Download CH 2 homework - CM

1. Define-Key terms
ACO- Accountable Care Organizations- a Legal entity that is recognized and authorized under applicable state, federal, or
tribal law, with a Tax Identification Number that is a voluntary partnership between hospitals and physicians to coordinate
and deliver quality care to Medicare patients and allow the participating organizations to share the savings that would
result from improvement of care for hose Medicare populations.
ARRA- American Recovery and Reinvestment Act of 2009- health information management law that provided stimulus
fronds to the US economy midst a major economic downturn.
ALOS-Average length of stay in a hospital or long term care facility
CDC-Center for disease control- Leading federal agency in charge with protecting the public health and safety from the
control and prevention of disease, injury and disability.
Continuum of Care-A system that guides and tracks patients over time through a comprehensive array of health services
spanning all levels and intensity of care.
Critical access hospital-1. Hospitals that are excluded from the outpatient prospective payment system because they are
paid under a reasonable cost based system as required under 1834 of ss act. 2. Under HITECH incentives, a facility that
has been certified as a critical access hospital
CEO-Chief Executive Officer- Senior manager appointed by a governing board to direct an organizations overall long
term strategic management.
COO-Chief operating officer- an executive level role responsible at a high level for day to day operations of an
organization.
CNO-Chief nursing officer- the Senior manager (typically an RN) responsible for administering patient care services
CIO- Chief information officer- Senior manager responsible for the overall management of information resources in an
organization.
Extended care facility- Healcare facility licensed by applicable state or local law to offer room and board, skilled nursing
by a full time RN, intermediate care or a combination of levels on a 24-hour basis over a long period of time
Health Information Technology for Economic and Clinical Health (HITECH) Act- Legislation created to promote the
adoption and meaningful use of health information tech. in the US. There is also additional privacy and security
requirements that will develop and support electronic health info, facilitate info exchange, and strengthen monetary
penalties.
Home Healthcare- care received at a person’s home
Hospice- healcare that is an interdisciplinary program of palliative care and supportive services that addresses the physical,
spiritual, social and economic needs of terminally ill patients and their families.
Medical staff bylaws- standards governing the practice of medical staff members; typically voted upon by the organized
medical staff and the medical staff executive committee and approved by the facility’s board. It governs the business
conduct, rights, and responsibilities of the medical staff; medical staff members must abide by these bylaws in order to
continue practice in healthcare facility
Medicare- a federally funded health program established to assist with the medical care costs of Americans 65 and over
and to individuals who receive social security benefits due to disabilities.
MCO- Managed care organization- a type of healcare organization that delivers medical care and manages all aspects of
the care or payment for care by limiting providers of care, discounting payment to providers of care or limiting access to
care
PRO- Peer review organization-Until 2002- reviewed the medical necessity and appropriateness of certain admissions
even before patients were admitted.
QIO- Quality Improvement Organization- Emphasize quality improvement processes. They ensure the quality, efficacy
and cost effectiveness of the healthcare services provided to Medicare beneficiaries.
SNF-Skilled Nursing Facility- provides long term care services like nursing homes. They provide medical, nursing, or
rehabilitative care.
Utilization Review- The process of determining whether the medical care provided to a specific patient is necessary
according to pre-established objective screening criteria at time frames specified in the organizations utilization
management plan.
IND- Integrated delivery network- comprises a group of hospitals, physicians, other providers, insurers or community
agencies that work together to deliver health services.
IDS- Integrated delivery system- a system that combines the financial and clinical aspects of healthcare and uses a group
of healthcare providers, selected on the basis of quality and cost management criteria, to furnish comprehensive health
services across the continuum of care.
2. Name and define the providers that are included under the term medical practice or doctor.
Chiropractor- diagnosis, treatment and prevention of disorders of the neuromusculoskeletal system
Dentist- diagnosis, prevention and treatment of diseases and condition of oral cavity
Medical- diagnosis, prevention and treatment and education of any human disease or condition
Optometry- focuses on vision, visual systems and are trained to prescribe and fit lenses to improve vision
Osteopath- focuses on manipulation of muscles and bones and incorporates the diagnosis and treatment of diseases
Podiatrist- focuses on the treatment of disorders of the foot, ankle, and lower extremity
Name and define: five (5) medical specialties.
Internal Medicine: Provides care to diagnosis and treatment to adults
Pediatrics: Provides care to infants, children and adolescents from birth to 18 years of age
Family practice: Provides comprehensive care to all ages
Cardiology: focuses on disorders of the heart
Radiology: uses imaging techniques to diagnose and treat disease
Name and define: five (5) surgical specialties.
Anesthesiology: focuses on relief of pain during surgery
Cardiovascular surgery: surgery on the heart and great vessels
Gynecology and Obstetrics: surgery for cesarean section or other female health related surgeries
Orthopedics: surgery on the musculoskeletal system
Ophthalmology: Surgery on the eye
Name and define: eight (8) Allied Health professions.
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Dietetics and nutrition: dietitians are trained in nutrition. Responsible for providing nutritional care too individual
and for overseeing nutrition and food services in a variety of settings from hospitals to schools and beyond.
Emergency Medical Technology: Provide a wide range of services on an emergency basis for cases of traumatic
injury and other emergency situations and in the transport of emergency patients to a medical facility.
Health Information Management: Health Information Management professionals oversee health record systems and
manage health related information to ensure that it meets relevant medical, administrative and legal requirements.
Occupational Therapy: OT uses work and play activities to improve patients independent functioning, enhance their
development and prevent or decrease their level of disability. They try to enhance the patient’s quality of life and
improve his or her ADS. May treat development disabilities, birth defects, learning disabilities, traumatic injuries,
burns, neurological conditions and more.
Optometry: focused on the eye and its structure, as well as vision, visual systems and vision information processing
in humans. They provide treatments like contact lenses, corrective and low vision devices, treat glaucoma and ocular
hypertension.
Speech Language pathology and audiology- Identify, assess, and provide treatment for individuals with speech,
language, or hearing problems.
Respiratory therapy- evaluate, treat and care for patients with acute or chronic lung disorders. They work under
direction of a physician.
Surgical technologist- Provide surgical care to patients in many settings. Most are in hospital operating rooms. They
facilitate the safe and effective conduct of invasive surgical procedures.
3. IN YOUR OWN WORDS:

