HCA Exam 2 Questions and Answers

What are some of the main challenges and/ or changes posed by the growing use of technology in the U.S.? - Answer- technology is costly/ needs research rise of customer expectations organization of medical services changed driven scope and content of medical training assessment complex social/ ethical concerns how do we define the term medical technology - Answer- application of scientific knowledge to improve health and make efficient development nanotechnolgy - Answer- nano science and nanotechnology are the study and application of extremely small things and can be used across all the other science fields, such as chemistry, biology, physics, materials science and engineering what are the three main types of information technology used in medical care delivery? - Answer- clinical information administrative information systems decision support systems clinical information systems - Answer- supports patient care delivery and clinical decision making include electronic medical records medical informatics encompass IT application that are designed to improve clinical efficiency, accuracy, and reliability administrative information systems - Answer- enable the organization to carry out financial and administrative support functions decision support systems - Answer- provide analytical tools for managerial decision making what are the four primary characteristics of electronic health records (EHRs)? - Answer- 1. collection/ storage of health info on patients over time 2. immediate electronic access to person and population level info 3. availability of knowledge and decision support 4. support of efficient processes for health care delivery HITECH act - Answer- health information technology for economic and clinical health act created to motivate the implementation of electronic health records and supporting technology in the US with financial incentives e-health - Answer- broad coverage of electronic health services m-health - Answer- mobile health, fitbit wearable devices e-therapy - Answer- mental health/ substance abuse concern telemedicine - Answer- virtual distance medicine what are some factors that drive innovation and technology diffusion - Answer- anthro-cultural beliefs and values medical specialization financing and payment technology-driven competition expenditure on research and development supply-side controls government policy technological imperative - Answer- implies the use of technology without cost considerations, especially when the benefits to be delivered the use of technology are small compared to the costs governments role in technology diffusion - Answer- government funds 46% of medical technology R&D in the US aside from development, they have a responsibility to intervene and ensure safety measures are in place as technology is introduced into the marketplace (via the FDA) responsibilities of the food and drug administration - Answer- government roles in tech diffusion regulation of drugs, devices and biologics evolution of the approval process drugs from overseas securing the supply chain regulation of medical devices and equipment regulation of biologics current federal legislation that regulates drugs and medical devices - Answer- FDA CON laws required hospitals to seek approval before acquiring major equipment/ projects certifications of need is an endorsement that numerous states require before approving the construction of a new health- care facility. the central idea of con legislation is the assertion that overbuilding and redundancy in health-care facilities leads to higher health-care costs classes of medical devices - Answer- 1. low risk 2. suntan booths, braces use and function 3. premarket approval health technology assessment - Answer- any process of examining and reporting properties of a medical technology used in health care, such as safety, effectiveness, feasibility, and indications for use, cost, and cost-effectiveness, as well as social, economic and ethical consequences, whether intended or unintended financing - Answer- purchase of insurance moral hazard of financing - Answer- if i have insurance, i will use it 1. patients consume more 2. leads to higher utilization or moral hazard financing influences the supply and distribution of health professionals four principles of insurance - Answer- 1. risk is unpredictable for the insured 2. risk can be predicted with reasonable accuracy 3. insurance mechanism transfers risk from the individual to the group 4. members of insured group share losses principle cost of sharing - Answer- **out of pocket not covered deductible- cost you pay until insurance kicks in copayment- overtime you see a provider coinsurance- a percentage you have to pay what is the purpose of a stop loss provision in an insurance plan - Answer- annual out of pocket max or stop loss - once you pay enough in the year then you stop paying this helps so that people aren't spending a ton of money paying deductibles all of the time. once they hit a certain number they no longer have to pay these deductibles. protects against catastrophic loss 4 types of private insurance - Answer- managed care plans (HMO and PPO) group insurance self insurance individual private health insurance HMO - Answer- in a network, one set PCP PPO - Answer- no referral from PCP needed, higher out of pocket group insurance - Answer- coverage to members of a group that tends to be employees of a company members of the group usually receive insurance at a reduced cost because the insurers risk is spread across a group of policyholders self insurance - Answer- a person does not take out any third party insurance or a business that is liable for some risk chooses to carry the risk itself and not take out insurance through an insurance company individual private health insurance - Answer- purchase on your own for you or your family, not through an employer 6 ACA provisions impacting private coverage - Answer- 1. insurers mandated to enroll young adults until age 26 under parent's plans 2. illegal to charge more or refuse coverage for preexisting conditions 3. all health plans had to include certain essential health benefits 4. fees imposed on insurers for selling plans through the exchanges 5. medical loss ratio (MLR) 6. legal US residents required to have health insurance or else pay a penalty tax medicare - Answer- insurance for those over 65 medicaid - Answer- those below the poverty line depending on state CHIP - Answer- children under the age of 19 free clinics/ ER - Answer- open to everyone with or without insurance vets/ military - Answer- government funded VA hospitals medicare part a - Answer- hospital insurance that covers inpatient hospital care, skilled nursing care, home health care, hospice care medicare part b - Answer- voluntary program that covers doctors services, outpatient care, preventative services, diagnostic tests, some therapies, durable medical equipment medicare c - Answer- medicare advantage includes all benefits from a and b, run by medicare-approved private insurance companies, usually includes part d, may include extra benefits and services at extra costs medicare d - Answer- voluntary program offering coverage to part a or b enrollees, helps cover cost of prescription drugs run by medicare-approved private insurance companies, doughnut hole medicaid - Answer- finances health care for the poor almost entirely a taxpayer-financed program means-tested program (eligibility depends on financial resources) rules for eligibility medicaid enrollment and spending CHIP - Answer- federal block grants to states covers children up to age 19 no federal income threshold states cover children in families with incomes up to 300% of the FPL reimbursement models - Answer- fee for service bundled payments resource-based relative value scale value-based reimbursement retrospective payment (cost plus) prospective payment diagnosis related group - Answer- gives standardized prospective price to people with the same diagnosis and tries to contain cost outpatient care - Answer- services not provided with an overnight stay ambulatory care growth in outpatient services - Answer- change in reimbursement development in new technology utilization controls social factors primary care - Answer- most basic initial interaction central role in delivery system distinguish from 2ndry and tertiary by duration, frequency, and intensity (more complex) primary care - Answer- basic most frequent first interaction secondary care - Answer- more complex and specialized seen less frequently specialist, routine surgery, rehab tertiary care - Answer- most complex uncommon highly specialized trauma, burn, NICU, transplants and open heart surgery domains of primary care - Answer- point of entry coordination of care essential care provisions of ACA that address primary care - Answer- increased medicare and medicaid payments new incentives for primary care providers working in undeserved areas expansion of health center program and strengthening the capacity of health centers creation of additional training programs patient centered medical home - Answer- team-oriented approach for special-needs children requiring constant care coordinations initially consisted of an interdisciplinary team of physicians and allied health professionals studies demonstrate positive impact with assessment tools private practice - Answer- physicians from the backbone of ambulatory care hospital based services - Answer- clinical services surgical emergency home health women's services freestanding facilities - Answer- walk in clinics urgent care surgery centers retail clinics mobile, medical, diagnostic and screenings emts paramedics home health care - Answer- nursing care medication monitoring bathing short term rehab homemaker medical equipment hospice care - Answer- comprehensive services for terminally ill (6 months or less) psychological support and spiritual support specific condition for medicare certification