question

Integrated Delivery System

answer

a group of healthcare organizations that collectively provides a full range of coordinated health-related services, full range of healthcare services at every level, providers made up of numbers of associated facilities that furnish coordinated healthcare services, purpose is to organize continuum of care, maximize effectiveness, and reduce costs

question

Integrated Delivery Network

answer

community that includes physicians, insurers, providers

question

Western Medicine

answer

Roots come from ancient Greeks who developed surgical procedures, documented clinical cases and created medical books.

question

North America's first hospital

answer

The Pennsylvania Hospital located in Philadelphia, in the British colonies, and cared for the sick/injured orphans and immigrants

question

AAMC - American Association of Medical Colleges

answer

to standardize the curriculum for US medical schools and developing the public's understanding of the need to license physicians, campaigned with AMA for medical licensing

question

Flexner report recommendations

answer

he visited every school in country, medical school applicants have college degree, training based on basic sciences, practical training at hospitals, and to close the bulk of medical schools

question

AMA - American Medical Association

answer

represents the interests of all physicians, mission to promote science and art of medicine and the betterment of public health, accredits medical schools and residency programs, maintains/publishes Current Procedural Terminology (CPT), approx 217000 members, Chicago

question

State licensing boards

answer

medical students must pass test to obtain license administered by?

question

Medical specialties

answer

internal medicine, pediatrics, family practice, cardiology, psychiatry, neurology, oncology, radiology

question

surgical specialties

answer

anesthesiology, orthopedics, cardiovascular surgery, obstetrics/gynecology, urology, ophthalmology, otorhinolaryngology, plastic and reconstructive surgery, neurosurgery

question

first nurses

answer

were moms and nuns with general duties - they were provided by the religious orders who sponsored more than half the hospitals in the US

question

first nursing school

answer

established in 1872 in New England Hospital for Women and Children

question

Registered nurses

answer

associate or bachelor degree, must have state license, works over LPNs, highly trained clinical professionals and may specialize in certain areas like surgery or intensive care

question

Nurse practitioner

answer

RN plus postgraduate education, must have state license, qualified to provide primary care to patients

question

LPN

answer

works under direct supervision of RN, graduate from nonacademic training programs

question

nursing specializations

answer

surgery, psychiatry, intensive care, nurse-midwives, pediatric, oncology

question

American College of Surgeons

answer

developed the Minimum Standards for hospital care, came about due to push for hospital reforms

question

Hospital standardization program

answer

adoption of Minimum Standards was basis for this program, marked beginning of modern accreditation processes, performance of participating orgs evaluated against the standards, accreditation voluntary, stepping stone to the formal body of The Joint Commission

question

Organized The Joint Commission

answer

American College of Surgeons, American College of Physicians, American Medical Association, American Hospital Association, Canadian Medical Association

question

The Joint Commission

answer

mission is to continually improve healthcare for the public in collaboration with other stakeholders by evaluating health care organizations and inspiring them to excel in providing safe and effective care of the highest quality and value. Surveys (accredits) acute care hospitals, long-term care facilities, ambulatory care facilities, psychiatric facilities, and home health agencies, standards setting body, emphasizes performance and quality improvement, approx 19000 facilities, Oakbrook Terrace IL and DC

question

Allied health professions

answer

\"According to the AMA, allied health incorporates the healthcare-related professions that function to assist, facilitate, and/or compliment the work of physicians and other clinical specialists\" - receive a certificate or higher in healthcare-related science - many require licensing - significant shortages, among the fastest growing in healthcare

question

Allied Health Professions

answer

Clinical laboratory science, diagnostic imaging technology, dietetics, emergency medical technology, health information mgmt, occupational therapy, physical therapy, respiratory therapy, speech-language pathology and audiology, radiology, nuclear medicine, optometry, pharmacy, surgical technologist

question

Blue Cross

answer

covers hospital services, prepaid plan

question

Blue Shield

answer

covers physician services, grew out of medical service bureaus created by large lumber and mining companies in the northwest, first one founded in California

