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CHAPTER 3
Health Care Settings Key Terms
| Question | Answer |
|---|---|
| ACTIVITY OF DAILY LIVING (ADL) | Bathing, dressing, grooming, going to the toilet, mealtime assistance, travel training and accessing recreation services |
| ACUTE CARE FACILITY (ACF) | A hospital that provides health care services to pts who have serious, sudden or acute illnesses or injuries and/or who need certain surgeries. Provide full range of services including emergency & critical care, surgery, obstetrics, etc. |
| ACUTE HOSPITAL CLASSIFICATION | Same as short term hospital classification; Average LOS of 4-5 days and a total LOS of less than 25 days |
| ADMINISTRATION FOR CHILDREN AND FAMILIES (ACF) | Responsible for programs that provide services and assistance to needy children and families |
| ADMINISTRATION ON AGING (AoA) | Supports a nationwide aging network providing services to the elderly to enable them to remain independent |
| ADULT DAY CARE | Provides care and supervison in a structured environment to seniors with physical or mental limitations. |
| AGENCY FOR HEALTHCARE RESEARCH AND QUALITY (AHRQ) | Supports research designed to improve the outcomes and quality of health care, reduce its costs, address pt safety and med errors and broaden access to effective services |
| AGENCY FOR TOXIC SUBSTANCES AND DISEASE REGISTRY (ATSDR) | Works w/ states and other federal agencies to prevent exposure to hazardous subs from waste sites |
| ALZHEIMER’S TREATMENT FACILITIES | Has some of the same things as ALF's but more extensive monitoring of residents and day to day care. |
| AMBULATORY CARE | Outpt care, no inpt hospitalization; care given in a freestanding or hospital based facility |
| AMBULATORY INFUSION CENTER (AIC) | Freestanding center that admins prescribed meds by IV to ambulatory pts. |
| AMBULATORY PATIENTS | Outpts that are treated and released the same day and do not stay overnight. Max LOS is 23 hrs, 59mins, 59secs |
| AMBULATORY SURGICAL CENTER (ASC) | Surgery performed on outpt basis at freestanding ambulatory surgical center. |
| AMBULATORY SURGERY PATIENT | Pts that undergo certain procedures that can be performed on an outpt basis with treatment and release on same day. LOS max of 23 hrs, 59mins, 59secs |
| ANCILLARY SERVICES | Diagnostic & therapeutic servies provided to inpts and outpts (labs, PT, etc) |
| ASSISTED-LIVING FACILITY (ALF) | Combo of housing and supporte services inclding personal care with ADL's and meals; not a nursing facility |
| BED COUNT | bed size-total # of inpt beds for which the facility is licensed by the state. |
| BED SIZE | bed count-total # of inpt beds for which the facility is licensed by the state. |
| BEHAVIORAL HEALTH CARE HOSPITAL | Specialize in treating individuals with mental health diagnoses. |
| BUREAU OF PRISONS (BOP) | Provides necessary medical, dental and mental health servies to inmates; provide inmate ambulatory care |
| CAFETERIA PLAN | Provides subscribers and employees w/ a choice of HMO, PPO or traditional health insurance plan AKA: Triple Option Plan or Fleible Benefit Plan |
| CAPITATION PAYMENT | Lump sum paid by the HMO to care for a group of subscribers |
| CENTERS FOR DISEASE CONTROL AND PREVENTION (CDC) | Provides a sstem of health surveillance to monitor and prevent outbreak of diseases |
| CHEMICAL DEPENDENCY PROGRAM | 24 hour medically directed eval and w/drawal management in an acute care inpt setting |
| CHEMOTHERAPY | IV administration of chemical agents that have specific and toxic effects upon a diease causing cell |
| CLINICAL LABORATORY | Stand alone lab that performs tests in microbiology, clinical chemistry and toxicology |
| CLINIC OUTPATIENT | Recieves scheduled diagnositc and therapeutic care (chemo) following an inpt stay |
| CLOSED-PANEL HMO | Includes group and staff models that provide services at HMO owned centers/clinics or by physians who belong to specially formed group that serves the HMO |
| CONTINUING CARE RETIREMENT COMMUNITIES (CCRC) | Provide difft levels of care based on the residents need from independent living quarters to skilled nursing care |
