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48 Cards in this Set

  • Front
  • Back
How much was spent on healthcare in 1997?
1 trillion
Who pays the most?
Private Insurance
How much do 1/6 of the population with disabilities consume?
50% of total health care costs
Men consistently reported lower disability rates than women during the past 25 years. Why?
Women live longer
Why is disability data important to rehab providers?
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;
Who pays in health care spending?
Private Insurance; Medicare; o-o-pocket; Medicaid; other public; other private;
At what rate do people 65 & older get disability?
2x rate of ppl 45-64yrs old; 4x rate of ppl 18-44yrs old;
What is the single greatest cost driver?
Acute care services-45%
How many people are uninsured or underinsured in the US?
40 million
What are the 5 myths about uninsured or underinsured?
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)
T/F anti-fraud initiatives are at an all-time high in both the private and public health care sectors.
What is the federal anti-kickback statute?
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
What happens if you violate the anti-kickback statute?
felony; both parties are liable
What is the "Stark" law?
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;
What happens if "Stark" law is violated?
denial of payment; refunds of billed amount;
What is HIPAA(health insurance portability and accountability act of 1996)?
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;
What is the Balanced Budget Act of 1997?
act contained major payment changes in Medicare program and new ways to combat fraud & abuse
What is Operation Restore Trust?
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;
What is Medicare? "health insurance for the aged and disabled"
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;
What is Medicaid?
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;
What is the Americans with Disabilities Act?
provides extensive protection to (43mill) americans w/ mental & physical disabilities; forbids discrimination;
What is the IDEA(individuals w/ disabilities education act)?
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;
What is the Rehabilitation Act of 1973?
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;
What is the Developmental Disabilities Assistance and Bill of Rights Act of 1984?
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;
What is OBRA (Omnibus Budget Reconciliation Act)?
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;
What is disability management?
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;
What is disability management?
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;
What is disability treatment?
direct hands on care; clinicians focus on;
Issues related to DM and chronicity.
best predictors of chornicity are psychosocial and economic issues; respond better to management skills than treatment; clinical trtmt ignores psychosocial aspects;
T/F Individual-based approaches represent the trad'l model of rehab. care.
What are some components of DM?
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;
What are some goals of todays DM?
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
What are the 9 Rehabilitation Principles for Disability Mgmt?
Timeliness; Education; Assessment; Continuum; Habilitation; Collaboration; Outcomes; Research; Prevention;
What are subjective disabilities?
disabilities in which a clinical exam, lab findings, or imaging studies fail to produce why person has symptoms.
What is an impairment vs. disability?
presence of disease or injury does not guarantee impairment; all impairment don't lead to disability;
What is neglected disability?
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;
What is early intervention?
successful rehab outcomes; diminished severity; lower costs; decreased re-injury or recidivism rates; pot'lly eliminate non-med obstacles to recovery;
How did worker's comp begin?
Industrial revolution, ppl dying, fault self-assumed-assumption of risk, fellow servant doctrine, and contributory negligence;
What was the transition in worker's comp?
unionization & congested civl courtrooms;
What are the standards for compensable injury?
injury must have direct causal rel'shp to work: "arisen out of" or "in course of"
What are dual claims?
seek benefits from others: personal injury suit or product liability; this is not prohibited anywhere; but can't sue employer & get work comp;
What is the ICF(international classification of functioning) model?
understand & measure health outcomes; used in clinical settings, health services, or surveys; classifies functioning and disabilty related to health conditions; biopsychosocial;
What is the medical model?
problem w/ person; caused by disease, trauma, or health condition; aimed at cure;
What is social model?
matter of full integration of person in society; attitudinal or ideological changes; environmental changes; complex collection of conditions;
What are some congenital disabilities?
cerebral palsy; spina bifida; congential osteogenesis; arthrogrypsosis; dwarfism; amputations;
What are some acquired disabilities?
TBI; stroke; amputations; MD; rheumatoid arthritis; MS; Myasthenia Gravis; SCI; polio-myelitis;
What is the cause of cerebral palsy?
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;
What are 5 problems you deal with in cerebral palsy?
spasticity-muscles contracting; athetosis-uncontrolled motion of limbs; ataxia-poor balance; tremor-sim. to Parkinsons, uncontrolled part of body; ridity-stiff;