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Chapter 3 Key Terms

Health Care Settings-Heather's class

Activities of daily living (ADL) activities like bathing, dressing, eating, toileting, walking, & so on.
Acute care facility (ACF) Hospital that provides health care services to patients who have serious, sudden, or acute illnessres or injuries and/or who need certain surgeries.
Acute hospital classification/ short term hospital classification Patients LOS of 4-5 days & a total LOS of less than 25 days.
Administration for Children & Families (ACF) DHHS programs that provide services & assistance to needy children & families, including Temporary assistance to needy families.(TANF)
Administration on Aging (AoA) DHHS program that supports a nationwide aging network, providing services to the elderly to enable them to remain independent.
adult day care Provides care & supervision in a structured environment to seniors with physical or mental limitations.
Agency for healthcare research & Wuality (AHRQ) DHHS agency that suports research designed to umprove the outcomes & quality of health care, reduce its cost, address patient safety & medical errors, & broaden access to effective services.
Agency for Toxic Substances & Disease Registry (ATSDR) DHHS agency that works with states & other federal agencies to provent exposure to hazardous substances from waste sites.
Alzheimer's treatment facilities Long-term care facility that specializes in the care of patients diagnosed with Alzheimer's disease.
ambulatory care/ outpatient care Outpatient care that allows patients to receive care in one day w/out the need for inpatient hospitalization.
ambulatory infusion center (AIC)/ infusion center Freestanding center that dispenses & administers prescribed medications by continuous or intermittent infusion to ambulatory patients. Infusion is supervised by a licensed health care professional.
ambulatory patients/ outpatients Treated & released the same day & don't stay overnight in the hospital.
ambulatory surgery patient Undergoes certain procedures that can be performed on an outpatient basis, with the patient treated & released the same, if they require a longer stay, they must be admitted to the facility as an inpatient.
ambulatory surgical center (ASC) Surgery is performed on an outpatient basis at a free-standing ambulatory surgical center. Patients arrive on the day of procedure, undergo surgery in an operating room, & recover under the care of nursing staff.
ancillary services Documented by such departments as lavoratory, radiology, nuclear medicine to assist phusicians in diagnosis & treatment of patients.
assisted-living facility (ALF) Combination of housing & supportive services including personal care & household management for seniors. Residents pay monthly rent & additional fees for services they require.
Bed count/ bed size Total # of inpatient beds for which the facility is licenced by the state
behavioral health care hospital Specializes in treating individuals with mental health diagnoses.
Bureau of Prisons (BOP) Federal program that provides necessary medical, dental, & mental Health services to inmates by a professional staff & consistent with acceptable community standards. It consists os 82 institutions, each of which provide inmate ambulatory care.
cafeteria plan/ triple option plan/flexible benefit plan Provides subscribers & employees with a choice of HMO,PPO or traditioal health insurance plan
Bed count/ bed size Total # of inpatient beds for which the facility is licenced by the state
behavioral health care hospital Specializes in treating individuals with mental health diagnoses.
Bureau of Prisons (BOP) Federal program that provides necessary medical, dental, & mental Health services to inmates by a professional staff & consistent with acceptable community standards. It consists os 82 institutions, each of which provide inmate ambulatory care.
cafeteria plan/ triple option plan Provides subscribers & employees with a choice of HMO,PPO or traditioal health insurance plan
capitation payment Lump sum paid by the HMO to the provider to care for a group of subscribers.
Centers for Disease Control & Prevention (CDC) DHHS agency that provides a system of health surveillance to monitor & prevent the outbreak of diseases
Chemical dependency program Provides 24-hour medically directed evaluation & withdrawl management in an acute car inpatient setting. Treatment services usually include detoxification & withdrawal management,chemical dependency/substance abuse assessment, & therapy.
chemotherapy Intravenous administration of chemical agents that have specific & toxic effects upon a disease-causing cell or organism.
clinical laboratory Performs testing in microbiology, clinical chemistry, & toxicology;diredted by a pathologist; & testing is performed by certified professional technologists & technitions
clinic outpatient Hospital ambulatory care patient who receives scheduled diagnostic & therapeutic care.
closed-panel HMO Includes group & staff models that provide services at HMO-owned health centers or satellite clinics, or by physicians who beling to a specially formed midical group that serves the HMO
continuing care retirement community (CCRC) Provides different levels of care based on the residents' needs from indeoendent living apts. to skilled nursing care in an affiliated nursing facility.
copayment Fixed amount a subscriber must pay when seeking health car services.
