Chapter 3 Health care settings
Activity of daily living(ADL)
Services provided by a residential care facility including: Bathing, dressing, eating, toileting, walking, etc…
Acute care facility (ACF)
Hospitals that provide health care services to patients who have serious, sudden, or acute illnesses or injuries and/or who need surgeries.
Acute hospital classification
Same as short term hospital
Administration for Children and Families (ACF)
DHHS programs that provide services and assistance to needy children and families.
Administration on Aging (AOA)
DHHS program that supports a nationwide aging network, providing services to the elderly to enable them to remain independent.
Agency for Healthcare Research and Quality (AHRQ)
DHHS agency that supports research designed to improve the outcomes and quality of health care, reduce its costs, address patient safety and medical errors, and broaden access to effective services.
Agency for Toxic Substances and Disease Registry (ATSDR)
DHHS agency that works with states and other federal agencies to prevent exposure to hazardous substances from waste sites.
Alzheimer’s treatment facilities
long-term care facility that specializes in the care of patients diagnosed with Alzheimer’s disease.
Outpatient care that allows patients to receive care in one day without the need for inpatient hospitalization; also called outpatient care.
Ambulatory Infusion Center (AIC)
Same as infusion center
Patients who are treated and released the same day and do not stay overnight in the hospital; length of stay is a maximum of 23 hours, 59 minutes, and 59 seconds; if patients require a longer stay, they must be admitted to the facility as inpatients.
Ambulatory surgical center (ASC)
Surgery is performed on an outpatient basis at a free – standing ambulatory surgical center. Patients arrive on the day of procedure, undergo surgery in an operating room, and recover under the care of the nursing staff.
Ambulatory surgical patient
Certain procedures can be performed on an outpatient basis, with the patient treated and released the same day. Length of stay is a maximum of 23 hours, 59 minutes, and 59 seconds. If patients require a longer stay, they must be admitted to the facility as inpatients.
Diagnostic and therapeutic services provided to inpatients and outpatients.
Assisted living facility (ALF)
Combination of housing and supportive services including personal care and household management for seniors. Residents pay monthly rent and additional fees for services they require.
Same as bed size
Total number of inpatient beds for which the facility is licensed by the state; also called bed count.
Behavioral health care hospital
Specializes in treating individuals with mental health diagnoses.
Bureau of prisons (BOP)
Federal program that provides necessary medical, dental, and mental health services to inmates by a professional staff and consistent with acceptable community standards. It consists of 82 institutions, each of which provides inmate ambulatory care.
See triple option plan
Lump sum paid by the HMO to the provider to care for a group of subscribers.
Centers for Disease Control and Prevention (CDC)
DHHS agency that provides a system of health surveillance to monitor and prevent the outbreak of diseases.
Chemical dependency program
Provides 24 – hour medically directed evaluation and withdrawal management in an acute care inpatient setting. Treatment services usually included detoxification and withdrawal management, chemical dependency/substance control assessment, and therapy.
Intravenous administration of chemical agents that have specific and toxic effects upon a disease – causing cell or organism.
Performs testing in microbiology, clinical chemistry, and toxicology; directed by a pathologist ; and testing is performed by certified, professional technologists and technicians.
Hospital ambulatory care patient who receives scheduled diagnostic and therapeutic care.
Closed – panel HMO
Includes group and staff models that provide services at HMO – owned health centers or satellite clinics, or by physicians who belong to a specially formed medical group that serves the HMO.
Fixed amount a subscriber must pay when seeking health care services.
Provides inmates with a secure housing environment that also offers vocational and educational advancement. Medical, dental, and mental health care services are provided to inmates according to a standard of care imposed by court decisions, legislation, accepted correctional and health care standards, and department policies and procedures.
Provides short – term (usually less that 15 days) crisis intervention and treatment; patients receive 24 – hour – per – day supervision.
Continuing Care Retirement Communities (CCRC)
Provides different levels of care on the residents needs from independent living apartments to skilled nursing care in an affiliated nursing facility.
Critical Access hospital (CAS)
Located more than 35 miles from any other hospital or another CAH, or they are state certified as being a necessary provider of health care to area residents
Day treatment program
Intensive treatment program provided to patients who live in the community but come to the facility up to five days per week.