question

Blue Cross/Blue Shield Association

answer

brought about during the Great Depression and boomed during second world war, baylor university hospital first provided hospital services to teachers for 50 cent per month due to financial probs of the hospital, coordinates activities of local plans through the US

question

Biologics Control Act of 1902

answer

research on controlling epidemics, now called the National Institutes of Health, gave authority to test/improve biological products and look at vaccines, serum and medications

question

National Institutes of Health

answer

mission is to uncover new medical knowledge that can lead to health improvements for all, lots of research and training, employs lots of data people, conducts and supports medical research, fosters communication of up-to-date medical information, and trains research investigators - most recently vital roles in treatment of heart disease and stoke, cancer, depression and schizophrenia, and spinal cord injuries

question

Social Security Act of 1935

answer

\"old age and unemployment programs\", provided state funding for material and infants, rehab of crippled kids, public health and for kids under 16, set up to give some supplemental income, up to the states how to spend $

question

Hill-Burton Act

answer

authorized grants for states to build new hospitals and modernize older ones, provided a lot of people with jobs

question

hospital decrease in 1980s

answer

HMOs cut stays short, medical advances helped lessen stays, cost containment measures caused many procedures that once required inpatient hospitalization to be performed on an outpatient basis

question

Public Law 89-97 of 1965

answer

Amendment for Social Security Act, federal legislation enacted, Medicare orig designed for people 65 yrs of age and older, Medicaid orig designed for medically indigent and aid to those low income families/kids, Medicare expanded to include those willing to pay premium, disabled and those with chronic kidney disease, Medicaid expanded to include poor children, disabled, pregnant women and very poor adults, Medicaid joint program w/states

question

Medicare

answer

FEDERAL program that finances healthcare for the elderly, retired and disabled, provides inpatient/outpatient services, lab and xray services, physician services, nursing facility care for those over 21 yrs old, family planning, 31 optional programs, part A (inpatient, home health, nursing homes) funded via payroll taxes, part B (physician svcs, outpatient hospital care, med svcs and supplies) via monthly premium

question

Public Law 92-603 of 1972

answer

mandated utilization review for medicare patients at hospitals/extended care facilities, now includes medicaid, established the Professional Standards Review Organizations (PSRO) which perform professional reviews and evaluate patient care for necessity, quality and cost-effectiveness, required hospitals and extended-care facilities to establish a plan for utilization review and permanent utilization review committees, required concurrent review for medicare/medicaid patients

question

Utilization Review Act of 1977

answer

mandated continued stay reviews for Medicare and Medicaid patients

question

Peer Review Improvement Act of 1982

answer

Professional Standards Review Organizations (PSRO) changed to Peer Review Organizations, looked at medical necessity and appropriateness of certain admissions prior to admission, name changed to QUALITY IMPROVEMENT ORGANIZATIONS (QIO) and there is one in each state, territory and DC, quality, efficiency and cost-effectiveness are ensured in the healthcare services, required professionals to report instances of sub-standard care to relevant licensing/certifying agencies, emphasize quality improvement processes

question

Tax Equity and Fiscal Responsibility Act of 1982 (TEFRA)

answer

called for gradual implementation of prospective payment system for Medicare reimbursement, predetermined level of reimbursement established before the service is provided, purpose to control the rising cost of providing healthcare services to medicare beneficiaries

question

Prospective Payment Act (1982)/Public Law 98-21 of 1983

answer

created diagnostic related groups (DRGs) for inpatient hospital care

question

Healthcare Quality Improvement Act of 1986

answer

established the National Practitioner Data Bank (NPDB), clearinghouse for malpractice and other quality issues, helps prevent physicians involved in malpractice suits and other issues with standards of care from gaining entrance to certain medical settings to practice services, established immunity from legal actions for practitioners involved in some peer review activities

question

Health Insurance Portability and Accountability Acot of 1996 (HIPAA)