correctional facilities Provides inmates with a secure housing environment that slso offers vocational & educational advancement. Medical, dental,& mental health care services are provided to inmates according to a standard of care imposed by court decisions, legislation, accept
crisis services Provides short-term (usually fewer than 15 days) crisis intervention & treatment; patients receive 24-hour-per-day supervision.
critical access hospital (CAH) Located more than 35 miles from any other hospital or another CAH, or they are state certified as being a necessary provider of health care to area residents.
curative care Therapeutic
day treatment program Intensive treatment program provided to patients who live in the community but come to the facility up to five days per week.
dementia care facilities Long-term care facilities that specialize in the care of patients diagnosed with dementia.
developmentally disabled/mentally retarded facilities Sometimes categorized as an intermediate care facility (ICF), these facilities provide residential care & day programming, including academic training, clinical & techinical assistance, health care services, & diagnosis & evaluation of individuals with de
diagnosis-reated groups (DRG's) Classify inpatient hospital cases into groups that are expected to consume similar hospital resources. Hospital inpatients are kiscahrged once the acute phase of illness has passed, & they are often transferred to other types of health care, such as outpa
direct contract model HMO Individual physicians in the community deliver contracted health care services to subscribers.
drug therapy Intravenous administration of other drugs including antibiotics, antivirals, & so on.
durable medical equipment (DME) Includes canes, crutches, IV supplies, hospital beds, ostomy supplies, oxygen, prostheses, walkers, wheelchairs, & so on.
emergency care center/ urgent care center Immediate care is provided by an onduty phusicican (usually salaried). The center is usually owned by private corporation in states where permitted or non-profit facilities.
emergency care patient Treated for urgent problems & either released the same day or admitted to the hospital as an inpatient.
Exclusive Provider Organization (EPO) Providers benefits to subscribers who receive health car services from network providers.
family practitioner Provides care for the entire family & focuses on genteral medicine, obstetrics, pediatrics, & geriatrics.
family support services Services provided to assist families in caring for the patient.
federal certification Measures ability of health care facilities to deliver care that is safe & adadequate, in accordance with federal law & regulation.
federal medical centers (FMCs) Provide major medical care to federal correctional facility inmates.
Food & Drug Administration (FDA) DHHS agency that assures the safety of foods & cosmetics, & the safety & efficacy of pharmaceuticals, biological products, & medical devices.
general hospitals Provide emergency care, perform general surgery, & admit patients for a range of problems from fractures to heart disease, based on licensing by the state.
group model (HMO) Participteing phusicians who are members of an independent multi-specialty group providing health care services. Physician groups either contract with the HMO or they are owned or managed by the HMO.
Group practice without walls (GPWW) Managed care contract in which physicians maintain their own offices & share services to plan members.
Health Maintenance Organization (HMO)/claims examiner An alternative to traditional health insurance coverage; based on the patient's diagnosis.
Health Resources & Services Administration (HRSA) DHHS agency that provides health resources for medically underserved populations, works to build the health care workforce, maintains the National Health Service Corps, oversees the nation's organ transplantation system, works to decrease infant mortality
heart & vascular center Provides ambulatory cardiovascular services to include diagnosis & treatment disease prevention, research, education, & cardiac rehabibilitation.
home care Allows people who are seriously ill or dying to remain at home & receive treatment from nurses, social workers, therapist, & other licensed health care professionals who provide skilled care in the home.
home infusion care Provided by home health care agencies when intravenous administration of of medication is medically appropriate for the patient's condition, & treatment is adminisstered in the home instead of on an inpatient hospital basis.
hospice care Provides comprehensove medical & supportive social, emotional, & spiritual care to terminally ill patients & their families. Goal is palliative rather than curative.
hospitalist Physiciam who spends most of his or her time in a hospital setting admiting patients to inpatient services from local primary care providers.
hospital-owned physiciam practice Practices that are at least partially owned by the hospital, & physiciams participate in a compensation plan provided by the hospital.
hydration therapy Intravenous administration of fluids, electrolytes, & other additives.
imaging center Freestanding facility that provides radiographic & other imaging services to ambulatory patients. Some centers also provide training & participate in mational research projects.
independent Practice Association (IPA)/Individual practice association (IPA) Physicians who remain in their independent office settings provide contacted health care services to subscribers. Negotiates the HMO contract & manages the capitation payment
indian health service (IHS) DHHS agency that supprots a network of 37 hospitals, 60 health centers, 3 school health centers , 46 health stations, & 34 urban Indian health centers to provide services to nearly 1.5 million American Indians & Alaska Narives of 557 federally recognized
inpatients Remain overnight in the facility for 24 or more hours & are provided with room & board & nursing services.