Developmentally disabled/mentally retarded facilities
Sometimes categorized as an intermediate care facility (ICF), these facilities provide residential care and day programming, including academic training, clinical and technical assistance, health care services, and diagnosis and evaluation of individuals with developmental disabilities.
Diagnosis related groups (DRG
Inpatient hospital cases classified into groups that are expected to consume similar hospital resources. Hospital inpatients are discharged once the acute phase of illness has passed, and they are often transferred to other types of health care, such as outpatient care, skilled care facilities, rehabilitation hospitals, home health care, and so on.
Dementia care facilities
Long term care facilities that specialize in the care of patients diagnosed with dementia.
Direct contract model HMO
Individual physicians in the community deliver contracted health care services to subscribers.
Intravenous administration of other drugs including antibiotics, antivirals, and so on.
Includes canes, crutches, IV supplies, hospital beds, ostomy supplies, oxygen, prostheses, walkers, wheelchairs, etc…
Emergency care center
Same as urgent care center.
Exclusive Provider Organization (EPO)
Provides benefits to subscribers who receive health care services from network providers.
Provides care for the entire family and focuses on general medicine, obstetrics, pediatrics, and geriatrics
Family Support Services
Services provided to assist families in caring for the patient.
Measures ability of health care facilities to deliver care that is safe and adequate, in accordance with federal law and regulation
Federal medical centers (FMC)
Provide major medical care to federal correctional facility inmates.
Flexible benefit plan
Same as Triple option plan.
Food and Drug Administration (FDA)
DHHS agency that assures the safety of foods and cosmetics, and the safety and efficacy of pharmaceuticals, biological products, and medical devices.
Provide emergency care, perform general surgery, and admit patients for a range of problems from fractures to heart disease, based on licensing by the state.
Group model HMO
Participating physicians who are members of an independent multi – specialty group providing health care services. Physician groups either contract with the HMO or they are owned or managed by the HMO.
Group Practice Without Walls (GPWW)
Managed care contract in which physicians maintain their own offices and share services to plan members.
Health Maintenance Organization (HMO)
An alternative to traditional health insurance coverage provides comprehensive health care services to members on a prepaid basis .
Health Resources and Services Administration (HRSA)
DHHS agency that provides health resources for medically underserved populations, works to build the health care workforce, maintains the National Health Service Corps, oversees the nation’s organ transplantation system, works to decrease infant mortality and improve child health, and provides services to people with AIDS through the Ryan Whit CARE Act programs.
Heart and vascular center
Provides ambulatory cardio – vascular services to include diagnosis and treatment, disease prevention, research, education, and cardiac rehabilitation.
allows people who are seriously ill or dying to remain at home and receive treatment from nurses, social workers, therapists, and other licensed health care professionals who provide skilled care in the home.
Home infusion care
Provided by home health care agencies when intravenous administration of medication is medically appropriate for the patient’s condition, and treatment is administered in the home instead of on an inpatient hospital basis .
Provides comprehensive medical and supportive social, emotional, and spiritual care to terminally ill patients and their families. Goal is palliative rather than curative.
physician who spends most of his or her time in a hospital setting admitting patients to inpatient services from local primary care providers.
owned physician practice – Practices that are at least partially owned by the hospital, and physicians participate in a compensation plan provided by the hospital.
Intravenous administrative of fluids, electrolytes, and other additives.
Freestanding facility that provides radiographic and other imaging services to ambulatory patients. Some centers also provide training and participate in national research projects
Independent Practice Association – (IPA)
Same as Individual Practice Association (IPA)
Industrial health clinic
Located in a business setting, the emphasis is on employee health and safety.
Freestanding center that dispenses and administers prescribed medications by continuous or intermittent infusion to ambulatory patients. Infusion is supervised by a licensed health care professional; aka ambulatory infusion center.
Those who remain overnight in the facility for 24 hours or more and are provided with room and board and nursing services.
Integrated Delivery System (IDS)
Organization of affiliated provider sites that offer joint health care services to subscribers.
Integrated Provider Organization (IPO)
Manages health care services provided by hospitals, physicians, and other health care organizations
Intensive case management
Specially trained individuals coordinate and/or provide mental health, financial, legal, and medical services to help the patient live successfully at home and in the community.
