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HA150 Final
| Term | Definition |
|---|---|
| Healthcare triumvirate | Model b/w cost, quality, and access of healthcare system |
| Hospitalist | MD/DO that acts as a PCP in hospitals, communicating w/ the patient's real PCP Speciality was introduced to incr quality & access of hospital care, while also lowering costs (shortens people’s stay) |
| Medicare | 65 and older, End-stage renal disease, and social security with disability income |
| Medicaid | low income, medically needy, and disabled without social security disability income |
| Diagnosis-related groups | Inpatient classification sys that standardizes payments to hospitals (when dealing w/ a patient covered under Medicare) Replaced fee-for-service payment model as that rewarded volume making PCP infinitely rich Incentive for hospitals to undertreat |
| PDPM | Patient Driven Payment Model For SNF reimbursement -> determines how much SNFs get paid per patient per day |
| PDGM | Patient Driven Grouping Model is similar to PDPM, just for home health care |
| ICD-10 | International Classification of Diseases vol. 10 (ICD-10) - determines how much outpatient care centers get paid for diagnosis by PHI CPT - for outpatient treatment PCS - for inpatient treatment (hospitals) |
| CPT | Coding procedural terminology - accompanies ICD-10 to determine how much outpatient providers get paid for the treatment |
| PCS | Procedural coding system - accompanies ICD-10 to determine how much inpatient providers get paid for the treatment |
| Most common health insurance | Employer based private health insurance Specifically PPOs (preferred provider organization) and HMOs (health maintenance organization) |
| SCHIP | State childrens health insurance program For children of parents w/o health insurance, but w/ a job so they don’t qualify for Medicaid |
| Prevention & Cost of Healthcare | More prevention lowers the cost of health care HMOs (health maintenance organizations) focus on prevention because they emphasized comprehensive, in-network care to control costs |
| Hospitals | Focus on Location, insurance/physician privilege, volume, quality ratings when choosing Hospital compare is a website that compares quality of hospital managed by CMS |
| Premium | amount you pay monthly for health insurance, does not change over a 12 month period |
| Deductible | Amount paid out of pocket before health insurance covers the rest |
| Co-pay | Fixed dollar amount paid for health insurance, doesn’t change over an insurance period |
| Co-insurance | Fixed percent amount paid for health insurance |
| Risk pool | group of individuals whose medical costs are combined to calculate premiums, allowing the high costs of the sick to be offset by the lower costs of the healthy |
| Hill-Burton Act | Expanded hospital access to rural areas in 1946, but w/ a lack of workers and patients, many hospitals shut down Hospitals now need to fill a certificate of need to prove the area needs a hospital in order for one to be built |
| Top 3 determinants of health for college-aged students | Health behavior - sleep, diet, physical activity, alcohol Environment - Physical (pollution, air quality) and social (living conditions, friends/family) environment Family history/Genetics |
| Health behaviors leading to depression and anxiety for college aged students | Isolation, Increased screen time, decreased physical activity, disrupted/lack of sleep, and poor nutrition |
| SNF | Patients that are require 24-hour monitoring, daily skilled nursing, or intensive rehabilitation after hospital stay, paid by medicare |
| Assisted living | Seniors/adults that need help with daily tasks (ADLs/IADLs) but not nursing care (not skilled care), Paid out of pocket. |
| Home health care | Homebound patients, SNF qualified, care is intermittent, and physician ordered, primary paid by Medicare |
| Home care | Not health care, it’s custodial care (typically a struggle with 2 ADLs/IADLs) received at home, paid for OOP |
| Hospice | People with 6 or less months due to terminal illness (and agree to not seek curative treatment), focus on mental/spiritual well-being, paid by medicare |
| Adult day services | Cognitive impaired adults paid by medicare (adult day health services) but social day services provide care services paid by out-of-pocket |
| Spend down | The concept where a person goes to a hospital and then SNF, covered under medicare. However, they stay past 100 days having to pay out of pocket, until they are able to claim medicaid due to low income. |
