US HC Systems Exam 2 (Ch 7-11)questions and answers 2022

US HC Systems Exam 2 (Ch 7-11)questions and answers 2022Accountability Refers to the respective responsibility by clinicians and patients for the provision and receipt of efficient and quality health care services. Alternative medicine Also called "alternative and complementary medicine." Nontraditional remedies, for example, acupuncture, homeopathy, naturopathy, biofeedback, yoga exercises, chiropractic, and herbal therapy. Case management An organized approach to evaluating and coordinating care, particularly for patients who have complex, potentially costly problems that require a variety of services from multiple providers over an extended period. Community-oriented primary care Incorporates the elements of good primary care delivery and adds to this a population-based approach to identifying and addressing community health problems. Durable medical equipment Supplies and equipment to immediately consumed, such as ostomy supplies, wheelchairs, and oxygen tanks. Emergent conditions An acute condition that requires immediate medical attention. Free clinic A general ambulatory care center serving primarily the poor and the homeless who may live next to affluent neighborhoods. Free clinics are staffed predominately by trained volunteers, and care is given free or at a nominal charge. Gatekeeping The use of primary care physicians to coordinate health care services needed by an enrollee in a managed care plan Home health care Services such as nursing, therapy, and health-related homemaker or social services brought to patients in their own homes because such patients are generally unable to leave their homes safely to get the care they need. Hospice A cluster of special services for the dying, which blends medical, spiritual, legal, financial, and family-support services. The venue can vary from a specialized facility to a nursing home to the patient's own home. Medical home Refers to the quality features of primary health care delivery in the primary care settings such as physician office or community health center. Medically underserved A designation determined by the federal government. It indicates a dearth of primary care providers and delivery settings, as well as poor health indicators of the populace. The majority of this population group are Medicaid recipients. Nonurgent conditions Do not require the resources of an emergency service, and disorder is nonacute or minor in severity. Palliation Serving to relive or alleviate, such as pharmacological pain management and nausea relief. Primary health care Essential health care that constitutes the first level of contact by a patient with the health delivery system and the first element of a continuing health care process. Secondary care Routine hospitalization, routine surgery, and specialized outpatient care, such as consultation with specialists and rehabilitation. Compared to primary care, these services are usually brief and more complex, involving advanced diagnostic and therapeutic procedures. Telephone triage Refers to a telephone call-in system staffed by specially trained nurses who receive patients' calls. Using a computer system, they can access a patient's medical history and view the most recent radiology and laboratory test results. The nurses use standardized protocols to guide them in dealing with the patient's problem and consult with primary care physicians when necessary. If necessary, the staff can direct patients to appropriate medical services such as an ED or a physician's office. Tertiary care The most complex level of care. Typically, tertiary care is institution-based, highly specialized, and highly technological. Examples include burn treatment, transplantation, and coronary artery bypass surgery. Urgent care centers A walk-in clinic generally open to see patients after normal business hours in the evenings and weekends without having to make an appointment. Urgent conditions Require medical attention within a few hours; a longer delay presents possible danger to the patient; and the disorder is acute but not necessarily severe Homemaker services Nonmedical support services given to a homebound individual, for example, bathing, food preparation, house repairs, and shopping. International Classification of Diseases, 9th Version, Clinical Modification (ICD-9-CM) The official system of assigning codes to diagnoses and procedures. Do-not-resuscitate (DNR) orders Advance directives telling medical professionals not to perform CPR. Medical tourism Travel abroad to receive elective, non-emergency medical care. Palliative Serving to relieve or alleviate, such as pharmacologic pain management and nausea relief. Surgicenter A freestanding, ambulatory surgery center that performs various types of surgical procedures on an outpatient basis. Supply-side rationing Generally carried out by a government to limit the availability of health care services, particularly expensive technology. Upcoding A fraudulent practice in which a higher-priced service is billed when a lower-priced service is actually delivered. Voucher Approach to health insurance reform relies on individual decisions to purchase health insurance. Tax credits are issued in advance to individuals in the form of vouchers with which to offset the costs of purchasing health insurance. Emergency department Hospital facilities for the delivery of unscheduled