integrated delivery system (IDS)/integrated service network, delivery system, vertically integrated plan, vertically integrated system, horizontally integrated system, health delivery network, & accountable health plan Organization of affiliated provider sites that offer joint helath care services to subscribers. Sites include ambulatory surgical centers, hospitals, physician groups & so on.
integrated provider organization (IPO) Manages helath care services provided by hospitals, physicians, & other health car organizations.
intensive case management Specially trained individuals coordinate &/or provide mental health, financial, legal, & medical services to help the patient live successfully at home & in the community.
intermediate care facility (ICF) Provides developmentally disabledpeople with medical care & supervision, nursing services, occupational & physical therapies, activity programs, educational & recreational services, & psychological services.
internal medicine physicians Specializes in the care of adults.
long-term care Includes a range of nursing, social, & rehabilitative services for people who need ongoing assistance. Lengths of stay typically average greater than 30 days.
long-term care hospital (LTCH)/long-term hospital classification Defined in Medicare law as hospitals that have an average inpatient length of stay greater than 25 days. These hospitals typically provide extendedmedical & rehavilitative care for patients who are clinically complex & may suffer from multiple acute or ch
managed care Originally referred to the prepaid health care sector, such as HMO's, which combined health care delivery with the financing of health care services; increasingly used to refer to proferred provider organizations (PPOs) & some forms of indemnity coverage
Management Service Organization (MSO) Provides practice management services including administrative & support services, to individual physician practices.
medical foundation Non-profit organization that contracts with & acquires the clinical & business assets of physician practices.
medical necessity Requires documentation of services or supplies that are proper & needed fort the diagnosid or treatment of a medical condition; are provided for the diagnosis, direct care, & treatment of a medical condition; meet the standards of good medical practive in
Military Health System (MHS) Administers health care for active members of the uniformed services (& their dependents) as provided by military treatment facilities & networks of civilian health care professionals.
Military Medical Support Office (MMSO) Coordinates civilian health care services when military treatment facility (MTF) services are unavailable.
Military treatment facility (MTF) Clinic &/or hospital located on a U.S. military base.
multi-hospital systems Category of hosptials where two or more hospitals are owned, managed, or leased by a single organization; thers may include acute, long-term, pediatric, rehabilitation, &/or psychiatric care facilities.
multi-specialty group physician practices Offer various types of medical specialty care in one organization, & they may be located in more than one location.
National Commission on Correctional Health Care (NCCHC) Provides an external peer review process for correctional institutions that wish to meet its nationally accepted Standards for Health Services.
National Institutes of Health (NIH) DHHS research center with 17 separate institutes, is the world's premier medical research organization, supporting some 35,000 research projects nationwide in diseases like cancer, Alzheimer's disease, diabetes, arthrutus, heart ailments, & AIDS.
neighborhood health center Health care is provided to economically disadvantaged, & treatment is family-centered because illnesses may result indirectly from crowded living conditions, unsanitary facilities, & other socioeconomic factors. Family care team consisting of a physician,
network model HMO Two or more physician multi-specialty group practices provide contracted health care services to subscribers.
network providers physicians & health care facilities under contract to the managed care plan.
newborn patients Receive infant care upon birth, & if necessary they receive neonatal intensive cre either within the hospiral or as the result of transfer to another hospital.
nursing facility (NF)/ skilled nursing facility (SNF) Provides medically necessary care to inpatients on a daily basis that is performed by, or ynder the supervision of, skilled medical personnel. SNF's provide IV therapy, rehabilitation, & wound care services
observation patients Receive services furnished on a hospital's premises that are ordered by a physician or other authorized individual, including use of a bed & periodic monoring by nursing or other staff, which are reasonable & necessary to evaluate an outpatient's conditio
Office of Public Health & Science (OPHS) Directed by the Assistant Secretary for Health, serves as focal point of leadership & coordination across DHHS in public health & science, provides direction to program offices within OPHS, & provides advice & counsel on public health & science issues to
Office of the Secretary of Health & Human Services (OS) DHHS office that advises the President on health, welfare, & income security plans, policies, & programs of the federal government.
open-panel HMO Includes direct contract, individual practice association, & network models; physicians are not employees of the HMO & they do not belong to a specially formed medical group that serves the HMO.
Pain Management Intravenous administration of narcotics & other drugs designed to relieve pain.