| COPAYMENT | A fixed amount a subscriber must pay when seeking health care services |
| CORRECTIONAL FACILITIES | Houses inmates and provides secure environment that offers vocational and edu advancement. Med, dental and mental health care are provided |
| CRISIS SERVICES | Provides short term less than 14 days crisis intervention and treatment; pt receive 24 hr supervision |
| CRITICAL ACCESS HOSPITAL (CAH) | Located more than 35 miles from any other hospital or other CAH OR they are state certified as being a necessary provider of health care to area residents |
| CURATIVE CARE | When the plan of care is to cure rather than give palliative care |
| DAY TREATMENT PROGRAM | Intensive tx program privided to pts who live in the community but come to the facility up to five days per week |
| DEMENTIA CARE FACILITIES | Has some of the same things as ALF's but more extensive monitoring of residents and day to day care. |
| DEVELOPMENTALLY DISABLED/MENTALLY RETARDED FACILITIES | Can be an intermediate care facility; provide residential care and day programming like academic training, clinical & technical assistance, health care sercies and dx and eval of those w/ devel. disabilities |
| DIAGNOSIS-RELATED GROUPS (DRG’S) | Used by inpt prospetive payment system to classify inpt cases into groups that are expected to consume similar hospital resources. |
| DIRECT CONTRACT MODEL HMO | Individual docs in the community deliver contracted health care services to subscribers |
| DRUG THERAPY | IV administration of antibiotics, antivirals etc |
| DURABLE MEDICAL EQUIPMENT (DME) | Canes, crutches, IV supplies, hospital beds, ostomy supplies, oxyen, prostheses, walkers, wheelchairs, etc |
| EMERGENCY CARE CENTER | Same as urgent care center; Immediate care is provided by onduty doc usually salaried. Center is usually owned by private corps or non profit facilities |
| EMERGENCY CARE PATIENT | Treated for urgent problems like trauma and are released that same day or admitted as inpt |
| EXCLUSIVE PROVIDER ORGANIZATION (EPO) | Provides benefits to subscribers who receive health care services from network providers that are under contract to the managed care plan |
| FAMILY PRACTITIONERS | Provide care for the entire family and focus on general med, obstetrics, peds and geriatrics |
| FAMILY SUPPORT SERVICES | Services are provided to assist families in caring for the pt |
| FEDERAL CERTIFICATION | Measures the ability of health care facilities to deliver care that is safe and adequate in accordance w/ federal law |
| FEDERAL MEDICAL CENTERS (FMC’S) | Provide major medical care to inmates |
| FLEXIBLE BENEFIT PLAN | Provides subscribers and employees w/ a choice of HMO, PPO or traditional health insurance plan AKA: Triple Option Plan or Fleible Benefit Plan |
| FOOD AND DRUG ADMINISTRATION (FDA) | Assures the safety of foods and cosmetics and the safety of and efficacy of pharmaceuticals, biological products and medical devices. |
| GENERAL HOSPITALS | Provide emergency care, perform general surgery and admit pts for a range of problems from fractures to heart disease based on licensing by the state |
| GROUP MODEL HMO | Participating docs who are members of an independent multi specialty group provide health care services. Phys groups either contract w/ the HMO or are owned or managed by it. |
| GROUP PRACTICE WITHOUT WALLS (GPWW) | Managed care contract in which physicians maintain their own offices and share services w/ plan members |
| HEALTH MAINTENANCE ORGANIZATION (HMO) | Prepaid health care |
| HEALTH RESOURCES AND SERVICES ADMINISTRATION (HRSA) | Provides resources for medically underserved populations, works to build the healthcare workforce, maintains the Natl Health Service Corps, oversees the organ transplant system, works to decrease infant mortality, improve child health, care for AIDs pts |
| HEART AND VASCULAR CENTER | Ambulatory cardiovascular services that include diagnosis, tx, prevention, research, educ, rehab. |
