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48 Cards in this Set
- Front
- Back
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How much was spent on healthcare in 1997?
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1 trillion
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Who pays the most?
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Private Insurance
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How much do 1/6 of the population with disabilities consume?
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50% of total health care costs
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Men consistently reported lower disability rates than women during the past 25 years. Why?
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Women live longer
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Why is disability data important to rehab providers?
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to identify emerging population trends; to provide baseline cost data against which clinical data can be compared; to identify and target demographic groups for current and new services; to assist in planning for resource allocation;
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Who pays in health care spending?
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Private Insurance; Medicare; o-o-pocket; Medicaid; other public; other private;
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At what rate do people 65 & older get disability?
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2x rate of ppl 45-64yrs old; 4x rate of ppl 18-44yrs old;
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What is the single greatest cost driver?
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Acute care services-45%
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How many people are uninsured or underinsured in the US?
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40 million
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What are the 5 myths about uninsured or underinsured?
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ppl w/o insurance get the health care service they need, they just got to the ER (far less likely to visit Dr or receive preventative services for chronic conditions); ppl w/o insurance are young, healthy adults who actually decline employer-sponsored benefit covereage(19-34 are most uninsured but bc ineligible for workplace insurance-only 4% decline); the number of uninsured Americans is not that large and it is declining(slightly declined in 99, future productions indicate growth, unless restructured opportunities); most insured ppl don't work or have a family member working(80% younger than 65yrs live in working families); immigration is the chief reason for the growing uninsured pop.(80% are US citizens)
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T/F anti-fraud initiatives are at an all-time high in both the private and public health care sectors.
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True
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What is the federal anti-kickback statute?
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cannot pay remuneration to anyone in attempt to get them to make referral or give goods paid for in whole or part by federal health care program
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What happens if you violate the anti-kickback statute?
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felony; both parties are liable
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What is the "Stark" law?
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section 1877 of Social Security Act; prohibits physician from referring Medicare patients to an entity that the physician has a financial rel'shp with, unless exception applies;
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What happens if "Stark" law is violated?
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denial of payment; refunds of billed amount;
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What is HIPAA(health insurance portability and accountability act of 1996)?
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fights health care fraud; $ is dedicated each yr for program integrity activities under Medicare Integrity Program; fraud & abuse includes: theft & embezzlement, obstruction of criminal investigations into health care fraud, and making false statements; addresses privacy health information and the prohibition of sharing info w/o consent of individual;
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What is the Balanced Budget Act of 1997?
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act contained major payment changes in Medicare program and new ways to combat fraud & abuse
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What is Operation Restore Trust?
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program to stop fraud & abuse in Medicare & Medicaid; focused on home health, medical equipment and nursing home care; project concluded but many ORT activities continue;
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What is Medicare? "health insurance for the aged and disabled"
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part of 1965 SS amendments; designed as health insurance program for aged ppl to complement retirement, survivors, and disability insurance benefits that exist under SS Act; covers most ppl over 65; ppl are entitled to disability benefits for 24 or more months; more ppl w/ ESRD require dialysis or kidney transplant; can buy into Medicare program; pays for RESTORATIVE not maintenance;
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What is Medicaid?
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title XIX of SS Act; Fed-state matching entitlement which provides medical assistance for certain individs and families w/ low incomes and resources; each state sets eligibility standards;
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What is the Americans with Disabilities Act?
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provides extensive protection to (43mill) americans w/ mental & physical disabilities; forbids discrimination;
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What is the IDEA(individuals w/ disabilities education act)?
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mandates free & appropriate education for all disabled childrend 3-21yrs; priority to children not receiving education than children with most acute disability receiving inadequate education; provides grants & incentives;
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What is the Rehabilitation Act of 1973?
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Nixon; provides rehabilitation & vocational services to individuals w/ disabilities including evaluation of rehab. pot'l; construction & improving rehab. facilities & number of profs.; underserved disabled ppl; promoting employment opportunities; establishing client assistance projects; and sol'n to architecture barriers;
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What is the Developmental Disabilities Assistance and Bill of Rights Act of 1984?
