Legal Ethics Final Exam

Front 1

1. basic & routine health care that is provided in an office or clinic by a provider who takes responsibility for coodrdination of a pt 's health care needs

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Primary care

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PCP

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primary care

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an approach to health care delivery that is the pt's first contact with the health delivery system & the first element of a continuing health care process

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primary care

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routine hospitalization, routine sx, & specialized outpt care such as consultation with specialist & rehab

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secondary care

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compared to primary care, these services are usually less brief & more complex involving advanced diagnostic & therapeutic procedures

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secondary case

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most complex level of care

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tertiary care

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institution based, highly specialized & highly technical
Burn tx
organ transplant
coronary artery bypass sx

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tertiary care

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1. by organizing providers into coherent networks
2. by intergrating the financing, delivery, payment fxn

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Managed care control costs BY:

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accomplished by:
1. eliminating insurance & payer intermediates
2. sharing risk with providers or extracting discounts from providers
3. coordinating a broad range of pt services & by monitoring care to determine what is appropriate & delivered in the most cost effective settings

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CONTROL COSTS

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1. an expert evaluation of which services are medically necessary in a given case
2. determination of how those services can be provided most INEXPENSIVELY while maintaining acceptable standards
3 a review of the process of care & changes in the pt 's condition to revise the course of tx if necessary

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Utilization mgmt requires

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1. choice restriction
2. gatekeeping
3. case mgmt
4. utilization review
5. practice profiling

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CGCUP
methods commonly used for utilization monitoring & control of service are:

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a plan does not allow members to use providers outside the plan
- members have to pay higher out of pocket
- better managed under this plan

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CLOSED panel

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a plan allow access to providers outside the panel

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OPEN panel

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a method in which a PCP coordinates all health care services needed by enrollee

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gate keeper

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practice guideline
pt. satification survey
practice profiling

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TOOLS

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help providers make clinical decisions for pts with specific clinical conditon

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practice guideline

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provide providers with feedback on IMPT dimensions of interpersonal communication &service quality

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pt satisification survey

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compare ind provider's tx pattern & use of resource with those of other providers

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practice profiling

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1. the health condition can identified or diagnosed
2. it can be eradicated or controlled with appropriate intervention
3. the benefit can be assigned a dollar value
4. the cost of intervention can be determined in dollars

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Cost benefit analysis is based on 4 assumption

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the value of one yr of high quality life, which in recent yrs has been assigned a value or $100,000

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quality adjusted life year QALY
heart attacks
low birth wt infants
depression
cats

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1. mission statement
2. program goals & objective
3. program design
4. scope of program
5. evaluation of program effectiveness

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components of a CQI

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the process by which an ind 's qualification to practice are assessed & vertified

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credentialing

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the process by which an institution grants an ind clinical privileges

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privileging

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is to purposely bill for services that were never given or to bill for a service that has a higher reimbursement than the service provided

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Fraud

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is any practice that directly or indirectly results in the unnecessary increased costs or utilization of medical services or products

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Abuse

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1. occupational vision
2. industrial vision
3. sports & home eye injuries
4. vision assessment
5. specific vision requirement & the demands generated by these requirement

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environmental vision

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is the branch of optometry that broadly considers the relationship of pp's eyes and vision to all aspects of their environments including home, work, recreation, transportation, underwater, outerspace

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environment optometry

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is the branch of environmental optometry that considers all aspects of the relationship btw work and vision, visual performance, eye safety, and health

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occupational optometry

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the occupational safety & health act of 1970 which is ADMINISTERED by :

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US department of labor (DOL)

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the americans with diabilities Act which is administered by :

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US department of justice

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part of the centers for dz control and prevention (CDC) in the department of health & Human services

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national institute for occupational safety and health

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OSHA & NIOSH

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two agencies

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OSHA has specific requirements for protective equipmet and requires that eye & face protection

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OSHA

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ANSI z.87.1-2000

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OSHA

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was established to conduct research about workplace hazards at the work site & thru other methods such as reviews of the scientific lit

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NIOSH

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can conduct workplace health hazard evaluations (HHE) at the request of an employer, employee and their representatives &other agencies

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NIOSH

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1.primary care provider
2. eye safety consultation
3. vision consultation

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optometrist can provide 3 levels of vision

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1. complete an occupational hx
2. dx & manage occupationally induced conditions ( includes making referral when necessary )
3. educate pts about the need to incorporate safety principles into their daily activities

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objectives

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1. writing & helping to enforce an eye safety policy
2. performing a workplace eye safety assessment
3. overseeing the procurement of both Rx & non Rx eye safety protection devices
4. educating workers about eye safety issues
5. overseeing pre placement & periodic vision screening
6. writing a contact lens wearing policy

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duties of OD serving an eye safety consultant 6 TASKS

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an optometrist is uniquely qualified to provide consulting services concerning the general area of visual efficiency

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vision consultant

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1. contrast
2. size (angular size by increasing or decreasing distance)
3. lighting
4. viewing time

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Four task characteristics can enhance visual performance

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1. VA (at various distance)
2. CV
3. Binocular interaction
4. RE
5. possibly visual fields

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Vision screening in the workplace

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1. prescribing protective devices for occupational & radiation hazard
2. designing environmental lighting for optimal visual performance
3. diagnosing work-related dz
4. providing tx & pt education in the optimal use of video display terminals VDTs
5. assessing the risk of UV radiation in the eye
6. establishing eye & vision health programs

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environmental problems

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1. job description
2. working distance
3. work mvmt
4. work areas
5. visual attn requirements
6. work and surround area illumination
7. color discrimination requirements
8. stereoacuity requirements
9. position of work surface
10. eye & vision hazards
11. size of task details
12. are there peripheral vision requirements
13. other service

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assessment of visual requirements

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1. pre-employment & placement evaluation
2. periodic examination
3. rehabilitation & post injury care
4. pre termination & pre retirement eye & vision assessment
5. health assessment
6. evaluation of potential hazards
7. standard determination
8. policy establishment
9. health education
10. regulatory compliance
11. regulatory compliance
12. adminstrative services

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other services

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FACTS

facial injury to the unprotected ice hockey player is extremely high

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HOCKEY
7% in the 1st of play, increasing 66% after 8 sessions & up to 95%

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injuries of hockey player

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1 facial bone fracture, 2 teeth lost & 15 facial lacerations that required sutures

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US consumer product safety commission (CPSC)
National electronic injury surveillance system (NEISS)

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tracking injuries

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American society for testing & material ( ASTM) standard
Protective eyecare certification council (PECC)

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sport eye wear recommendation