Pain Management Center Specializes in treatment of acute & chronic pain syndromes using proven medications & procedures. Usually a multi-disciplinary approach is used, involving paricipating specialists such as physiatrists, psychiatrists, neurologists, neurosurgeons, internist
Palliative Care Comfort management.
partial hospitalization program Program for hospital patients who regularly use the hospital facilities for a substantial # of either daytime or nighttime hours.
Pediatriation Provides comprehensive services for infants, children, & adolescents.
Personal care & support services Provide assistance in performing daily living activities, such as bathing dressing, grooming, going to the toilet, mealtime assistance, travel training, & accessing recreation services.
Physician-hospital organization (PHO) Managed care contracts are negotiated by hospital & physician groups; physicians maintain their own practices & provide services to plan members.
Point-of-Service Plan (POS) Parients have the freedom to use an HMO panel of providers (for which a copayment is paid) or to self-refer to non-HMO providers (for which greater out-of-pocket expenses apply.)
Preadmission Certification (PAC) Form of utilization management that involves the review for medical necessity of impatient care prior to inpatient admission.
Preferred Provider Organization (PPO) Network of physicians & hospitals join together to contract with third-party payers, employers & other organizations to provide health care to subscribers for a discounted fee.
Primary care center Offers adult & family care medicine in internal medicine, pediatrics. & family practice.
Program Support Center (PSC) DHHS service-for-fee organization that utilizes a business enterprise approach to provide gavernment support services throughout DHHS & other federal agencies. Administrative operations, financial management, & human resources are solution- & customer-ori
Public Health Service (PHS) Uniformed Service of the Department of Health & Human Service. Leadership is provided by the U.S. Surgeon Genersl. It provides highly trained & mobile health professionals who carry out programs to promote the nation's health, understand & prevent disease
public health department Provides preventive medicine services such as well baby clinics, which include ummunizations & routine checkups.
Referred outpatient Hospital ambulatory care patient who receives diagnostic or therapeutic car because such care is unavailable in the primary care provider's office. Follow-up care is done at the primary care provider's office.
Rehabilitation Facility Outpatient
Rehabilitation Hospital Inpatient-- Admits patients who are diagnosed with trauja or disease & who need to learn how to function.
residential care facility (RCF) Provides non-medical custodial care, which can be provided in a single family residence, a retirement residence, or in any appropriate care facility including a nursing home.
Residential treatment facility Seriously disturbed patients receive intensive & comprehensive psychiatric treatment on a long-term basis.
respite care Care provided by specially trained individuals at a setting other tham the patent's home to offer relief & rest to primary caregivers.
satellite clinics Ambulartory care centers established remotely from the hospital. Primary care is provided by an on-duty physician (usually salaried).
single hospitals Category of hospitals that are self-contained & not part of a larger organization.
single-specialty group physcian practices Single-specialty practices that consist of two or more physicians who provide patients with one specific type of care.
skilled care Includes services that are ordered by a physician & provided under the supervision of a registered nurse, physical, occupational, or speech therapist.
solo physician practices Do not have physician partners or em,ployment affiliations with other practice organizations.
specialty hospital Concentrates on a particular population of patiets or disease.
staff model health maintenance organization (HMO) Similar to large,multi-specialty group practices, itmay be partially owned by the physician employees, with the physicians typically functioning as employees of either the physician group owning the practice or the insurer. Most physicians in this type of
student health center Provides health care to full- & parat-time students who become ill or injured.
subacute care Provided in hospitals that provide specialized long-term acute care such as chemotheraphy, injury rehabilitation, ventillator support, wound care, & other types of health care services provided to seriously ill patients.
subscribers Individuals who pays health insurance premiums.
Substance Abuse & Mental Health Services Administration (SAMHSA) DHHS agency that works to improve the quality & availablity of substance abuse prevention, addiction treatment, & mental health services.
swing bed Allows a rural hospitalto admit a nonacute care patient.
Temporary Assistance to Needy Families (TANF) State-federal welfare program.
Therapeutic group home Six to 10 individuals are provided with supervised housing that may be linked with a day treatment program.
total parenteral nutrition (TPN) Administration of nutritional substances by peripheral or central intravenous infusion to patients who are either already malnourished or have the potential for developing malnoutrition.
utilization management Controls health care costs & the quality of health care by reviewing cases for appropriateness & medical necessity.
ventilator breathing machine.
Veterans Health Administration (VHA) An agency in the Department of Veterans Affairs that provides medical, surgical, & rehabilitative care to veterans of the armed services.
Veterans Intergrated Service Network (VISN) Administers & provides health care services at VA Medical Centers(VAMC)& community-based outpatient clinics.
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