Summarize the Social Security Act of 1935.
The Great Depression is going on and administration decided to involve the federal government in
management economic and social welfare. A program was reacted to assist with unemployment and
retirement. The committee on Economic Security studied the issues. Since adding health insurance
wouldn’t allow Social Security to grow, health coverage wasn’t included in the 1935 social security act.

Summarize Public Law 89-97 of 1965 and Public Law 92-603 of 1972
Medicare and Medicaid were added to the Social Security act. Medicare allows adults 65 and older who
have social security coverage to receive healthcare benefits. Medicaid is also an added amendment to
the SSA. It is for people who are unable to afford medical care as well as those who are blind, disabled
and aged. It also expanded to assist very poor adults, poor children and pregnant women. It’s federally
mandated to low income people and their children. States also help pay for it. Medicaid is an umbrella
program for the 50 different states. 4 types of coverage are required: x ray services, physician services,
and nursing facility care for persons over 21 years of age. Medicaid also pays the Medicare premium,
deductible and coinsurance costs for some low income Medicare beneficiaries.

Summarize the Health Insurance Portability and Accountability Act of 1996 (HIPAA).
It addresses issues to the portability/share ability of health insurance after leaving employment,
established a national’s standard for Electronic Health Transactions, national identifiers for providers,
health plans, and employers. It also addressed the security/privacy of health records and information to
ensure they all meet a specific standard. It also covered the Healthcare Integrity and Protection Data
Bank to reduce fraud and abuse towards health insurance agencies and the healthcare provider. They
inform federal and state agencies about some quality problems with clinicians, service providers, and
suppliers.