| HOME CARE | A team of specially trained staff visit the pt in the home to develop a tx program and care is provided in the home. |
| HOME INFUSION CARE | Provided by home health care agenscies when IV administration of meds is needed and tx is given at the home instead of on an inpt basis |
| HOSPICE CARE | Comprehensive medical and supportive social, emotional, and spiritual care to terminally ill pts and their families. |
| HOSPITALISTS | Physicians who spend most of their time in a hospital setting admitting pts to their inpt services from local primary care providers. |
| HOSPITAL OWNED PHYSICIAN PRACTICE | Partially owned by the hospital and physicians participate in a compensation plan provided by the hospital |
| HYDRATION THERAPY | IV admin fluids, electrolytes, etc |
| IMAGING CENTER | Freestanding fac that provides xray, MRI, PET, CT to ambu pts. |
| INDEPENDENT PRACTICE ASSOCIATION (IPA) | Same as individual practice association; Docs who remain in their independent offices but provide contracted care to subscribers; negotiates the HMO contract and manages capitation pymnt |
| INDIAN HEALTH SERVICE (IHS) | Supports a network of indian health centers to provide servies to 1.5 million American Indians and Alaska Natives |
| INDIVIDUAL PRACTICE ASSOCIATION (IPA) | Docs who remain in their independent office settings provide contracted health care services to subscribers. IPA negotiates the HMO contract and manages the capitation payment |
| INDUSTRIAL HEALTH CLINIC | Located in a business setting like a factory the emphasis is on emp health and safety |
| INFUSION CENTER | Freestanding that dispenses/admins prescribed meds by infusion |
| INPATIENTS | Stay overnight for 24 or more hours, provided w/ room and board and nursing services. |
| INTEGRATED DELIVERY SYSTEM (IDS) | Organization of affiliated provider sites that offer joint health care to subscribers; include ambu surgical centers, hospitals, physician groups, etc |
| INTEGRATED PROVIDER ORGANIZATION (IPO) | Manages health care services provided by hospitals, physicians and other organizs. |
| INTENSIVE CASE MANAGEMENT | Specially trained individulas coordinate and/or provide mental health, financial, legal and medical servies to help the pt live successfully at home and in the community |
| INTERMEDIATE CARE FACILITY (ICF) | Provides developmentally disabled people w/ medical and supervision, nursing services, occupational and physical therapies, activity programs, educ, rec & phyc services. Help w/ ADL's, meals, housekeeping meds. Are state licensed; can get reimb by med |
| INTERNAL MEDICINE PHYSICIANS | Special in care of adults |
| LONG TERM CARE | Nursing, social and rehav services for pts who need ongoing assistance. LOS average greater than 30 days |
| LONG TERM CARE HOSPITAL (LTCH) | Average inpt stay of more than 25 days |
| LONG TERM HOSPITAL CLASSIFICATION | Average LOS of greater than 25 days |
| MANAGED CARE | A concept NOT a type of health care facility; was a prepaid health care sector (HMO) but can be a PPO and some indemnity coverage |
| MANAGEMENT SERVICE ORGANIZATION (MSO) | Provides practice managment servieces including administrative and support services to individual physician practices |
| MEDICAL FOUNDATION | Nonprofit organization that contracts w/ and acquires the clinical and business assets of physician practices |
| MEDICAL NECESSITY | Requires the documentation of services or supplies that are proper and needed for the dx or tx of a medical condition |
| MILITARY HEALTH SYSTEM (MHS) | Administers health care for active members of the uniformed services and their dependents as provided by military tx facilities and networks of civilian health care professionals |
| MILITARY MEDICAL SUPPORT OFFICE (MMSO) | Coordinates civilian health care services when MTF services are unavailable |
| MILITARY TREATMENT FACILITY (MTF) | Is a clinic and or hospital located on a US military base |
| MULTI HOSPITAL SYSTEMS | Hospital systems are 2 or more and owned, managed or leased by a single organization; can be acute, long term, ped, rehab and/or psychiatric care facilities |
