Download Chapter 2 - CM

1. Define-Key terms
ACO- Accountable Care Organizations, voluntary partnerships between hospitals and physicians to
coordinate and deliver quality care.
ARRA- American Recovery and Reinvestment Act, a bill that provided the investment of billions of dollars
in health information technology and gave incentives to hospitals and providers to use the information
technology. The Act also made important changes to HIPAA
ALOS- Average Length Of Stay, in an acute-care hospital this is a stay less than 25 days.
CDC- Center for Disease Control and Prevention, a federal agency that protects public health and safety
through the control and prevention of disease, injury, and disability.
Continuum of care- The range of healthcare services provided to patients, from routine ambulatory care
to intensive acute care. Emphasizing the treatment of individual patients at the level of care required by
their course of treatment with the assurance of communication between caregivers.
Critical access hospital- A hospital that meets the criteria of a CAH must be located in a state that
accepted a grant under the Medicare Rural Hospital Flexibility Program, be located in a rural area, and
must meet may other criteria. A CAH are allowed a separate payment system that allows 101% of
reasonable costs to be reimbursed for Medicare patients.
CEO- Chief Executive Officer, a leader responsible for implementing the policies and strategic direction
set by the hospital’s board of directors.
COO- Chief Operating Officer, member of the executive management team, this team is responsible for
managing the hospital’s finances and ensuring the hospital complies with federal, state, and local laws,
standards and rules.
CNO- Chief Nursing Officer, a registered nurse with advanced education and experience usually
administers patient care services, and reports directly to the CEO.
CIO- Chief Information Officer, a member of the Executive management team, this team is responsible
for managing the hospital’s finances and ensuring the hospital complies with federal, state, and local
laws, standards and rules.
Extended care facility- A healthcare facility for patient who require long-term care and support; i.e. a
skilled nursing facility, or a convalescent home.
Health Information Technology for Economic and Clinical Health (HITECH) Act- signed into law in 2009 it
promotes the use of health information technology like electronic health records.
Home Healthcare- Home health is healthcare services that can be conducted at home; i.e. wound care,
diabetes teaching, injections, and illness monitoring.
Hospice- Healthcare to cushion death for people with terminal illnesses. They assist with pain,
emotionally, spiritually, and physically.
Medical staff bylaws- Predetermined policies about qualifications physicians must demonstrate before
they can practice medicine in the hospital.
Medicare- A national insurance program for people age 65+, and people with certain disabilities.
MCO- Managed Care Organization, a healthcare reimbursement system that manages cost, quality, and
access to services.
PRO- Peer Review Organization; until 2002 it was a medical organization that performed a professional
review of medical necessity, quality, and appropriateness of healthcare services provided to Medicare
beneficiaries.
QIO- Quality Improvement Organization; performs medical peer review of Medicare and Medicaid
claims, including the review of validity of diagnosis and quality of care.
SNF- Skilled Nursing Facilities, providers of long-term care services are nursing homes. Providing
medical, nursing, rehabilitation care to residents usually over the age of 65.
Utilization Review- determining whether medical care provided to a specific patient is necessary
according to pre-established objective screening criteria.
IDN- Integrated Delivery Networks, group of hospitals, physicians, other providers, insurers, or
community agencies that work together to deliver health services.
IDS- Integrated Delivery System; system that combines financial and clinical aspects of healthcare and
uses a group of healthcare providers to furnish comprehensive healthcare services across the continuum
of care.
2. Name and define the providers that are included under the term medical practice or doctor.
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
Cardiology- Focused care on disorders of the heart
Psychiatry- Focuses on diagnosis and treatment of mental disorders
Radiology- Uses imaging techniques to diagnose and treat disease
Name and define five (5) surgical specialties.
Cardiovascular surgery- surgery on the heart and great vessels
Gynecology and Obstetrics- Surgery for Cesarean sections or other female health-related surgeries
Ophthalmology- Surgery on the eye
Otorhinolaryngology- Surgery on the ear, nose, and throat
Neurosurgery- Surgery on the brain, spinal cord, and peripheral nerves
Name and define eight (8) Allied Health professions.
Audiology- The study of hearing, balance, and related disorders.
Dietetics and Nutrition- Dieticians provide nutritional care and food services in setting from the hospital
to school
Emergency Medical Technology- EMT, paramedics provide care for traumatic and emergent situations
Health Information Management- Oversee health records and manage health related information
Occupational Therapy- Occupational Therapists use work and play activity to improve patients’
independent functioning and decrease or get rid of their disability
Optometry- Profession focused on the eyes and related structures including vision, visual systems, and
vision information processing
Pharmacy- Compounding and dispensing medications as well as providing drug information to
physicians. Experts on drug therapy.
