROSPECTIVE PAYMENT SYSTEM
-DIAGNOSIS-RELATED GROUPS (DRGs)
-RESOURCE UTILIZATION GROUPS (RUGs)
REIMBURSEMENT RATES ARE BASED ON A REVIEW OF AVERAGE COSTS FOR SIMILAR DIAGNOSES, PROSEDURES, AND TREATMENTS IN THE PAST
DIAGNOSIS-RELATED GROUPS (DRG's)
FEDERAL GOVERNMENT COVERTED FEE-FOR-SERVICE SYSTEM TO THIS
DIAGNOSIS-RELATED GROUPS (DRG's)
A DISEASE THAT WORSENS OR AFFECTS A PRIMARY DISEASE
COMORBIDITY
A PERSON THAT EXCEEDS THAT MAXIMUM LENGTH OF STAY
OUTLIER
BASED ON THIS HOSPITALS HAVE AN INCENTIVE TO DISCHARGE PATIENTS AS QUICKLY AS POSSIBLE
PROSPECTIVE PAYMENT SYSTEM
DISCHARGE PLANNING IS LARGELY THE RESPONSIBILTY OF WHO
THE NURSE
TAKES PLAVE THE MINUTE THE PATIENT ENTERS THE HOSPITAL
DISCHARGE PLANNING
HOME CARE NURSES NEED TO BE MORE UP TO DATE ON WHAT
-ACUTE CLINIAL ASSESSMENT
-TREATMENT SKILLS
MEANS COLLECTIVE LAWS
LEGISLATION
HOW CAN NURSES BE INVOLVED WITH LEGISLATION
-AS ADVOCATES FOR PATIENTS
-AS ADVOCATES FOR THEMSELVES
SOMEONE WHO WRITES OR SPEAKS IN SUPPORT OF SOMEONE OR SOME CAUSE
ADVOCATE
STRATEGIES FOR NURSES WHO WANT TO AFFECT THE LEGISATION PROCESS
-CULTIVATE POLIRICAL AWARENESS
-LOBBYING
-WRITING LETTERS OR E-MAILS
-TESTIFYING
-NETWORKING WITH OTHER PEOPLE
INVOLVES BEING AWARE OF ISSUES THAT AFFECT BOTH CONSUMERS OF HEALTH CARE AND PROVIDERS OF HEALTH CARE
CULTIVATE POLITICAL AWARENESS
MEANS TO ELICIT SUPPORT FOR SOMETHING OF IMPORTANCE
LOBBY
MEANS TO BEAR WITNESS OR TO GIVE EVIDENCE
TESTIFY
ORGANIZED GROUPS THAT RISE MONEY TO ELECT OR DEFEAT CANDIDATES WHO ARE RUNNING FOR OFFICE
POLITICAL ACTIONS COMMITTEES (PAC)
LOBBY FOR OR AGAINST VARIES PIECES OF LEGISLATION
POLITICAL ACTIONS COMMITTEES (PAC)
ARE USALLY FORMED BY BUSINESSES, ASSOCIATIONS, OR ORGANIZATIONS INCLUDING FOR PROFIT AND NOT-FOR-PROFIT
POLITICAL ACTIONS COMMITTEES (PAC)
THE ANA HAS INFLUENCED THE LEGISLATION PROCESS THROUGH
ANA POLITICAL ACTION COMMITTEE (ANA-PAC)
ISSUES THAT THE ANA-PAC HAVE SUPPORTED
-HEALTH CARE REFORM
-MEDICARE REIMBURSEMENT FOR RN's IN ADAVANCED PRACTICE
-STRONGER NEEDLE STICK PRETECTION LAWS
SPECIAL INTEREST GROUPS CAN INFLUENCE WHO
LEGISLATION