outpatient services to patients whose conditions require immediate care. Staffed 24 hours a day. Medically underserved area (MUA) A federal designation for a geographic area that has a shortage of personal health services for its residents. Homeopathy A system of medicine based on the theory that "like cures like," meaning large doses of substances that produce symptoms of a disease in healthy people can be administered in small and diluted doses to cure the same illness. The system was founded in the late 18th century by a German physician, Samuel Hahnemann (). Mammography The use of breast X-ray to detect unsuspected breast cancer in asymptomatic women. Home health services Services such as nursing, therapy, and health-related homemaker or social services brought to patients in their own homes because such patients are generally unable to leave their homes safely to get the care they need. Package pricing Bundling of fees for an entire package of related services. Pediatrics General diagnosis and treatment for children. Speech therapy Therapy focusing on individuals with communication problems, including using the voice correctly, speaking fluently, and feeding or swallowing. Telemedicine Use of technology that enables physicians to conduct two-way, interactive video consultations or transmit digital images, such as X-rays and MRIs, to other sites. Outpatient services As opposed to inpatient services, outpatient services include any health care services that are not provided based on an overnight stay in which room and board costs are incurred. Ambulatory care Also referred to as outpatient services. Includes (1) care rendered to patients who come to physicians' offices, outpatient departments of hospitals, and health centers to receive care; (2) outpatient services intended to serve the surrounding community (community medicine); and (3) certain services that are transported to the patient. Adult day care A community-based, long-term care service that provides a wide range of health, social, and recreational services to elderly adults who require supervision and care while members of the family or other informal caregivers are away at work. Safety net Programs, generally government financed, that enable people to receive health care services when they lack private resources to pay for them. Paramedic Health care workers other than physicians who work as emergency medical technicians. Uncompensated care Charity care provided to the uninsured who cannot pay. Walk-in clinic A freestanding, ambulatory clinic in which patients are seen without appointments on a first come, first served basis. Out-of-pocket costs Costs of health care paid by the recipient of care. Carve out The assignment through contractual arrangements of specialized services to an outside organization because these services are not included in the contracts MCOs have with their providers or the MCO does not provide the services. Provisions in the ACA related to primary care include: 1. Increasing Medicare and Medicaid payments to primary care providers 2. Creating new incentives such as funding for scholarships and loan repayment for primary care providers working in underserved areas 3. Expanding the health center program and bolstering the capacity of health centers 4. Establishing additional training programs such as establishing 11 Teaching Health Centers for training primary care providers WHO three key elements of primary health care 1. Point of entry 2. Coordination of care 3. Essential care Institute of Medicine Key Definition of Primary Care 1. Integrated 2. Comprehensive 3. Coordinating 4. Continuity 5. Accessibility 6. Accountability What are the 5 main hospital-based outpatient services? 1. Clinical (special consultation) 2. Surgical 3. Emergency -Emergent require immediate attention -Urgent require attention within a few hours -Nonurgent, nonemergency used mostly by uninsured as substitute for primary care 4. Home health 5. Women's health -Women major users of healthcare due to a female majority -Change in culture towards women's equality -National priority List 5 reasons for growth in outpatient services: 1. Changes in reimbursement 2. Fewer payment restrictions 3. Development of new technology 4. Utilization controls 5. Social factors Academic medical center A term commonly used when one or more hospitals organize around a medical school. Apart from the training of physicians, research activities and clinical investigations become an important undertaking in these institutions. Accreditation A private undertaking designed to assure that healthcare facilitites meet certain basic standards. Seeking accreditation is voluntary, but the passage of Medicare in 1965 specified that accredited facilities were eligible for purposes of Medicare reimbursement. Advance directives Refers to the patient's wished regarding continuation or withdrawal of treatment when the patient lacks decision-making capacity. Intended to ensure that the patient's end-of-life wisher are carried out. Average daily census Average number of inpatients receiving care each day in a hospital. Average length of stay (ALOS) Calculated by dividing the total days of care by the total number of discharges. Board of trustees (also called governing body or board of directors) Consists of influential business and community leaders and is legally responsible for the operations of the hospital. The board has specific