question

Integrated Delivery System

answer

offers a full range of healthcare services along a continuum of care to ensure that patients get the right care at the right time from the right provider

question

Integrated Delivery Networks

answer

a group of hospitals, physcicans, other providers that work together to deliver health services

question

Roots of Medicine Came from

answer

The ancient greeks

question

Managed Care organizations

answer

a type of healthcare organization that delivers medical care and manages all aspects of the care or the payment for care by limitin providers of care, discounting payment to providers of care, and/or limiting access to care

question

North America's First Hospital

answer

the pennsylvania hospital in philadelphia, 1752.

question

The NY Hospital

answer

opened in 1771 and first to make a MPI

question

Massechusttes General Hospital

answer

opened in 1821

question

Standardization of Medical Practice

answer

no formal medical education First regluation was in the form of licensure, first issued in NY No Std. Curriculum for medical schools

question

AMA

answer

Established in 1847 to represent the interests of physcicans .

question

American Association of Medical Colleges

answer

established in 1876, dedicated to standarizing the curriculum for US medical schools and the make the public understand the need to license physcians.

question

Flexnor report

answer

1906 - visited every medical school in the country and documented his findings. Describe poor quality of the training being provided int he colleges. Noted that most school lacked basic sciences. Also noted, no hospital based training . Graduates all lacked alot of unacceptable levels of medical skills.

question

Flexnor report influenced

answer

Required medical school aplicants to hold a college degree, medical training based on the sciences, required med students to recieve practical hospital based training.

question

By the 1920's, most Medical Schools

answer

met rigorous academic standards and were approved by the AAMC

question

Medical Students must obtain what?

answer

a license administered by state boards

question

Specialty Physicians are required to

answer

complete post-grad medical education.

question

The most common Specialty Physcians are

answer

Internal medicine, pediatrics, family practice, cardiology, psychiatry, neurology, oncology radiology - SURGICAL SEPCIALTIES - anesthesia, cardio surgery, OB, Ortho, urology, optha, ent, plastic, neurosurgery

question

Subspecialties of Physcians include

answer

endocrinologist, pulmonary meds, rhemotology, geriatrics, hematology

question

PA's/SA's

answer

work under the supervision of physicians and surgeons

question

Standardization of Nursing Practice

answer

Religious orders provided nurses care, nurses received no formal education, lack of training led to many deaths of pts

question

American Nurses Association

answer

established in 1897, named in 1911

question

nurse responsibilities in late 19th century

answer

housekeeping, cooked meals for pts, gave baths, changed dressings, monitored vital signs, gave meds, assited physicians (at this time did not require a license to practice)

question

Modern Nursing (RN) Requires what education

answer

BS or AA - Nurse Practiioner - Post grad education as well ALL NURSES MUST PASS STATE LICENSE EXAM

question

The push for hospital reforms led to the formation of

answer

The ACS in 1913

question

First hospital standardization efforts began in what year and these min. stds where the beginning of what

answer

1918-- **Adoption of the minimum standards was the basis of the standardization program and marked the beginning of the modern accreditation process for healthcare organizations

question

Joint commision initially composed of

answer

ACS American College of Physicians AMA AHA Canadian Medical Assoc.

question

Joint Commission Surveyed

answer

Acute Care hospitals Long-term care facilities Abulatory Care facilities Psychiatric Facilities home health agencies companies that sell equipment

question

Allied Health Professionals do what

answer

function to assist, facilitate, or complement the work of physicians and other clinical specialists - they are not RNS, physicians, and PA's) Women dominate the field

question

Allied Health professions include the following

answer

Audiology, clinical library science, diagnostic medical, dietetics, emergency medical technology, HIM, OT, optometry, Pharmacy, PT, Respiratory therapy, speech language pathology/Audiology, surgical technologist

question

During the Great Depression, the first pre-paid health plan was inagurated by

answer

Baylor University Hospital in texas, 1929 for school teachers

question

Pre-paid health plan became what

answer

Blue Cross - for hospitalization Blue Shield Plan to cover the cost of physician services

question

Decreased use of medical services because of lack of $ lead to what

answer

Government sponsored health insurance under the administration of Farnkin Roosevelt.

question

The medicare/Medicaid programs were legislated in

answer

1965 to pay for the cost of providing healthcare services to the elderly and poor. (under Lyndon B Johnson)

question

What healthcare professional assists physicians in clinical assessments and patient education

answer

Physician assistants

question

Licensure tests to practice medicine are administered by

answer

State Licensure Boards

question

Nurses are required to have what to practice

answer

Liceneses

question

Which profession is generally conisdered an allied health career

answer

Clinical Labratory Science

question

To become board certified in pediatrics, what would an internal medicine doctor have th do

answer

complete continuting education courses in pediatric medicine and pass a national exam

question

the adoption of min standards marked the beginning of what modern practice for healthcare organizations?

answer

Licensing

question

According to the AMA which of the following incorporates the healthcare related professions that function to assist, facililitate, and or compliment the work of physicians?