Intermediate care facility (ICF)
Provides developmentally disabled people with medical care and supervision, nursing services, occupational and physical therapies, activity programs, educational and recreational services, and psychological services.
Internal medicine physicians
Specializes in the care of adults.
Long – term care
Includes a range of nursing, social, and rehabilitative services for people who need ongoing assistance. Lengths of stay typically average greater than 30 days.
Long – term care hospital (LTCH)
Defined in Medicare law as hospitals that have an average inpatient length of stay greater than 25 days. These hospitals typically provide extended medical and rehabilitative care for patients who are clinically complex and may suffer from multiple acute or chronic conditions.
Long – term hospital classification
Same as long – term care hospital.
Originally referred to the prepaid health care sector, such as HMOs, which combined health and some forms of indemnity coverage that incorporate utilization management activities. care delivery with the financing of health care services; increasingly used to refer to preferred provider organizations
Management Service Organization (MSO)
Provides practice management services, including administrative and support services, to individual physician practices.
Nonprofit organization that contracts with and acquires the clinical and business assets of physician practices.
requires documentation of services or supplies that are proper and needed for the diagnosis or treatment of a medical condition; are provided for the diagnosis, direct care, and treatment of a medical condition; meet the standards of good medical practice in the local area; and are not mainly for the convenience of the physician or health care facility.
Military Health System (MHS)
Administers health care for active members of the uniformed services as provided by military treatment facilities and networks of civilian health care unavailable
Military Medical Support Office (MMSO)
Coordinates civilian health care services when military treatment facility services are unavailable.
Military treatment facility (MTF)
Clinic and/or hospital located ona U>S. military base.
Multi – hospital systems
Category or hospitals where two or more hospitals are owned, managed, or leased by a single organization; these may include acute, long – term, pediatric, rehabilitation, and/or psychiatric care facilities.
Multi – specialty group physician practices
Offer various types of medical specialty care in one organization, and they may be located in more than one location.
National Commission on Correctional Health Care (NCCHC)
Provides an external peer process for correctional institutions that wish to meet its nationally accepted Standards for Health Services.
National Institutes of Health (NIH)
DHHS research center, with 17 separate institutes, is the world’s premier medical research organization, supporting some 35,000 research projects nationwide in diseases like cancer, Alzheimer’s disease, diabetes, arthritis, heart ailments, and AIDS.
Neighborhood health centers
Health care is provided to economically disadvantaged people, and treatment is family – centered because illnesses may result indirectly from crowded living conditions, unsanitary facilities, and other socioeconomic factors. Family care team consisting of a physician, nurse, and social worker provides continuity of care to families.
Network model HMO
Two or more physician multi-specialty group practices provide contracted health care services to subscribers.
Physicians and health care facilities under contract to the managed care plan.
Those who receive infant care upon birth, and if necessary they receive neonatal intensive care either within the hospital or as the result of transfer to another hospital.
Nursing facility (NF)
Same as skilled nursing facility.
Receive services furnished on a hospital’s premises that are ordered by a physician or an the authorized individual, including use of a bed and periodic monitoring by nursing or other staff, which are reasonable and necessary to evaluate an outpatient’s condition or determine the need for a possible admission as an inpatient.
Open – panel HMO
Includes direct contract, individual practice association, and network models; physicians are not employees of the HMO and thery do not belong to a specially formed medical group that serves the HMO.
Same as ambulatory care.
Same as ambulatory patients.
Intravenous administration of narcotics and other drugs designed to relieve pain.
Pain management center
Specializes in treatment of acute and chronic pain syndromes using proven medications and procedures. Usually a multidisciplinary approach is used involving participating specialists such as physiatrists, psychiatrists, neurologists, neurosurgeons, internists, and physical and occupational therapists.
Partial hospitalization program
Program for hospital patients who regularly use the hospital facilities for a substantial number of either daytime or nighttime hours.
Provides comprehensive services for infants, children, and adolescents.
Personal care and support services
provide assistance in performing daily living activities, such as bathing, dressing, grooming, going to the toilet, mealtime assistance, travel training, and accessing recreation services.
Physician – Hospital Organization (PHO)
Managed care contracts are negotiated by hospital(s) and physician groups; physicians maintain their own practices and provide services to plan members.