responsibilities for defining the hospital's mission and long-range direction; evaluating, from a strategic standpoint, major decisions such as incurring capital expenditures for building and equipment; approving annual budgets; and monitoring performance against plans and budgets. Certification Gives a hospital the authority to participate in Medicare and Medicaid. Chief of service Heads each specialty on the medical staff. Chief of staff Heads the medical staff. In all but the smallest hospitals, the medical staff are organizationally divided by major speicalties into departments, such as anesthesiology, internal medicine, obstetrics, and gynecology, orthopedic surgery, pathology, cardiology, and radiology. Community hospital Nonfederal, short-term, general or special hospital whose services are available to the public. Conditions of participation Health, safety, and quality standards developed by the Department of Health and Human Services (DHHS). They can be enforced for any hospital that participates in Medicare or Medicaid. They are intended to focus primarily on the actual quality of care furnished to patients and the outcomes of that care. Credentials committee Grants and reviews admitting privileges for those already credentialed and for new doctors whose skills are yet untested. Critical access hospital (CAH) Medicare designation for small rural hospitals with 25 beds or fewer that provide emergency medical services besides short-term hospitalization for patients with noncomplex health care needs. CAHs receive cost-plus reimbursement. Days of care The cumulative number of patient days over a certain period. Deemed status A designation used when a hospital, by virtue of its accreditation by the Joint Commission or the American Osteopathic Association, does not require separate certification from the DHHS to participate in the Medicare and Medicaid programs. Discharge Refers to the total number of patients discharged from a hospital's acute care beds in a given period. Deaths in hosptials are counted as discharges. Discharge rates per 1,000 population are important because all other inpatient use patterns depend on them. Do-not-resuscitate (DNR) order Advance directives telling medical professionals not to perform CPR. Through DNR orders, patients can have their wishes known regarding aggressive efforts at resuscitation. Durable power of attorney A written document that provides legal means for a patient to delegate authority to another to act on the patient's behalf, even after the patient has been incapacitated. Ethics committees Charged with developing guidelines and standards for ethical decision making in the delivery of helath care. Responsible for resolving issues related to medical ethics. These committes are multidisciplinary, includig physicians, nurses, clergy, social workers, legal expers, ethiccists, and administratiors. Executive committee Has continuing monitoring responsibility and authority over the hospital. Usually, it receives reports from other committees, monitors policy implementation, and makes recommendations. General hospital Provides a variety of services, including general and specialized medicine, general and specialized surgery, and obstetrics, to meet almost all medical needs of the community it serves. It provides diagnosic, treatment, and surgical services for patients with a variety of medical conditions. Most hospitals in the United States are general hospitals. Hospital An institution with at least six beds whose primary function is "to deliver patient services, diagnostic and therapeutic, for particular or general medical conditions." Infection control committee Responsible for reviewing policies and procedures for minimizing infections in the hospital. Informed consent A fundamental patient right to make an informed choice regarding medical treatment based on full disclosure of medical information by the providers. Inpatient Requiring an overnight stay in a healthcare facility Inpatient day (or patient day) A night spent in the hospital by a patient. Licensure Overseen by state governments and is a basic regulatory requirement for operation of a hospital. Living will A legal document in which a patient puts into writing what his or her preferences are regarding treatment during terminal illness and the use of life-sustaining technology. It is a directive instructing a physician to withhold or discontinue medical treatment when the patient is terminally ill and unable to make decisions. Long-term care hospital (LTCH) A special type of long-stay hospital described in section 1886(d)(1)(B)(iv) of the Social Security Act. LTCHs must meet Medicares conditions of participation for acute (short-stay) hospitals and must have an average length of stay greater than 25 days. LTCHs serve patients who have complex medical needs and may suffer from multiple chronic problems requiring long-term hospitalization. Magnet hospital A special designation by the American Nurses Credentialing Center, an affiliate of the American Nurses Association, to recognize quality patient care, nursing excellence, and innovations in professional nursing practice in hospitals. Medical records committee Ensures that accurate documentation is maintained on the entire regimen of care given to each patient. Also oversees confidentiality issues related to medical records. Moral agent Morally affects and is morally affected by actions taken.