answer

Allied Health

question

T/F - Respiratory thera[osts treat pts with limited mobility

answer

FALSE

question

T/F Physical Therapy assistatnts develop treatment plan

answer

False

question

T/F - A sonographer is a speciailization of diagnostic imaging technologists

answer

TRUE

question

Biologics Control Act

answer

1902 - Research on methods for controlling epidemics of infectious diseases

question

Natiional Institute of health

answer

1930 - Mission to uncover new medical knowledge that can lead to health improvements for all - 'In charge of research\"

question

Social Security Act

answer

1935- old age and unemployment programs - provided states funding for material and infants, rehab of crippled children, public health and for children under 16

question

Hill burton Act/Hospital Sruvey and Construction Act

answer

1946 - Authorized grants to build new hospitals and modernize old ones

question

Public Law 89-97

answer

1965 - Amendment to SS Act - Medicare implement for Age 65+ expanded to disabled, chronic kidney disease - Medicaid expanded to include - poor children, disabled, pregnant women, poor adults

question

Public Law 92-603

answer

1972 - Mandated utilization review for medicare patients at hospitals, extended care facilities - Amendments to the SS act - required concurrent review for medicare and medicaid pts. It Established a professional standards review organization for medicare and medicaid patients (PSRO) to implement concurrent review - evaluated patient care services for necessity, quality and cost efffectiveness

question

ACHA

answer

Agency for healhcare administraton - oversees responsibilities for medicaid funds (FL ONLY)

question

Health planning and resources development Act

answer

1974 - called for a new type of organization, the health systems agency, to have broad representation of health care providers and consumers on governing boards and committees.

question

Utilization review Act

answer

1977- mandated continued stay review for medicare and medicaid patients

question

Peer review Improvement Act

answer

1982 PSRO change to Peer review organizations, looked at medical necessity for certain admissions prior to admission- name changed to Quality Improvement organizations

question

Tax Equity and fiscal responsibility Act (TEFRA)

answer

1982- Called for gradual implementation of prospective payment system for medicare reimbursement - in the PPS, a predetermined level of reimbursement is established before the service is provided.-

question

Prospective payment act/Public Law 98-21

answer

1983 - PPS for acute hospital care (inpatient) was implemented. Under the inpatient PPS, reimbursement for hospital care provided to medicare patients is based on DRGS - each case is designed a DRG on the patients diagnosis at the time of discharge

question

Consolidated Omnibus budget Reconcilliation Act

answer

1985 - made it possible for the centers for medicare and medicaid services (CMS) to deny reimbursement for substandard health care services provided to medicare and medicaid beneficiaries

question

Omnibus Budget reconciliciation act of 1986

answer

1986 - require pRo's to report instrances of substandard care to relevant licensing and certification agencies

question

Healthcare Quality Improvement Act

answer

Established the national practioner data bank - This provided a clearninghouse for information about medical practioners who have a history or malpractice and suits

question

Omnibus Budget reconciliciation act of 1989

answer

instituted the agency for healthcare policy and research - the mission of this agency is to develop outcome measures to evaluate the quality of healthcare services

question

Omnibus reconciclation act of 1990

answer

requires PROs to report actions taken against physicians to state medical boards and licensing agencies

question

Mental Health Parity Act

answer

1996 - a federal low that may apply to large group self - funded plans or large group fully insured group health plans - the purpose of the law is to provide equality (parity) for mental health benefits with medical/surgical benefits when applying aggregate lifetime and annual dollar limits under a group health plan

question

Health Insurance Portability and Accountability Act

answer

1996 - addresses issued related to the portability of health insurance after leaving employment, establishing national standards for electronic health care transactions, and national identifiers for providers, health plans, and employers. Also addresses the security and privacy of health information by establishing privacy standards for electronic healthcare information

question

American recovery and reinvestment act (HITECH)

answer

2009- Provides stimulus funds to the US economy in the midst of major econmic downturn. - Entitles the Health Information technology for econmic and clinical health- which allocatres funds for implementaton of nationwide health information exchange, use of health information, and EHRs.Provides invenstment of billions in health info technology ARRA requires the gov't to take a leadership role in developing standards for exchange of health information nationwide.

question

What organization has the mission of promoting the science and art of medicine and improve public health?

answer

American medical assoc

question

Which organization certifies the EHR?

answer

Commission of health information Technology

question

A college wants to start a new HIT program. Who should the staff contact for program accreditation information?

answer

CAHIM

question

At our hospital, a patient died in childbirth, As this is a sentinel event, what do we need to do?

answer

Perform a root cause analysis

question

I need to order the coding clinic for our coders. Who should I contact

answer

AHA

question

This Association was founded in 1928 under ARLNA

answer

AHIMA

question

Part of this organization's mission is to work for the improvement of health standards and the availability of healthcare services

answer

American Nurses Assoc

question

This organization's mission is to certify EHR

answer

CCHIM

question

This organization developed the National Patient Safety Guidelines

answer

TJC

question

This organization shares information on health and medical practices

answer

AMA

question

Average Length of Stay in acute care is

answer

30 days

question

Hospital's can be classified in what ways

answer

1. number of beds 2. types of services provided 3. types of patients served 4. for profit-notforprofit 5. Type of ownership

question

The board of the hospital works with who?