answer

portability of insurance after leaving employment, national standards for electronic transactions, national identified for providers/health plans/employers, privacy, security, and Healthcare Integrity and Protection Database which combats fraud and abuse in health insurance and healthcare delivery

question

American Recovery and Reinvestment Act of 2009

answer

Health Information Technology for Economic and Clinical Health (HITECH) Act, nationwide health information exchange, use of health information, implementation of electronic health records, strengthened privacy and security standards, made the Office of the National Coordinator (ONC) for Health Information Technology a permanent office to meet requirement that govt take a leadership role, allocate funds for #1 long term goal of nationwide health information exchange, use of health info and implementation of electronic health records

question

Current Advances

answer

most important discovery was bacteria as cause of infectious disease, most important tech advance was use of anesthesia for surgical procedures, human genetics, cellular and molecular research including tissue engineering, human embryonic stem cells and/or adult stem cells, gene therapy/cell transplantation, cell-based technologies will diagnose diseases earlier

question

AHA - American Hospital Association

answer

advances the health of individuals and communities, published the Coding Clinic, approx 5000 members, Chicago and DC

question

The Joint Commission members

answer

American College of Physicians, American College of Surgeons, American Dental Association, American Hospital Association, American Medical Association

question

The Joint Commission safety programs

answer

National Patient Safety Goals (NPSG), sentinel event policy, sentinel event alert (requires root cause analysis), universal protocol

question

ACHE - American College of Healthcare Executives

answer

mission is to advance their members and healthcare management excellence and to be the premier professional society for healthcare executives dedicated to improving healthcare delivery - organization for healthcare administrators, approx 40000+ members, Chicago, publishes books and textbooks on healthcare services mgmt

question

ANA - American Nurses Association

answer

Professional organization and LARGE labor union, started by group of nurses attending annual meeting of American Society of Superintendents of Training Schools for Nursing, goal to increase competence of nurses

question

AHIMA - American Health Information Management Association

answer

mission is to lead the health informatics and information mgmt community to advance professional practice and standards, professional organization for mgrs of health record services and health information, started 1928 as Record Librarians of North America then American Medical Record Association, CAHIMA, CCHIMA, 64000+ members, Chicago

question

CCHIT - Commission on Certification of Health Information Technology

answer

CERTIFIES THE EHR - mission to accelerate adoption of health information technology, certifies health information technology based on criteria (functionality, interoperability, privacy, security)

question

Hospitals

answer

provide inpatient/outpatient care, have organized medical staff, provides permanent medical staff, offers around the clock nursing service, provides diagnostic and therapeutic services - most US hospitals are nonprofit or owned by local, state or federal governments

question

Acute care

answer

short term care provided to diagnose/treat illness or injury, average LOS 30 days or less, requires clinicians, administrators, managers, support staff

question

outpatient care

answer

does not require overnight stay

question

hospital classification

answer

number of beds (bed capacity adults/kids), types of services provided (rehab, psych, general, specialty), types of patients serviced (kids), for profit or not for profit, type of ownership (govt owned, proprietary, voluntary)

question

Organization of hospital services

answer

board of directors, professional medical staff, executive admin staff, med and surg staff, patient care (nursing) services, diagnostic and lab services, support services

question

Board of directors

answer

primary responsibility for setting overall direction of the hospital, strategic, mission, values, establish bylaws, select qualified administrator, approve organization and makeup of clinical staff, monitor quality of care, members serve for a specific period of time, officers

question

medical staff

answer

diagnose and treat patients, clinical privileges, medical staff classification, officers, medical staff bylaws, must have clinical background

question

clinical privileges

answer

must apply for, will be looked up in the National Practitioner Data Bank (NPDB)

question

medical staff classification

answer

the organization of physicians according to clinical assignment - active, honorary (from out of town, etc), provisional (limited), consultant (might specialize in area/get called upon), courtesy (might go to hospital as favor and have rare privileges), medical resident