Summarize Patient Protection and Affordable Care Act of 2010
The patient protection and affordable care act of 2010 was established to reform the health insurance
market, development sate based and state administered health insurance programs, consumer operated
and oriented plan program, expansion of Medicaid to people under 65 with incomes up to 133 percent of
federal poverty level, ensure all people have health coverage or pay a penalty, require employers with 50
or more people health coverage, offer subsidies to individuals and provide a small employer tax credit

What is a Critical Access Hospital?
A critical access hospital are hospitals that meet requirements and are allowed a separate payment
system that allows reimbursement for Medicare patients of 101 percent of reasonable costs. They are
not subject to the inpatient prospective payment system or the outpatient prospective payment system.

What is an outpatient?
A person who receives ambulatory healthcare. It is nonresidential care.

Name 3 Ancillary Support Services and their function.
Food and nutrition services- develop general and special diet menus and nutritional plans for individual
patients
Environmental Services provides housekeeping in hospitals, clinics, long term facilities, etc.
Pharmaceutical services- ensure patients receive proper medications

Summarize - Ambulatory Care; Public Health Services; Long Term Care; Behavioral Health Services.
Ambulatory care- Preventative or corrective healthcare provided on a nonresident basis maybe in an
office, clinic, hospital emergency setting
Public Health services that deals with providing services to the public.
Long term care- is care for a patient overnight, 24/7, and longer than 20 days
Behavior health services- Provides a service to patients with behavioral needs.

What is an ACO and its function?
An ACO (Accountable Care Organization)- The law now allows The Center for Medicare and Medicaid
Services to create ACO’s. They develop voluntary partnerships between hospitals and physicians to
coordinate and deliver quality care to Medicare patients ad allow the organization to share the savings
that result from the improvement of care. The participating ACOs are accountable for improving quality
care while reducing costs.
Center for Medicare and Medicaid services CMS

Summarize -Healthy People 2020
Healthy People 2020 is a plan to improve the nation’s health with the vision: “a society in which all
people live long healthy live”. They goal is to ensure the overall population lives high quality and long
loves that are free of preventable disease, disability, injury, and premature death. It hopes to achieve
health equity, climate differences and improve the health of all groups. They want to encourage a better
quality of life with happy development and healthy behaviors across all life stages.
4. Identify
1. Acute care hospitals- It is a hospital that provides 24-hour care to people who have severe illness. It is to diagnose or
treat an illness or injury. It is typically for no longer than 20 days of stay.
2. Ambulatory care/physician office settings- It is considered preventative or corrective healthcare that occurs in an
office, clinic or a hospital. It is Nonresidential (outpatient). People go to locations outside of their home to receive
healthcare then return the same day.
3. Long-term care facilities- This is nonacute care, generally. It is for patients that require inpatient nursing care for more
than 30 consecutive days. These are also known as nursing homes and rehab hospitals.
4. Behavioral healthcare facilities- Can be long stay instructions but today they are focused more on community based
settings. This means someone cares/assists the person at their home and then during the day gets dropped off at a day
center then picked up in the afternoon. If they are unable to function in the community, they may return to a full time
institution
5. Home health organizations- Provides assistance to patients that choose to have assistance in their home. These services
may simply include assisting with one ADL to assisting with many ADL’s. It is typically intermittent assistance
throughout the week.
6. Hospice organizations- It’s a service provided typically in the home for people who have a limited amount of time to
live. Nurses and assistants help the family as well as the patient. They try to control pain, maintain independence and
minimize the stress and trauma of death.
7. Obstetric/gynecologic care settings- Hospitals, clinics, home health care, outpatient and inpatient
8. Rehabilitation services organizations: Amputation System of Care, Audiology & Speech Pathology,
Chiropractic care
Instructions:
Upload answers to the above key terms and questions in a WORD document only.