Point – of – service plan (PSO)
Patients have the freedom to use an HOM panel of providers (for which a copayment is paid) or to self – refer to non – HMO providers (for which greater out – of – pocket expenses apply).
Preadmission certification (PAC)
form of utilization management that involves the review for medical necessity of inpatient care prior to inpatient admission.
Preferred Provider Organization (PPO)
Network of physicians and hospitals join together to contract with third – party payers, employers, and other organizations to provide health care to subscribers for a discounted fee.
Primary care center
Offers adult and family care medicine in internal medicine, pediatrics, and family practice.
Public Health Service (PHS)
Uniformed Service of the DHHS. Leadership is provided by the U.S. Surgeon General. It provides highly trained and mobile health professionals who carry out programs to promote the nation’s health, understand and prevent disease and injury, assure safe and effective drugs and medical devices, deliver health services to federal beneficiaries, and furnish health expertise in time of war or other national or international emergencies.
Public health department
Provides preventive medicine services such as well baby clinics, which include immunizations and routine checkups.
Hospital ambulatory care patient who receives diagnostic or therapeutic care because such care is unavailable in the primary care provider’s office. Follow – up is done at the primary care provider’s office.
Admits patients who are diagnosed with trauma or disease and who need to learn how to function.
Residential care facility (RCF)
provides non – medical custodial care, which can be provided in a single family residence, a retirement residence, or in any appropriate care facility including a nursing home.
Residential treatment facility
Seriously disturbed patients receive intensive and comprehensive psychiatric treatment on a long – term basis.
care provided by specially trained individuals at a setting other than the patient’s home to offer relief and rest to primary caregivers.
Ambulatory care centers established remotely from the hospital. Primary care is provided by an on – duty physician.
Short – term hospital classification
Patients have an average LOS of 4 – 5 days and a total LOS of less than 25 days; also called acute hospital classification.
Category of hospitals that are self – contained and not part of a larger organization.
Single – specialty group physician practice
Single – specialty practice that consists of two or more physicians who provide patients with one specific type of care.
Includes services that are ordered by a physician and provided under the supervision of a registered nurse, or physical, occupational, or speech therapist.
Skilled nursing facility (SNF)
Provides medically necessary care to inpatients on a daily basis that is performed by, or under the supervision of, skilled medical personnel. SNF’s provide IV therapy , rehabilitation, and wound care services; also called nursing facility.
Solo physician practices
Organizations that do not have physician partners or employment affiliations with other practice organizations.
concentrate on a particular population of patients or disease.
Staff model Health maintenance organization (HMO)
Similar to large, multispecialty group practices, it may be partially owned by the physicians employees, with the physicians typically functioning as employees of either the physician group owning the practice or the insurer. Most physicians in this type of HMO are paid a salary.
Student health center
Provides health care to full and part – time students who become ill or injured.
Provided in hospitals that provide specialized long – term acute care such as chemotherapy, injury rehabilitation, ventilator support, wound care, and other types of health care services provided to seriously ill patients.
Individuals who pay health insurance premiums.
Substance and Mental Health Services Administration (SAMHSA)
DHHS agency that works to improve the quality and availability of substance abuse prevention, addiction treatment, and mental health services.
Allows a rural hospital to admit a nonacute care patient.
Temporary Assistance to Needy Families (TANF)
State federal welfare program.
Therapeutic group home
6 to 10 individuals are provided with supervised housing that may be linked with a day treatment program.
Total parenteral nutrition (TPN)
Administration of nutritional substances by peripheral or central intravenous infusion to patients who are either already malnourished or have the potential for developing malnutrition.
Triple Option plan
Provides subscribers and employees with a choice of HMO, PPO, or traditional health insurance plan; also called cafeteria plan.
Urgent care center
Immediate care is provided by an on – duty physician. The center is usually owned by private corporations in states where permitted or non – profit facilities; also called emergency care center.
Controls health care costs and the quality of health care by reviewing cases for appropriateness and medical necessity.
Veterans Health Administration (VHA)
An agency in the Department of Veterans Affairs that provides medical, surgical, and rehabilitative care to veterans of the armed services.
Veterans Integrated Service Network (VISN)
Administers and provides health care services at FA Medical Centers and community based outpatient clinics.
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