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68C Ph.2 T.1

Health Care Cost and Quality

QuestionAnswer
ELO> Given a list of economic factors effecting the health care system, describe the economic factors by correctly responding to written, oral, and experiential assessment measures
ELO> Given a list of quality improvement measures within the healthcare delivery system, compare the types of quality improvement measures by correctly responding to written, oral and experiential assessment measures
Factors affecting rising healthcare cost aging population, advancement in technology, healthcare insurance, malpractice insurance
how has healthcare reimbursement change the role of the LPN? healthcare reimbursement change has expanded the responsibilities and roles of the LPN because it is more cost effective
Changes in the delivery system a.case management b.cross-training c.multisystem health care chains/ managed care plans
Case-management manage and direct to receive cost-effective care quickly
HMO-lower premium, STRICT Health-maintenance organization>group insurance plan, fixed fee for service, provides ambulatory/hospitalization/home care services, utitlize "gate keepers" primary physician, member responsible for all costs of unauthorized care
PPO -co-pay, Discounted rates Preferred provider organization> network of providers who discount their rates for plan members, members pay higher rates if Rx is provided outside the network
MCO's Managed care organizations> plan and supervise distribution of health care services, use resources effectively, reasonable cost, client education
In order for HMO to pay for secondary care you must need a.. Referral
Positive changes in health care cost reduced redundancy in health care services, new and expanded roles for nurses
Negative effect in health care cost decision making power moved from providers to insurance companes, increased economic pressure on the consumer
The Joint Commission accreditation needed to receive money from medicaid (state) and medicare (federal)
POS Point of Service, pay at the time you receive the service
Can LPN be case managers? yes
Created by: ajwildasin30