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permits significant increase in spending for developmental disabilities program; priority to those whose needs aren't met under RA of 73 or other programs; support ppl with developmental disabilities;
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What is OBRA (Omnibus Budget Reconciliation Act)?
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Nursing home reform; required nursing homes to provide services that include those nursing and specialized rehab. services needed to attain or maintain each resident's highest practical level of mental, physical, and psychosocial well-being;
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What is disability management?
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skillful handling of ppl and details in systematic, cohesive, functionally oriented application of services and resources to minimize the effect of disease, injury, impairment, and disability; covers prevention, treatment, and management; consider functional, social, and environmental needs;
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What is disability management?
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not about referring to someone else; handling of issues outside of hands on care; proactive process; includes physical, emotional, vocational, and medical factors; needs go beyond physical functioning altogether; pyschosocial & economic issues;
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What is disability treatment?
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direct hands on care; clinicians focus on;
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Issues related to DM and chronicity.
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best predictors of chornicity are psychosocial and economic issues; respond better to management skills than treatment; clinical trtmt ignores psychosocial aspects;
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T/F Individual-based approaches represent the trad'l model of rehab. care.
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True
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What are some components of DM?
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case mgmt; vocat. rehab. & counseling; pain clinics; return to work programs & interventions; employee assistance programs; psychological evaluations; functional capacity evaluations; ADL's assessment; restorative rehab; functional job analysis; identification of architecture barriers; ergonomics; reasonable accomodations; safety & health programs; work hardening; utilization rev. & mgmt; patient & famliy edu; employer edu; pre-employ & post-offer exam; light, modified, or transitional duty design & ident;
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What are some goals of todays DM?
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focus on prevention, early intervention and RTW; targets newly disabled ppl to prevent chronicity, maximize function, enhance worker prod, reduce cost, and facilitate earlier RTW
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What are the 9 Rehabilitation Principles for Disability Mgmt?
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Timeliness; Education; Assessment; Continuum; Habilitation; Collaboration; Outcomes; Research; Prevention;
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What are subjective disabilities?
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disabilities in which a clinical exam, lab findings, or imaging studies fail to produce why person has symptoms.
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What is an impairment vs. disability?
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presence of disease or injury does not guarantee impairment; all impairment don't lead to disability;
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What is neglected disability?
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delay rehab; application of palliative modalities only; medical care w/o a focus on worksite demands; absence of modified or transitional duty; failure to address various psychosocial elements;
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What is early intervention?
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successful rehab outcomes; diminished severity; lower costs; decreased re-injury or recidivism rates; pot'lly eliminate non-med obstacles to recovery;
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How did worker's comp begin?
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Industrial revolution, ppl dying, fault self-assumed-assumption of risk, fellow servant doctrine, and contributory negligence;
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What was the transition in worker's comp?
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unionization & congested civl courtrooms;
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What are the standards for compensable injury?
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injury must have direct causal rel'shp to work: "arisen out of" or "in course of"
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What are dual claims?
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seek benefits from others: personal injury suit or product liability; this is not prohibited anywhere; but can't sue employer & get work comp;
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What is the ICF(international classification of functioning) model?
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understand & measure health outcomes; used in clinical settings, health services, or surveys; classifies functioning and disabilty related to health conditions; biopsychosocial;
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What is the medical model?
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problem w/ person; caused by disease, trauma, or health condition; aimed at cure;
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What is social model?
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matter of full integration of person in society; attitudinal or ideological changes; environmental changes; complex collection of conditions;
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What are some congenital disabilities?
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cerebral palsy; spina bifida; congential osteogenesis; arthrogrypsosis; dwarfism; amputations;
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What are some acquired disabilities?
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TBI; stroke; amputations; MD; rheumatoid arthritis; MS; Myasthenia Gravis; SCI; polio-myelitis;
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What is the cause of cerebral palsy?
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can be due to injury to the brain at birth(bleeding, lack of oxygen, infection) or fetal development before birth; if acquired then head injury, meningitis, brain damage first few yrs;
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What are 5 problems you deal with in cerebral palsy?
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spasticity-muscles contracting; athetosis-uncontrolled motion of limbs; ataxia-poor balance; tremor-sim. to Parkinsons, uncontrolled part of body; ridity-stiff;
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