| MULTI SPECIALTY GROUP PHYSICIAN PRACTICES | Offer various med specialty care in one organiz and may be located in more than one location. |
| NATIONAL COMMISSION ON CORRECTIONAL HEALTH CARE (NCCHC) | Provies an external peer review process for correctional institutions that wish to meet its nationally accepted standards for health services |
| NATIONAL INSTITUTES OF HEALTH (NIH) | Worlds premier medical research organiz, w/ research projects for cancer, alheimer's, diabetes, arthritis, heart ailments and AIDS |
| NEIGHBORHOOD HEALTH CENTER | Care provided to economically disadvan; illnesses may result from crowded living conds, unsanitary fac; Physician, RN and social worker. |
| NETWORK MODEL HMO | 2 or more docs multi specialty group practices provide contracted health care services to subscribers |
| NETWORK PROVIDERS | Physicians and health care facilities under contract to the managed care plan |
| NEWBORN PATIENTS | Receive infant care upon birth; receive neonatal intensive care w/i hospital or as the result of transfer to another hospital |
| NURSING FACILITY (NF) | Same as skilled nursing facility;Provides med nec care to inpts on a daily basis that is performed by or under the superv of skilled med personnel giving IV therapy, rehab, wound care |
| OBSERVATION PATIENTS | Receive services furnished on a hospital's premises that are ordered by a physician including use of a bed and periodic monitorying which are reasonable and necessary to evaluate an outpts condition or determine the need for admission |
| OPEN-PANEL HMO | Icludes direct contract, individual practice assoc and network models; docs are NOT employees of the MO and do NOT belong to a specially formed medical group that serves the HMO |
| OUTPATIENT CARE | Same as ambulatory care; Care that allows the pts to receive care in one day w/o inpt hospitalization |
| OUTPATIENT CLINIC | Pts receive FU mental health care and visits are under one hour. |
| OUTPATIENTS | Same as ambulatory pts; Pts who are tx and released the same day-no overnighters; max LOS is 23hrs, 59mins, 59secs |
| PAIN MANAGEMENT | IV admin of narcotics designed to relieve pain |
| PAIN MANAGEMENT CENTER | Specializes in txing pain syndromes using meds and procedures; physiatrists,psychs, neurologists, neurosurgeons, internists, PT and OT |
| PALLIATIVE CARE | Comfort management as opposed to cure |
| PARTIAL HOSPITALIZATION PROGRAM | Program for hospital pts who regularly use the hospital facilities for a substantial # of day or night hours |
| PEDIATRICIANS | Provide comprehensive services for infants, children, adoleschents |
| PERSONAL CARE AND SUPPORT SERVICES | Provides assistance in performing daily living activies |
| PHYSICIAN HOSPITAL ORGANIZATION (PHO) | Managed care contracts are nego'd by hospitals and phys groups. Physns maintain their own practices and provide services to plan members. |
| POINT OF SERVICE PLAN (POS) | Pts have freedom to use an HMO or to self refer but pay greater out of pocket expenses |
| PREADMISSION CERTIFICATION (PAC) | Is a form of utilization management that involves the review for medical necessity of inpt care prior to inpt admission |
| PREFERRED PROVIDER ORGANIZATION (PPO) | A network of docs and hospitals join together to contract w/ 3rd party payers, employers etc to provide health care to subscribers for a discounted fee. |
| PRIMARY CARE CENTER | Offers adult and famicly care medicine in internal medicne, peds and family practice. |
| PUBLIC HEALTH DEPARTMENT | Provides preventive medicine services such as well baby clinics, which include immunizations and routine checkups |
| REFERRED OUTPATIENT | Recieves diagnostic/therapeutic care because this care is unavailable in the primary care providers office. |
| REHABILITATION FACILITY (OUTPT) | Provides occupational, physical, speech therapy to pts with orthopedic injuries,work related injuries, sports related injuries and neurological and neuromuscular conditions |
| REHABILITATION HOSPITAL (INPT) | Admit pts who are diagnosed with trauma or disease and need to learn how to function again. |
