Excelsior Transition Rn Health Care Delivery System

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Family New Trends

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Single Parent
Female Headed Households
Higher average age for womens1st marriage and childbirth.

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Family New Trends

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Increased entrance of women in workforce.
Shifting gender roles within family.
Shifting of enconomic responsibilities in families.

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Family New Trends

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Decreasing family and household size.
Increase burden on working age families by younger and older dependents.

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Goals of Healthy People 2012

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Reduce/iliminate illness, disease, and premature death among individuals and communities.

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Goals of Healthy People 2012

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Improve access to health care.

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Goals of Healthy People 2012

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Improve the availability and dissemination of health-related information.

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Demographic Changes

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Rise in immigrants w/i US will require health care workers to learn new languages, appreciate different cultural values in health and healing.

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Demographic Changes

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Homeless and poor do not have access to healthcare by means of where they are living or their inability to pay which exacerbates health problems.

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Demographic Changes

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Life Span- increase in lifesan is related to new medical advances, better health care, and technology. Increased need for health care for chronic cond.

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Leading Health Indicators

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Physial Activity
Overweight/obesity
Tobaco use
Substance abuse
Responsible sexual behavior.

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Leading Health Indicators

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Mental Health
Injury and violence
Enviromental quality
Immunization/ access to health care.

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Fee-for-Service

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Traditional kind of health care policy.
Offers most choice of doctors and hospitals.

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Fee-for-Service

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After deductible is paid, bill s shared with insurnce company.
Most fee-for-service plans have a "cap" as to amount covered.

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Health Maintenance Organizations (HMO)

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Voluntary enrollment of individuals or families to a prepaid group health practice system to deliver comprehensice health care

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HMO

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Includes health promotion and health maintenance services.
All care is overseen by a primary care health provider (PCHP)

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HMO

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Choices are limited to those that have agreements with the HMO to provide care.
Medicare and Medicaid recipients can join.

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Preferred Provider Organization (PPO)

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combination of traditional fee-for-service and HMO.
List of providers and institutions that can be utilized at a negotiated fee.

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PPO

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small co-payment for each visit.
you may have to pay a deductible.

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PPO

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Use of other providers and institutions can be used at a higher rate.
Medicare and Medicaid recipients can join.

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Government Health Financing Plans

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Medicare and Medicaid were initiated in 1965 under the social security act.

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Medicaid

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Programs were administered by the Social and Rehabilitation Services.

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Medicare

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Medicare was a responsibility of the Social Security Administration (SSA) with provisions for federal assistance to the states.

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Health Care Financing Administration

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To better coordinate services the Health Care Financing Administration (HCFA) was created in 1977.

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HFCA

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Was renamed Centers for Medicare and Medicaid Services in 2001 (CMS)

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Medicaid

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Individuals who have low incomes nd resiources may qualify for medicaid to pay medical expenses.

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Medicaid

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Jointly funded by the federal and state govt .
Largest source of funding for medical and health related services for people with limited income.

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Medicare

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Provides coverage to approximately 40 million Americans

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Medicare

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People over 65
Some people under 65 with disabilities.
People with end stage renal disease (ESRD) which is permanent kidney failure requiring dialysis or kidney transplant.

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Medicare Part A.
Hospital Insurance

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Most People don't pay a premium for part a because it was usually paid for through their/spouces taxes while working.
Helps cover inpatient hospital care.

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Medicare Part A.

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Helps cover inpatient care in critical access hospitals and skilled nursing homes.

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Medicare Part A.

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Helps cover hospice care and some home health care.
Must meet certain conditions to get these benefits.

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Medicare Part B.

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Helps cover Dr services and outpatient care.
Covers some services that Part A does not cover. PT/OT and some health care.

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Medicare Part B.

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Most people pay a monthly premium for Part B.
Pay a $110 art B deductible yearl before medicare starts to pay.

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Medicare Modernization Act 2003

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Gives option to stay with traditional medicare coverage or choose a private managed care plan, ppo, or fee for service plan.

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COBRA (Consoidated Omnibus Budget Reconciliation Act of 1985)

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Allows employer group health plan coverage for a limited period of time after employment eds or after ending of coverage as a dependant.

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Diagnosis Related Groups (DRG)

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System for classifying patient care by relating common characteristics such as diagnosis, treatment, and age that generalizes expected hospital resources and length of stay.

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DRG

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The development for DRG and their acceptance for prospective payment under Medicare fundamentally changed the way hospitals think about their clinical and financial information systems.

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Prospective Payment System

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Skilled Nursing Facilities are reimbursed for Medicare patients based on their resource ultilization groups (RUG)

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Prospective Payment System

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Patients are classified in 1-44 RUG based on seven categories.

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Prospective Payment System- Categories

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Special Care, extensive services, special rehab, clinicall complex, impaired cognitionbehavior problems, reduced physical function.

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Educational

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Health Care info on Internet.
Illiteract makes it difficult for patients to be efective consumers of health care.

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Physiological Monitoring

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Measures aspects such as heart rate, bp, in adition to other vital measurments.

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Diagnostic Techniques

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Transmit data from the patient to the physician over telephone lines.

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Drug Administration

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Use of implantable infusion pumps that can be programmed to administer medication at a certain rate over a period of time.

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Information Technology

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Access clinicl data bases eficiently
Maintains computerized health records
Provides easy access to health care info

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Information Technology

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Permit consultation around the world at the point of care site.
Expand how health care is delivered.

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Information Technology

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Decrease medical errors by havingbstandardized and automated decision trees
enhance communicationbetween pt and health care professional

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Medline

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Information for consumers on hundreds of health topics and reputable links to websites.

