Reading...
Play button
Play button
Use LEFT and RIGHT arrow keys to navigate between flashcards;
Use UP and DOWN arrow keys to flip the card;
H to show hint;
A reads text to speech;
91 Cards in this Set
- Front
- Back
|
Integrated delivery systems (IDS)
|
combines clinical and financial aspects of healthcare
w/ continuum of care |
|
|
Continuum of care
|
range of health services from ambulatory care (walk in) to acute cure (admitted)
-different levels of system |
|
|
American Medical Association (AMA) represents?
|
represents the interests of physicians
|
|
|
Specialty physicians
|
-completion of postgrad training
-passing score on standard exam ex. pediatrics, radiology, obgyn |
|
|
physician assistants (PAs)
|
help physicians carry out their clinical responsibilities
|
|
|
American Nurses Association (ANA)
|
-must pass exam
LPN- 1yr, RN- 2 yr, BN- 4 yr Nurse Practitioner- 6yr (RN/post) mission: to improve health services |
|
|
American College of Surgeons
|
-1918
-developed minimum standards for hospitals |
|
|
Minumum Standards
|
marked the beginning of accredidation process for health organizations
|
|
|
Accredidation standards
|
-reflect reasonable quality standards by evaluation
-improves care for patients |
|
|
American Hospital Association (AHA) represents?
|
represents the interests of hospitals
|
|
|
Joint Commission
|
accredidation organization that surveys organizations
|
|
|
Allied health professionals
|
share responsibilty with clinicians
-recieve certification or higher ie. coders, radiography, therapists |
|
|
Medicare and Medicaid were legislated by? When?
|
Lyndon Johnson in 1965
|
|
|
National Institutes of Health (NIH)
|
conducts/ supports medical research
mission: to uncover new medical that can lead to health improvements |
|
|
Social Security Act of 1935
|
"old-age" pension and unemployment insurance
-funded by states |
|
|
Hill-Burton Act of 1946
|
authorized grants for states to construct new hospitals and modernize old ones
|
|
|
Public Law 89-97 of 1965
|
-passed ammendments to the Social Security Act
-created Medicare/Aid |
|
|
Medicare (MCR)
|
-65 years and older
-disabled -federal funding *care for old* |
|
|
Medicaid (MCD)
|
-low income and their families
-disabled -pregnant -state funding w/ federal help *band-aid on poor* |
|
|
Public Law 92-603 of 1972
|
ensures Medicare/Aid spending is medically neccessary
|
|
|
Utilization Review Act of 1977
|
hospitals must conduct continued stay reviews that ensures medical neccessity
-inlcudes fraud and abuse |
|
|
Peer Review Improvement Act of 1982
|
implemented PROs- which review medical need of admissions even before admittance
|
|
|
peer review organizations (PROs)
|
reviews actual medical neccessity
and appropriateness of admissions -now called QIOs (quality improvement org) |
|
|
Tax Equity and Fiscal Responsibility Act of 1982 (TEFRA)
|
required prospective payment system for reimbursement
|
|
|
prospective payment system (PPS)
|
payment system set in advance for reimbursement
|
|
|
Prospective Payment Act 1982
|
reimbursement is based on diagnosis related groups (DRGs)
|
|
|
diagnosis-related groups (DRGs)
|
patient's diagnosis at time of discharge
-used for reimbursement |
|
|
Consolidated Omnibus Budget Reconciliation Act of 1985
|
made it possible for CMS (Medicare/Aid) to deny reimbursement for substandard services
|
|
|
Omnibus Budget Reconciliation Act of 1986
|
requires PROs to report instances of substandard care
|
|
|
Healthcare Qulaity Improvement Act of 1986
|
established the National Practioner Data Bank (malpractice issues)
|
|
|
National Practioner Data Bank (NPDB)
|
info about practitioners who have a history of malpractice suits or other problems
|
|
|
Omnibus Budget Reconciliation Act of 1989
|
instituted the Agency for Healthcare Policy and Research (evaluate the quality of services)
|
|
|
Omnibus Budget Reconciliation Act of 1990
|
requires PROs to report action against physicians
ie, hysterectomy doc. Is there a problem? |
|
|
Mental Health Parity Act of 1996
|
self-funded or fully insured group that provides equality for mental health benefits
|
|
|
Health Insurance Portability and Accountability Act of 1996
(HIPPA) |
portability= move after employment
-standards for electronic transactions -privacy and security standards |
|
|
Flexner report
|
-reported lack of medical education
-required that medical training be imperative and degrees must be held |
|
|
American Recovery and Reinvestment Act of 2009
(ARRA) |
changes in HIPPA security/privacy
-provides stimulus funds to the economy in the midst of economic downturn -includes HITECH (funds for implementing health records) |
|
|
Health Information Technology for Economic and Clinical Health
(HITECH) Act |
allocates funds for the implementation of nationwide health information exchange and electronic health records (EHRs)
|
|
|
National Institutes of Health (NIH)
strategic initiative? |
research and biomedical advances for effective prevention and treatment of disease
|
|
|
Benefits of cell-based technology?
|
diseases can be diagnosed much earlier!