question

Officers

answer

president, chief of staff

question

medical staff bylaws

answer

rules and regulations that physicians agree to abide by, dictates how the medical staff operates, legally binding

question

Administrative Staff

answer

executive mgmt team, CEO, COO (day to day ops), CIO (IT/networks/communications), responsible for managing finances and compliance with laws and standards, a lot belong to ACHE, may have vice presidents and dept directors

question

patient care services

answer

largest amount of resources/people, most care provided by nurses, case mgmt, patient assessments, care plans, evaluate appropriateness of treatment and effectiveness of care, clinical expertise

question

chief nursing officer

answer

head nurse

question

ancillary (Clinical) support services

answer

aka clinical support services...pharmaceutical, food and nutrition, health information mgmt, social work and social services, patient advocacy services, environmental services, purchasing, central supply, materials management, engineering and plan operations

question

Administrative support services

answer

admissions and central registration, claims and billing, accounting, information services, human resources, public relations, fund development, marketing

question

Peer Review and Quality Improvement Programs

answer

Appropriateness, technical excellence, accessibility, acceptability

question

peer review

answer

member of profession assesses the work of someone in same profession, required of CMS and Joint Commission

question

quality improvement

answer

required by medicare and medicaid, monitor physicians, nursing and other depts

question

managed care

answer

healthcare reimbursement system that manages cost, quality and access to services (all boils down to money), HMOs, PPOs, POS plans, negotiates fees, premium, most do not provide healthcare directly but enter into service contracts with physicians, hospitals, etc

question

ways to control costs

answer

preset pmt amounts, restrict patient access to services, precertification, utilization review, financial incentives for providers, promoting healthy lifestyles, identify risk factors and illnesses early, provide patient education

question

patient focused care

answer

more care provided on nursing units, cross-training staff

question

evidence based best practices and outcomes

answer

conscientious, explicit and judicious use of current best evidence in making patient care decisions, AHRQ (Agency for Healthcare Research and Quality), integrates individual clinical expertise with best available external clinical evidence from systematic research

question

licensing

answer

STATE, required to for healthcare facilities to operate, standards for adequacy of staff, physical aspects of facility, and service provided, will they participate with medicare

question

certification for medicare participation

answer

conditions of participation are standards and deemed status

question

voluntary accreditation

answer

independent body develop standards, process is voluntary, some orgs are The Joint Commission, AOA (American Osteopathic Association), who will accredit them

question

hospital based ambulatory care

answer

emergency services and trauma care, outpatient surgical services, outpatient diagnostic and therapeutic services

question

community based ambulatory care

answer

freestanding ambulatory care and surgery centers

question

public health services

answer

office of surgeon general of the US, office of disease prevention and health promotion

question

home care services

answer

fastest growing sector in healthcare because of increased economic pressure from third party payers, cheaper @ home than 24 hr facility

question

voluntary agencies

answer

red cross, city shelters targeting low income residents, community health centers

question

long term care

answer

care rendered in nonacute care facility to patients needing inpatient nursing and related services for more than 30 consecutive days, skilled nursing facilities, nursing homes, rehab hospitals, hospice care, adult daycare programs, mainly rehabilitative and supportive but not curative, people living longer so these services are needed more

question

behavioral health services

answer

long-stay state institutions, residential treatment centers (inpatient services to children until 18), day hospital (alternative to inpatient care, transition from inpatient to outpatient), usually many restrictions like # of outpatient visits

question

reimbursement

answer

evolved to third-party reimbursement

question

commercial health insurance

answer

group policies, individual policies, major medical, cash payment

question

Medicaid

answer

FEDERALLY mandated program that finances healthcare services for low-income americans and their children, jointly funded by federal, state and local governments

question

government agency provided services

answer

Tricare, Dept of Veterans Affairs, Indian Health Services, state govts

question

workers compensation

answer

insurance, operated by the STATES, covers healthcare costs and % of loss of income due to work related injuries and illnesses, covered by Federal Employees Compensation Act

