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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.