-tissue engineering/transplanting -embryonic stem cells -gene therapy |
|
|
American Medical Association (AMA)
|
1847 as a voluntary service organization
mission: promote the science and art of medicine -world leader for integrating info on health/medical practice |
|
|
American Hospital Association (AHA)
|
facilitate interchange of ideas and betterment of operations at hospitals
mission: to advance the health of individuals and communities |
|
|
Coding Clinic
|
-published by AHA
-provides official coding advice |
|
|
acute hospitals
|
sudden/emergency
-Inpatients -less than 30 days |
|
|
long-term care facilities
|
30 days+/ skilled nursing
-use continuum of care ie. nursing homes |
|
|
ambulatory care facilities
|
seperate/ free standing
-walk in/walk out -OUTpatient |
|
|
psychiatric facilities
|
rehab or mental health
|
|
|
home health agencies
|
-at home "OASIS"
-Medicare related |
|
|
Joint Commission
|
-accredidation organization that surveys organizations
-aids organizations in providing safe quality healthcare |
|
|
National Patient Safety Goals
|
addresses patient safety concerns
|
|
|
Sentinel Event Policy
|
identify and prevent unexpected deaths or serious injury
-perform root analysis |
|
|
root analysis
|
discovers the underlying problem and risks to make improvements
|
|
|
American Health Information Management Asscociation
(AHIMA) |
mission: professional community that improvies healthcare practices and standards with credentialing
|
|
|
Commission on Accredidation for Health Information Management Education (CCHIIM)
|
accrediting organization enforcing standards for HIM programs
|
|
|
Certification Commission for Health Information Technology (CCHIT)
|
mission: accelaerate the adoption of health information technology
-offers certification for amb., inpatient and emergency EHRs |
|
|
ALOS
|
average length of stay
-30 days or less typically |
|
|
Types of hospitals are classified by:
|
-number of beds
-types of services -types of patients -profit or non-profit -type of ownership |
|
|
for-profit healthcare organizations
|
funds are paid back to managers, owners and investors in the form of dividends and bonuses
|
|
|
not-for-profit organizations
|
provide free care
ie. churches, universities |
|
|
board of directors
|
responsible for setting the overall direction of the hospital w/CEO
mission: organization's purpose and service |
|
|
clinical privileges
|
aggregate (small group) of physicians who have been granted permission to provide clinical services in hospital
|
|
|
medical staff classification
|
organization of physicians according to clinical assignment
|
|
|
medical staff by-laws
|
staff operates to predetermined set of policies
|
|
|
Blue Cross Blue Shield
|
coordinate activities of local plans through united states
|
|
|
CEO responsibilites:
|
implementing the policies and startegic direction set by board
|
|
|
patient care services
|
largest clinical department in terms of staffing, budget, services and expertise
|
|
|
rehabilitaion services
|
involve entire healthcare team
|
|
|
occupational therapy
|
medically directed use of work and play activities
|
|
|
diagnostic
|
finds out problem
ie. xray, lab |
|
|
theraputic
|
provides treatment for problem
ie. resperitory, physical |
|
|
clinical support services examples:
|
pharmacy, food nutrition, coders, etc.
|
|
|
quality improvement standards (QI)
|
-required by Medicare/Aid
appropriate- right care/right time technical- right care/right manner accessible-right care when need acceptable-patient satisfied |
|
|
peer review
|
assesses colleagues in the same profession
|
|
|
Managed Care
|
reimbursement system that manages cost, quality and access to services
-indirect result of Medicare/Aid |
|
|
Patient focused care
|
improve quality by cross-training staff in nursing units
|
|
|
Evidence-based medicine
|
providers combine experience and knowledge with clinical research to make decisions
|
|
|
Integrated Healthcare Delivery Systems (IDS)
|
provider made up of a number of medical facilities that coordinate services
|
|
|
skilled nursing facilities (SNFs)
|
-organize the continuum of care
-maximize effectiveness -reduce costs ie. Hospice |
|
|
voluntary accredidation
|
review performed by an independent body that develops standards
|
|
|
private practice
|
physician owned entity
|
|
|
ambulatory surgery and freestanding ambulatory care center
|
no overnight stay for patients with minor illness/injury
|
|
|
public health service
|
-ensures health
-provides human services -resposible for prevention |
|
|
home healthcare services
|
-fast growing
-Medicare related -pressure from third party payers |
|
|
voluntary agencies
|
planning and services for low-income patients
-funds from variety of sources |
|
|
subacute care
|
offers access to constant nursing care while recovering at home
|
|
|
residential care
|
more homelike
-assistance with daily activities available |
|
|
Hospice care
|
mainly in home
-terminally ill and their families |
|
|
day-treatment programs
|
serve as transitions from inpatient care or discharge
|
|
|
Medicare Part B
|
optional federal funding
|
|
|
TRICARE
|
pays for care delivered by civilian health providers to retired members of military
-1st WW |
|
|
Health Savings Accounts (HSA)
|
offer members control on how healthcare dollars are spent
-benefit is that member pays for deductible w/pretax $$ |