| Minimum data set | under the OBRA 1987 (nursing home reform act), determines quality and pay for nursing homes, state inspections, and written care plans DRG bundling incentives nursing homes to improve quality |
| Outcome Assessment and Information Set | Determines pay and quality for HHC |
| OBRA 87 (Nursing home reform act) | Created the MDS - minimum data set which determines pay and quality for nursing homes, also started state inspections that regulated quality of care (check for deficiencies) and written care plans |
| Direct care workers | Perform hands-on care for people who need skilled and custodial care Training requirement for skilled care but none for custodial care Demographic is a 25-44 year old minority females (stagnant) while aging population is growing |
| DCW turnover | Lack of satisfaction w/ worker empowerment, worker respect, and supervision quality Consequences are more turnover (quit), decrease quality (bad experience/workers), and higher costs for companies employing DCWs (retraining) |
| EDs | Utilized by uninsured patients since Outpatient acute care facilities (urgent cares) can deny them |
| Moral hazard | Concept of people using healthcare more if they have health insurance Ex - mothers who have insurance taking their baby to pediatricians more over a sickness compared to moms who don’t (“might as well because they can”) |
| Outpatient acute care facilities | Individuals w/ health insurance are likely to because they r typically quicker & cheaper for minor conditions than EDs Can deny uninsured |
| Hospitals | Don't make profit on patient care, rather use parking and gift shops |
| Managed care | Plans that contract patients with health care providers to provide care at reduced costs (HMO, PPO, POS, EPO). A gatekeeper is someone that can deny referrals like a PCP in HMO and PPO insurance plans |
| Health maintenance organization | Restrictive, cheapest premium, must get referral from primary care provider and stay in network (out of network services will be full price) |
| Preferred provider organization | Less restrictive than HMO, can go out of network if you pay more (out of network isn’t full price, but still more expensive than in-network). Most popular provider |
| Point of Service | Most expensive premium, close to traditional indemnity but allowed the most choices Still need PCP referral like HMO |
| Retrospective payment (fee for service) | Doctors get to charge insurance based on how much the service cost after the service is done Old model for health care payment |
| Prospective payment | Doctors get fixed amount based on the patient’s diagnosis & treatment, doctors know how much will be paid before service |
| Complementary therapy | Used along with conventional medicine Ex - Chiropractic care, acupuncture, and yoga |
| Alternative therapy | Treatment used in place of conventional medicine Ex - Traditional Chinese medicine (acupuncture & herbs) and Ayurveda (traditional Hindu medicine theory, focuses on balance of bodily systems (fire, water, air - straight up chakra) |
| CAM medicine | Paid out of pocket because “they aren’t proven to work” NCCIH (national center for complementary and integrative medicine) is barely funded so they can't prove it works (which would also make pharmaceutical companies lose money) |
| NCCIH (national center for complementary and integrative medicine) | Barely funded (1%) so they can't prove it works (which would also make pharmaceutical companies lose money) |
| Stress | Physiological response to perceived threats, not letting the parasympathetic nervous system relax. 70-80% of doctor visits are stress-related or stress-induced illness Stress contributes to 50% of all illness in the US |
| Can prescribe medication for mental health | Psychiatrist (MD), Nurse practitioners, and Physician’s Assistant. Psychologists, social workers, and counselors CANNOT prescribe medication |
| Maintain perspective | With regard to stress, what does “maintain perspective” mean? Keeping a balanced, objective, and realistic outlook ensures that immediate challenges are not blown out of proportion which makes you overwhelmed. Never streSS |
| Why nursing school is difficult to get into | Not a lot of nursing teachers |
| “You can’t medicate your way out of a bad lifestyle” | Expensive pharmaceutical or clinical treatments cannot prevent lifestyle changes US ranks low on health outcomes compared to other developed countries |
Created by:
phillipchristopherr