question

health savings accounts

answer

control how healthcare dollars are spent, uses pretax dollars, comprehensive medical insurance coverage, used to pay deductible, amount deposited may be limited, insurer pays after deductible is paid, account earns interest

question

health reform initiatives

answer

rising cost of healthcare, 2009 changes were tax credit to keep health insurance through COBRA, increasing health care coverage for kids, computerizing health records in 5 years, develop and disseminate info on effective medical interventions, investing in prevention and wellness, result in closing of some hospitals

question

Lyndon Johnson

answer

under which president was legislation on national health insurance passed?, came about following the second world war

question

ambulatory surgery

answer

any surgical procedure that does not require an overnight stay in a hospital

question

for profit hospital

answer

privately owned, pay out their excess revenues in the form of bonuses and dividends to managers, owners and investors

question

voluntary hospitals

answer

not for profits hospitals owned by universities, churches, charities, religious orders, unions and other not for profit entities. often provide free care to patients who otherwise would not have access to healthcare services

question

CEO

answer

responsible for implementing the policies and strategic direction of the hospital or healthcare organization and for building an effective executive management team

question

mission

answer

states purpose and who we're going to serve

question

vision

answer

goal, what they'd like to do

question

values

answer

beliefs and principles

question

subacute care

answer

the level of skilled care needed by patients with complex medical conditions typically medicare patients with multiple medical problems

question

appropriate

answer

right care, right time

question

technical excellence

answer

latest and greatest

question

accessibility

answer

care can be obtained when needed

question

acceptability

answer

patient is happy and satisfied

question

best practice

answer

best way to do something based on research and past cases, etc

question

physician assistants

answer

assists physicians in clinical assessments and patient education

question

CPT codes

answer

basis of reimbursement systems for physician's services and other types of healthcare services provided on an ambulatory basis.

question

NPSG - National Patient Safety Goals

answer

annually addresses specific patient safety concerns

question

Sentinel event policy

answer

identify and prevent occurrence of events that lead to unexpected deaths or serious physical injuries. When it occurs, a root cause analysis and identification of improvements to risks must be undertaken (how it happened)

question

Sentinel event alert

answer

newsletter that provides important information on specific types of sentinel events like medication or blood transfusion errors and how to prevent their occurrence.

question

universal protocol

answer

provides protocol to prevent surgical mishaps such as procedures performed on the wrong person and wrong site

question

CAHIM

answer

independent accrediting organization whose mission is to serve the public interest by establish/enforce quality accreditation standards for HI and HIM educational programs.

question

CCHIM

answer

to make sure certified and keeping up with credentials, assures competency of HI/HIM professionals

question

govt owned hospitals

answer

operated by a specific branch of federal, state or local government as not for profit orgs

question

proprietary hospitals

answer

owned by private foundations, partnerships or investor owned corporations

question

acute care

answer

short term care provided to diagnose and/or treat an illness

question

AHRQ - Agency for Healthcare Research and Quality

answer

promotes evidence-based practice in everyday care to improve healthcare by facilitating the use of evidence-based research findings, established 12 evidence based practice centers (EPC) that develops evidence reports related to issues that are common, expensive and significant for Medicare/medicaid population

question

private medical practice

answer

physician owned entities providing primary care or medical surgical specialty care services in freestanding office setting. physicians have medical privileges at local hospitals and surgical centers but aren't employees of other healthcare entities.

question

day treatment program

answer

provides alternatives to inpatient care or serves as a transition from inpatient to outpatient care of discharge

question

skilled nursing facility

answer

healthcare rendered in nonacute care facility to patients who require inpatient nursing and related services for more than 30 consecutive days

question

residential care facility

answer

designed to meet patients daily living, schooling, recreational, socialization and routine medical care needs

question

public health service

answer

has an analysis and leadership role for health promotion and disease prevention

question

continuum of care

answer

care provided by different caregivers at several different levels of the healthcare system

HIM 101 Ch 12

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