Download chapter 2 key terms - CM

Rona Michaud
Health Information
September 5, 2016
1. Define-Key terms
ACO- a legal entity recognized and authorized under
applicable state, federal or tribal law. It is identified by a
Taxpayer Identification Number (TIN).
ARRA-It is to preserve and create jobs and promote
economic recovery.
ALOS- This is the length of stay for hospital inpatients
discharged during a given period of time
CDC- Federal agency dedicated to protecting health and
controlling diseases.
Continuum of care- It places an emphasis on treating
individual patients at a level of care required by their
course of treatment
Critical access hospital- These are hospitals that meet certain
requirements and are able to have separate payment
system for Medicare patients
Critical access hospital
CEO- Person responsible for implementing the policies and
strategic direction set by the hospital’s board of directors.
COO-An executive –level role responsible at a high level
for day-to-day operations of an organization
CNO- The senior manager responsible for administering
patient care services usually registered nurse with
advanced education
CIO- Senior manager responsible for the overall
management of information resources in an organization
Extended care facility- Healthcare facility licensed by state
or local government to provide room, board, skilled
nursing by a full-time registered nurse. This is on a 24hour basis over a period time
Health Information Technology for Economic and Clinical Health
(HITECH) Act- Legislation that was created to promote the
adoption and meaningful use of health information in the
United States
Home Healthcare- This healthcare that is limited part-time
or intermittent it is done in the patients home and patient
is under the care of a physician.
Hospice- This provided to individuals that are diagnosed
with a terminal illness with a limited life expectancy of six
months or less.
Medical staff bylaws- Predetermined set of policies that spell
out the specific qualifications that physicians must
demonstrate before they can practice medicine in the
hospital
Medicare- This is a federal program that provides
healthcare benefits for people age 65 and older who are
covered by Social Security
MCO- This is a healthcare reimbursement system that
manages cost, quality and access to services
PRO- This is when hospitals reviewed medical necessity
and appropriateness of certain admissions even before
patients were admitted
QIO- The emphasize quality improvement processes. They
insure the quality, efficiency, and cost-effectiveness.
SNF- These are long-term care facilities or nursing homes
that provide medical, nursing or rehabilitative care, in
some cases around the clock. Residents are usually 65
and older and classified as the frail elderly
Utilization Review- This required hospitals to conduct
continued-stay reviews for Medicare and Medicaid patients
IND- This is comprises a group of hospitals, physicians,
other providers, insurers, or community agencies that
work together to deliver health services
IDS- Healthcare system that combine the financial and
clinical aspects of healthcare and use a group of
healthcare providers 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, treatment of disease and
condition of the oral cavity
Medical- concentrates on diagnosis, prevention, treatment
of any human disease or condition
Optometry- focuses on vision, visual systems, they are
trained to prescribe and fit lenses to improve vision
Osteopath- Along with focusing on manipulation of
muscles and bones also incorporates the diagnosis and
treatment of disease
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 of adults
Pediatrics- Provides care to infants, children, and
adolescents , birth to 18 years of age
Oncology- focuses on diagnosis and treatment of tumors,
both malignant and benign
Cardiology- focuses on disorders of the heart
Neurology- Focuses on the diagnosis and treatment of the
nervous system
Name and define: five (5) surgical specialties.
Anesthesiology- focuses on relief of pain during surgery
Cardiovascular surgery- Surgery on the heart and great
vessels
Ophthalmology- Surgery on the eyes
Orthopedics- Surgery on the musculoskeletal system
Plastic and reconstructive surgery- Surgery to restore the
form of the body
Name and define: eight (8)
Allied Health professions.
Audiology- Studies hearing, balance, and related disorders
Clinical laboratory science- Study of body fluids, tissues
and cells and this information is used for detection,
diagnosis and treatment of diseases
Emergency medical technology- Individuals that work
under this profession provide a wide range of services on
an emergency basis for cases of traumatic injury or other
emergency situations
Health information management- Oversee health record
systems and manage health-related information to ensure
that it meets relevant medical, administrative and legal
requirements.
Occupational therapy- use of work and play activities to
improve patients independent functions, enhance their
development and prevent or decrease their level of
disability.
Optometry- focuses on the eyes and related structures as
well as vision, visual systems and vision information
processing in humans
Pharmacy- roles of compounding and dispensing
medications as well as modern services including
reviewing medications for safety and efficacy and
providing drug information to physicians and patients
Speech-language pathology and audiology- identify,
assess, and provide treatment for individuals with speech,
language or hearing problems
3. IN YOUR OWN WORDS:
• Summarize the Social Security Act of 1935.
