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PN Exam 1 Class #89
chapter 2
| Question | Answer |
|---|---|
| What is the description of an LPN/LVN? | Practices within a defined scope under the supervision of a physician, dentist, or RN; provides direct patient care and supervises assistive personnel. |
| What is the most positive outcome when health care workers collaborate effectively? | Improved patient safety. |
| What is Managed Care? | Any method of financing health care in which costs are contained by controlling the provision of benefits and services. |
| What is medical necessity? | Services or items reasonable and necessary for the diagnosis or treatment of illness or injury or to improve the functioning of a malformed body member. |
| What is an inpatient health care setting? | One in which the patient stays overnight or longer in a health care facility. Often includes acute care hospitals, LATCH, skilled nursing facilities, and rehab facilities. |
| What are the 4 requirements to be admitted into a Skilled Nursing Facility (SNF)? | 1. Patient hospitalized for at least 3 days. 2. Patient must enter the home within 30 days of being hospitalized.3. There is a 100 day stay maximum per year related to any one hospitalization or diagnosis.4. Patient must be making regular progress. |
| What is Rehabilitation (Rehab)? | A level of care in which the patient can receive intense physical, occupational, and speech therapy services. |
| What is the main rule regarding patient entry into a rehab facility? | The patient must be capable of completing 3 hours of therapy a day. |
| What is Outpatient care? | Care provided in different settings designed to meet the needs of the patient in 1 day, allowing them to return home. |
| What is the primary goal of outpatient care? | To decrease medical costs while still providing quality care. |
| What are health depertments? | Public facilities that provide health care services, and are funded by county, city, and federal governments. |
| What is home health care? | Health or medical services provided to patients in theri homes because they are confined to their homes by an illness or disability. |
| What is Hospice? | An interdisciplinary program of palliative care and support services that addresses the physical, spiritual, social, and economic needs of terminally ill patients and Thier families. |
| What are the 2 most common conditions to seek Hospice care? | 1. When a patient is no longer seeking treatment to arrest or cute their disease. And 2. When a patient is expected to live 6 months or less. |
| What is Client-centered care? | System that empowers the patient to take control of and manage his or her care. |
| What is specific to the training of health care workers in Client-centered care? | Health care workers are cross-trained to perform as many tasks as possible for each patient. |
| What is Primary Care Nursing? | One nurse is responsible for all aspects or nursing care for their assigned patients. Often completed one-on-one. |
| What are the 5 ways patients pay for health-care? | 1. Public health insurance 2. Private health insurance 3. Insurance for special populations 4. Charitable Organizations 5. Self-pay |
| What are the 2 federally funded healthcare options? | Medicare and Medicaid |
| What is Medicare? | A federal gov'ts health insurance program for people older than 65 years. |
| What does Medicare use for it's payment schedule that is specific for it's policy? | DRG's (or diagnostic related groups): a classification of illnesses and diseases are used to determine the amount of money paid by Medicare toward medical costs. |
| What is Medicaid? | A federal-state program in which the gov't helps states pay for the health care of those with an income below the poverty level and certain other individuals. |
| What are the 4 parts of Medicare programs? | Part A: insurance for hospitalization. Part B: supplementary health insurance. Part C: AKA Medicare advantage plans. Part D: Medicare prescription drug conerage. |
| What are Diagnosis-Related Groups (DRG's)? | Determining factors in payment schedules used by Medicare. |
| What is a Third-Party Payer? | The insurance company: when the bill is received from a hospital or health-care provider. |
| What is Capitation? | Refers to a payment system used by health maintenance organizations (HMO's). Primary care physicians (PCP's) are paid a set amount per member per month to manage the health care of those members. |
| What is a Referral? | When a PCP is unable to successfully treat the patients condition and makes a recommendation to a specialist, individuals cannot refer themselves. |
| What are 3 common types of health insurance programs? | 1. Health Maintenance Organizations 2. Preferred Provider Organizations 3. Point-of -Service Plan |
| What is a Health Maintenance Organization (HMO)? | A cost-containment program featuring a primary care physician as the "gatekeeper" to eliminate unnecessary testing procedures. Patient must seek care with in the network. |
| What is a Preferred Provider Organization (PPO)? | When a group of health-care providers contract with a health insurance company to provide services to a specific group of patients on a discount basis. |
| What is a Point-of-Service Plan? | Similar to the Health Maintenance Organization in that a primary care physician still serves as a gatekeeper, but it is NOT capitated. Hence, insured people can seek care in and out of the network. Patient pays a percentage of the total costs. |
| How is Nursing Care delivered? | By utilizing team nursing, client-centered care, primary care nursing, and case management. |
| What is case management? | When the nurses providing case management services act simultaneously as coordinators, facilitators, impartial advocates, and educators. Often, they handle worker's compensation claims resulting from severe injury or disability. |
| What is Public Health Insurance? | Health insurance funded by the federal gov't, state gov't or a combination of both. It includes Medicare, Medicaid, and the IHS. |
| What is Private Health Insurance? | Companies, AKA third-party payers, include HMO's, PPO's, and POS plans and a variation of these services. |
| How do HMO's pay PCP's? | By a capitation system. |
| What is the primary role of a PCP? | To act as a "gatekeeper" for referrals to other health-care professionals such as specialists and therapists. |
Created by:
merelisen3
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