| RESIDENTIAL CARE FACILITY (RCF) | Provides non medical custodial care; not allowed to provide skilled services but can help w/ ADL's |
| RESIDENTIAL TREATMENT FACILITY | Seriously disturbed pts receive intensive and comprehensive psychiatric tx on a long term basis |
| RESPITE CARE | Offers relief to primary caregivers by giving care at a setting other than the pts home |
| SATELLITE CLINICS | Ambulatory care centers that are established remotely from the hospital |
| SHORT TERM ACUTE HOSPITAL CLASSIFICATION | Average LOS of 4-5 days and a total LOS of less than 25 days |
| SINGLE HOSPITALS | Hospital is self contained and not part of a larger organization |
| SINGLE-SPECIALTY GROUP PHYSICIAN PRACTICES | Consists of 2 or more physicians who provide pts with one specific type of care |
| SKILLED CARE | Includes services that are ordered by a physician and provided under the supervision of a RN or physical, occupational or speech therapist. |
| SKILLED NURSING FACILITY (SNF) | Provides medically necessary care to inpts on a daily basis; under the superision of skilled med personnel; iv therapy rehab, wound care, PT speech therapy, etc |
| SOLO PHYSICIAN PRACTICES | Do NOT have physician partners or employment affils with other practice organzs. |
| SPECIALTY HOSPITALS | Concentrate on a particular population of pts or disease category (ex: kids or cancer) |
| STAFF MODEL HEALTH MAINTENANCE ORGANIZATION (HMO) | may be partially owned by the physician employees that are emps of the phys group owning the practice or the insurer. Paid a salary |
| STUDENT HEALTH CENTER | Provides health care to students who become ill or injured; allergy injections, birth control, health ed, shots, hiv testing, labs, meds, primary care and preventative med, std screening, smoking cessation and womens health care |
| SUBACUTE CARE | Provided in hospitals that provide specialized long term acute care such as chemo, rehab, ventilation, wound care for seriously ill pts. Usually do NOT offer full range of health care services available in acute care facilities. Costs less than acute |
| SUBSCRIBERS | Individuals who pay health insurance premiums |
| SUBSTANCE ABUSE AND MENTAL HEALTH SERVICES ADMINISTRATION (SAMHSA) | Works to improve the quality and availability of substance abuse prevention, addiction treatment and mental health services |
| SWING BED | Criteria that allows a rural hospital to admit a nonacute care pt |
| TEMPORARY ASSISTANCE TO NEEDY FAMILIES (TANF) | The new state federal welfare program |
| THERAPEUTIC GROUP HOME | 6-10 individuals are provided w/ supervised housing |
| TOTAL PARENTERAL NUTRITION (TPN) | Admin of nutritional subs by infustion to pts who are wither malnourished or have the ptotential for developing malnutrition |
| TRIPLE OPTION PLAN | Provides subscribers and employees w/ a choice of HMO, PPO or traditional health insurance plan AKA: Triple Option Plan or Fleible Benefit Plan |
| URGENT CARE CENTER (EMERGENCY CARE CENTER) | Immediate care given by on duty physician usually salaried; usually owned by private corps or non profit facilites |
| UTILIZATION MANAGEMNT | Controls health care costs and the quality of health care by reviewing cases for appropriateness and medical necessity |
| VENTILATOR | Breathing machine |
| VETERANS HEALTH ADMINISTRATION (VHA) | Agency in the Department of Veterans Affairs that provides medical, surgical and rehab care to vets of the armed services |
| VETERANS INTEGRATED SERVICE NETWORK (VISN) | Administers and provides health care services at VA medical centers and community based outpt clinics |
| PUBLIC HEALTH SERVICE (PHS) Part I | One of 7 uniformed services of the US and provides highly trained and mobile health profs who carry out programs to promote the nations health, prevent disease and injury, assure safe/effective drugs & med services, deliver health services to federal ben- |
| PUBLIC HEALTH SERVICE (PHS) Part II | ficieries and deliver health services to furnish health expertise in time of war or other emergencies |
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