This was an act that was created to cover health insurance
that was paid for by the federal government.
•
Summarize Public Law 89-97 of 1965 and Public Law 92-603
of 1972
Public Law 89-97 of 1965 brought two programs Medicare
and Medicaid into existence. These two programs
changed how healthcare organizations were reimbursed
for services.
Public Law 92-603 of 1972 it was established so that the
payment systems for Medicare and Medicaid could be
reviewed and payments were based on quality and
necessity of care
•
Summarize the Health Insurance Portability and
Accountability Act of 1996 (HIPAA).
It was developed to protect individuals’ privacy to
healthcare information as well as how healthcare records
were transmitted.
•
Summarize Patient Protection and Affordable Care Act of
2010
This is where health insurance markets were created to
provide individuals who were not covered by insurance
the ability to obtain insurance at a subsidized rate. It also
required individuals to obtain insurance or they would be
penalized.
• What is a Critical Access Hospital?
These are hospitals that as long as they meet certain
requirements they would qualify to receive a higher
reimbursement rate from Medicare but they have certain
restrictions as far as being located in a Rural area with no
hospitals within a certain mile radius.
• What is an outpatient?
This is when patients are not admitted to the hospital for
observation and can receive their services at the hospital
or other healthcare facility but do not stay over night.
• Name 3 Ancillary Support Services and their function.
Pharmaceutical services- these are provided by registered
pharmacists and pharmacy technologists
Environmental services- theses services are what cleans
areas in the hospitals
Patient advocacy services- these are preformed by several
types of healthcare professionals mainly registered nurses
and licensed social workers
• Summarize - Ambulatory Care; Public Health Services; Long
Term Care; Behavioral Health Services.
Ambulatory Care- these are the preventative or corrective
healthcare provided in a practitioner’s office, clinic or a
hospital on an outpatient basis. Patients go to locations
outside their home to receive healthcare treatments.
There are two different categories, physicians who work in
a private practice and physicians who work for ambulatory
care organizations.
Public Health Services- These are services that are
coordinated by a federal agency such as The Department
of Health and Human Services it ensures health and
essential human services. There are home care services
and voluntary agencies.
Long Term Care- These are facilities who have patients
that have non-acute care services needed for more than
30 consecutive days. Example of these would be Skilled
Nursing Facilities, nursing homes, and rehabilitation
hospitals. Long-term care can be provided by healthcare
workers in the home or in residential or institutional
settings.
Behavioral Health Services- these are services based on
psychiatric services. Some services are provided seven
days a week while others are only done during business
hours. Insurance coverage for behavioral health has
changed over the years some coverage is restricted to
limit the number of days that a patient may need
outpatient behavioral services or even inpatient long-term
treatments.
• What is an ACO and it's function?
•
It is a voluntary partnership between physicians and
hospitals to coordinate and deliver quality care to
Medicare patients. Participating agencies are able to
share in the savings that is a result from the improvement
of care that the Medicare population receives.
• Summarize -Healthy People 2020
It is a vision of the Department of Health and Human
Services to see that the nation lives a long healthy life. It
sets goals in which people can live their lives free of
preventable disease, disability, injury and premature
death. They recognize the importance of health
information and communication.
4. Identify
1. Acute care hospitals
This where a patient would receive short-term treatment
for a severe injury or illness, an urgent medical
condition, or during recovery from surgery.
2.
Ambulatory care/physician office settings
This would be services that a patient would receive in a
physicians office that the patient would return home after
the service/procedure is completed. Examples of theses
are settings would be, renal dialysis centers, walk in
clinics.
3. Long-term care facilities
These are located in a variety of places. Skilled nursing
facilities or nursing homes, hospice programs, and
residential care facilities.
4. Behavioral healthcare facilities
These used to be deemed as long term care and now these
include inpatient and outpatient services. Some of these
facilities provide seven days a week services and many
provide services during normal busing hours only.
5. Home health organizations
These are part-time skilled nursing they offer physical
therapy, occupational therapy, speech-language therapy,
medical supply and other services
6. Hospice organizations
They treat individuals with terminal illnesses with life
expectancy of six months or less. Services have gained
acceptance as an alternative to hospital care of the
terminally ill.
7. Obstetric/gynecologic care settings
This is where women would go to have cesarean sections
or other female health related surgeries
8. Rehabilitation services organizations
These are usually made up of physicians, nurses,
occupational therapists, physical therapists, respiratory
therapists, speech therapists, social workers, and other
healthcare personnel. They provide services within an
acute care setting or hospital.