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Telemedicine

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Use of telecommnunications to provide health informationand services.

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Telemedicine

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Can reduce health care cost by allowing doc to quickly and effectively address health care concerns. Could be future of preventative med.

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The Medicare Telehealth Validation Act 2003

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Expanded Medicare reimbursment for telehealth services to inpatient services w/o geographoc restriction.
Reduce licensing barriers to multi-state practitioners.

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International Aids Treatment and Prevention Act

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Designed to provide substantial bilateral and multilateral assistance to combat theHIV?AIDs pandemic in developing countries.

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Victims Economic Security and Safety Act (VESSA)

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Bill designed to help victims of domestic violence to keep their jobs, find a safe place to live, unemployment benefits if fired as result of abuse. Emergency leave for court and obtaining health related care.

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The Oragon Health Plan

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Rational plan for expanding services to the population of the state while acknowledgingthe limitations of funding resources.

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Oragon Health Plan

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Accomplished by expanding eligibility for medicaid to people with income at 100% of the federal poverty level.

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Oragon Health Plan

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Has had a significant inpact in the US, sparking a public debate over issues suc as cost-containment and access.

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Oragon Health Plan
Arguments for the plan

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innovativeness plans to accessibility and contain health care cost, incouragement of public govt in health care issues.

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Oragon Health Plan
Arguments Against

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Provides no guarantee of a minima level of service for medicare recipientst and it rations health care for the poor based on prioritization of condition treatment pairs.

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Types of Organizations

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Acute Care, Long Term Care, Rehabilitive Facilities. They are differentiated by types of service, length of stay, ownerhip, and teaching status.

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Types of Service

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Services an be limited in scope/speific (ex: psychiatric care) or wide range in scope/general (ex: acute care hospital)

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Length of Stay

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Trend in health care is to manage health rather than illness. This is a wellness persective rather than an illness perspective.

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Primary Care

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Entry into system
Early detection and routine care , BP, screening, PAP
Clinics, physicians office, school nursing, occupational health

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Secondary Care

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Prevention of disease compliations, Acute care, Emergency Care, Outpatient surgical procedures, hospital care.

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Secondary Care

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Prevention of disease complications, Aute care, emergency care, outpatient surgical procedures,hospital care

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Tertiary Care

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Rehab, rehab centers, long term care facilities, skilled nursing facilities, assisted living facilities.

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Public Institutions

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controlled by local, state, or federal govt.

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Private/Voluntary

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Controlled by voluntary boards or private/proprietary (for profit)are investor owned.

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Home Health Care Organizations

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Fastest growing segment of healthcare today. They may be free standing or owned by a hospital. May be profit or not-for-profit.

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Joint Commission

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Focus is related to continuous improvement of the safety and quality of health care provided in public.

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Joint Commission

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Accredits approximately 80% of all acute care hospitals in the US. Also accredits abulatory care centers, clinical labs, HMO preferred provider organizations, home health care agencies, and hospice.

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National Commitee for Quality Assurance (NCQA)

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Responsible for reviewing HMO's. It is independant, not for profit organization. Provides statistical data for employers and consumers to evaluate HMO

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Regulatory Bodies

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Numerous agencies that provide health care, also agencies that accredit health care agencies.

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Regulatory Bodies

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Ex:State Health Dept. Medical Administration, OSHA, EqualEmployment Opportunity Commission, CMS

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Health Care Legislation and Policy

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Act of making or enacting laws occurs at the local, state, and federal levels.

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Steps of Federal Legislation

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Bill is introduced to house, it is assigned to house committee having jurisdiction.

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Steps of Federal Legislation

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If favorably considered it is reported to the house either in its original form or with recommended ammendments

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Steps of Federal Legislation

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If passed by the house, it is messaged to the senate and referred ti the committee having jurisdiction.

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Steps of Federal Legislation

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In the senate commitee the bill if favorably considered may be reported in the form it is recievedfrom the hoise or with ammendments.

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Steps of Federal Legislation

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The bill is approved, reported to the senate and if passed by that body returned to the house.

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Steps of Federal Legislation

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If the body does not accept the ammendments to the bill by another bodya conference committee comprised of members of both bodies is usually appointed to affect a compromise.

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Steps of Federal Legislation

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When bill is finally approved by both houses it is signed by the speaker ad the vice pres. and is presented to the president.

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Steps of Federal Legislation

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President signs bill and it becomes a law UNLESS it is re-passed by a two-thirds vote of both houses.

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American Nurses Association Political Action Committee (ANA PAC)

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Est to promote the improvment of the health care system in the US by raising funds from Constituent Member Association (CMA) and contributing funds to support canidates for federal office.

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American Medical Association (AMA)

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Promtes art and science of medicine and the betterment of public health through its core values of leadership, excellence, integrity and ethical behavior.

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AMA

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Unites physicians nationwide to work on the most important professional and public health issues.

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American Hospital Association (AHA)

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Ensures that members needs are heard and addressed in national health policy development. Provides education for health care leaders and is a source of info on health care issues and trends.

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American Association of Retired Persons (AARP) 50 years and older

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Provides services like informing members and public on issues important to this age group. Advocating on legislative , consumer and legal issues. offers wide range of specialproducts/services to members.

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Magnet Hospitals

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Certified by American Nurses Credentialing Center.
Attraction and retention of professional nurses.

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Magnet Hospital Satisfaction

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Autonomy, control of practice settings, relationship with physicians, attractive practive enviroments, powerful chief nurse ex. adequate staff, recognition of work, time to discuss patient problems.