answer

The CEO

question

What does the hospital BOD's do?

answer

Establish bylaws, select admins, approve the makeup of clinical staff, monitors quality of care

question

What is medical staff classification?

answer

the organization of physicians according to clinical assignment

question

Medical staff operates according to what predetermined set of policies?

answer

Medical staff bylaws

question

What are line relationships?

answer

superiors and subordinates, indicates level of authority

question

What are lateral relationships?

answer

define connections among various positions in which hieracrhy of authority is not involved

question

What are functional relationships?

answer

the duties that are divided according to function, individuals exercise authority in one particular area by virtue of their expertise

question

What are some of the clinical (Anciallary) support services?

answer

pharm, food and nut, Him, social work, environmental, purchasing, engineering

question

What are some of the administrative services?

answer

admissions, claims and billing, accounting, information services, PR, fund development, marketing

question

Which of the following are an example of a voluntary hospital?

answer

a non-profit hospital owned by a church

question

I have been asked who has the primary resonsibility to guide the direction of the hospital, my response would be?

answer

bod

question

The HIM Dept. is conisdered what type of dept?

answer

Clinical support svcs

question

What service uses work and play to help the pt improve independent functioning?

answer

OT

question

Dr. Smith has been granted permission by community hospital to perform cardiac catheterizations. this permission is called?

answer

clinical privleges

question

Ambulatory care is short term care

answer

false

question

A RN qualified by advanced education and clinical and mgmt experience usually administered patient care svcs

answer

True

question

Healthcare reform results in closing of some hospitals

answer

True

question

the avg LOS of an acute care hospital is 21 days or less

answer

False

question

Rehabilitation services include only pt/ot

answer

False

question

managed care is?

answer

a healthcare reimbursement system that manages cost, quality, and access to svcs

question

AHRQ

answer

Agency for Healthcare Research and Quality - established 12 evidence based practice centers

question

What is quality of care?

answer

The right care provided at the right time

question

I work for an organization that owns a hospital, skilled nursing facility, and physician practices. I work for what kind of organization?

answer

An intergrated delivery system

question

Which of the following is true regarding medicare certification of hospitals?

answer

must be join commission accredited

question

I have been asked what is the purpose of evidence-based guidelines. How would I repsond?

answer

They help to improve the quality of pt. care

question

at our facility our nurses are cross-trained to perform many tasks for a small group of pts. this is called?

answer

Patient focused care

question

A medicare pt needs intermittent skilled nursing and speech therapy. Which of the following is the best svc for the pt

answer

Home care

question

Quality has several components, including approriateness, technical excellence. acceptability and

answer

accessibility

question

What type of program has been in place for years and is required by the medicare and medicaid programs as well as accreditation stds?

answer

quality improvement

question

Which of the following is a true statement about peer review?

answer

usually does not improve pt care

question

What program attempts to contain hospital inpatient costs and improve quality by restructuring services so that more is done in a nursing unit?

answer

pt. focused care

question

I am a patient. I went to see the DR who owns her own practice. this type of care is called which of the following?

answer

Private medical practice

question

My daughter fell and cut herself tonight, I believe she needs stiches it is not an emergency but she needs a dr tonight? What setting would i access?

answer

freestanding ambulatory care center

question

I work for a healthcare provider that provides ambulatory care to low-income patients. We recieve funding from many sources? What type of setting do i work for?

answer

Voluntary agency

question

Which of the following statements is true about behavioral health?

answer

insurance coverage generally places restrictions on the psychiatric care such as a limit on the number of outpatient visits

question

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

answer

Residential care facility

question

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

answer

public health svc

question

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

answer

day-treatment program

question

care provided by different caregivers at severl levels of the health care system

answer

Continuum of care

question

healthcare rendered in non-acute care facility to pts who require inpatient nursing and related svcs for more than 30 days

answer

SNF

question

A disadvantage of individual health plans is

answer

they cost more than group policies

question

I am retired from the military. I am seeing a civilian healthcare provider for my care - what insurance do i most likely have?

answer

TRICARE

question

An HMO is a model of a prepaid healthcare plan that calls under what type of reimbursement philospohy

answer

Managed care

question

Which of the following best descirbes workers comp insurance

answer

ins plan administered by the federal govt

question

which of the following alllows the pt to pay for deductible with pre tax dollars

answer

health savings accts

question

The development of managed care was a direct result of the federal govt's enactment of medicare and medicaid laws in 1965

answer

false

question

medicare part B is optional

answer

true

question

workers comp are operated by state gov't

answer

false

question

one of the disadvantages of health savings accts is that the deductible is paid with pretax dollars

answer

false

question

medicaid is co-funded by federal and state gov'ts

answer

true

HIM – Chapter 12

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