Physical Therapy- Physical therapists treat/ or evaluate and treat patients to improve functional
mobility, reduce pain, and limit disability.
3. IN YOUR OWN WORDS:
Summarize the Social Security Act of 1935. The Social Security Act of 1935 included only one reference
from President Roosevelt, a reference to health insurance as a subject that the new social security board
might study. The act was to provide welfare for the aged, blind, or disabled.
Summarize Public Law 89-97 of 1965 and Public Law 92-603 of 1972. Public Law 89-97 was an
amendment to the Social Security Act of 1935; it introduced Medicaid and Medicare into play. Public
Law 92-603 tried to curtain Medicare and Medicaid spending by requiring concurrent review for all
Medicare and Medicaid patients.
Summarize the Health Insurance Portability and Accountability Act of 1996 (HIPAA). HIPAA established
a national standard for electronic healthcare information. It also made a standard on the protection and
integrity of this information.
Summarize Patient Protection and Affordable Care Act of 2010. The Patient Protection and Affordable
Care Act included revisions to insurance, consumer operated plans, Medicaid expansion, and requiring
employers with more than 50 employees to provide healthcare coverage.
What is a Critical Access Hospital? A CAH is a hospital in rural location in a state that accepted a grant
under the Medicare Rural Hospital Program. Must provide emergency care 24 hours a day, 7 days a
week. These CAH’s are able to use a different payment system that allows Medicare patients to be 101%
reimbursed.
What is an outpatient? An outpatient is someone who receives treatment in a hospital, lie an x-ray,
blood tests, or mammogram. They also do not spend more than 24 hours as a patient in hospital care.
Name 3 Ancillary Support Services and their function.
Pharmaceutical services- provide medication, and medication teaching
Health Information Management- The managing of health records, providing appropriate records to
providers
Social work and social services- In situations of questionable grounds like child abuse, child suicide
attempts a social worker in the hospital is called upon to retrieve insight from their home situation.
Summarize - Ambulatory Care; Public Health Services; Long Term Care; Behavioral Health Services.
Ambulatory Care is preventative and corrective healthcare provided in a practitioner’s office, a
clinic, or a hospital.
Public Health Services provides essential care for Medicare recipients, this include Home
Healthcare.
Long Term Care is healthcare in a nonacute-care facility, like a nursing home, for patients who
require inpatient nursing for more than 30 days.
Behavioral Health Services include substance abuse counselors and centers, psychiatric
institutions, this also include occupation therapy and psychotherapy.
What is an ACO and its function?
An ACO is an Accountable Care Organization. These are voluntary partnerships between hospitals and
providers to coordinate the best possible care for Medicare patients. It also saves money for each
system.
Summarize -Healthy People 2020
Healthy People 2020 is plan to improve the nation’s overall health. Goals including high-quality longer
lives, eliminating disparities to achieve health equity, and the development of healthy behaviors.
4. Identify
1. Acute care hospitals- Hospitals that provide acute but active treatment for illness, disease, and
injury. They also provide the means of Diagnosis.
2. Ambulatory care/physician office settings- Ambulatory care in a private practice is preventative and
corrective medicine. They diagnose and treat symptoms or signs to the best of their ability.
3. Long-term care facilities- Long-term care facilities include Nursing Homes, Convalescent homes, and
rehab hospitals. These facilities are for patients who require more than 30 days of inpatient nursing and
care.
4. Behavioral healthcare facilities- Behavioral Health Facilities include Psychiatric hospitals, Substance
Abuse centers, and Residential treatment centers. These facilities provide emotional and behavioral
support systems and educate patients.
5. Home health organizations- Home Health organizations provide in home care for patients who require
assistance on a daily, weekly, or monthly basis. Through these organizations hospital remittance
numbers lower.
6. Hospice organizations- Hospice provide emotional, spiritual, and physical support for terminally ill
patients. Hospice care is for patients with less than 180 days until their expected passing.
7. Obstetric/gynecologic care settings- Women’s reproductive health, including pregnancy support and
cesarean sections. These can be provided in hospital or for gynecology it can be provided in private
practice settings.
8. Rehabilitation services organizations- Rehabilitation services organizations provide acute or long term
services to patients with acute, chronic, and sometimes fatal conditions. They try to lessen pain,
improve mobility, or completely cease their disabilities.