WGU D050 - History of Healthcare in America QUESTIONS AND ANSWERS Correctly Solved 2023 score A+

WGU D050 - History of Healthcare in America QUESTIONS AND ANSWERS Correctly Solved 2023 score A+ When was healthcare first created in the United States? *ANS* 1798 Act for Relief of the Sick and Disabled Seaman What was created in 1915? *ANS* American Association for Labor Legislation... created in the model bill What was the precursor of Medicare and Medicaid? *ANS* Social security passed in 1935 What are the three main goals of ACA? *ANS* expand access to health insurance, reduce healthcare costs, support innovative delivery methods What area *medicare or medicaid* was improved by the ACA? *ANS* medicare How many children were on CHIP as of Feb 2020? *ANS* 6 million What year was medicare and medicaid formed? *ANS* 1965 What areas can Mezzo interactions influence? *ANS* organizations, schools, buisnesses and political relms What areas do Macro interactions influence? *ANS* interactions between healthcare workers and patients/support systems of patients What do macro indentify and influence? *ANS* systemic cause of health disparities (not the indiviual) What is the foundational reimbursement model used during the establishment of the Medicare and Medicaid programs. *ANS* Fee for service if a patient is readmitted to the hospital within 30 days for the same diagnosis, the hospital will receive a reduced payment *ANS* 30 day policy under value based healthcare Which fee-for-service model are lump-sum payments paid by nonprofit, for profit, and medical organizations? *ANS* membership fees What is an advantage of FFS? *ANS* being able to have a flexible schedule How many conditions do DRG classify? *ANS* 450 Which provision of value-based care is important when coordinating care for a patient with end-stage renal disease? *ANS* provide the best care at the lowest cost Which action could a healthcare coordinator take when providing value-based care to an obese patient? *ANS* provide follow up communication to support adoption of healthy behaviors A care coordinator is explaining value-based care to a patient with cancer. Which statement should be included in the teaching? *ANS* This model provides incentives to providers based on positive outcomes What are the four types of value based models? *ANS* share risks, bundles, global capitation, and shared savings environment consists of trends and changes in various areas, including inflation, employment, economics, and GDP. *ANS* macro trend enacted, administered, and enforced by the government (federal, state, and local) *ANS* laws and rules Centers for Medicare and Medicaid Services (CMS) sets quality standards for what areas? *ANS* standards for nursing homes and hospitals, diagnostic standards and billing codes How does CMS evaluate nursing homes? *ANS* rates the quality of US nursing homes through the Star rating program What standards are established (Medicaid) through CMS? *ANS* billing, diagnostic, and national policy standards What does the state level do with these standards? *ANS* implementation, provision, and day-to-day administration What is the CDC part of? *ANS* US public health service What is the main goal of the CDC? *ANS* standards surrounding control, detection, and prevention of communicable diseases while responding to public health emergencies Office for Civil Rights ensures what? *ANS* all individuals receiving services from HHS administered systems or programs are not subject to unlawful discrimination; privacy violations, enforces laws/regulations regarding sex, religion and race This agency not only detects waste, fraud, and abuse; it also works with federal and state law enforcement agencies to prosecute individuals or organizations that have violated federal health regulations and misappropriated healthcare dollars. *ANS* Office of Inspector General What is a nonprofit organization that oversees hospitals and other institutions that provide inpatient and outpatient care? *ANS* joint commission When was the national mental health act created? *ANS* 1946 at the end of WW2.... importance placed on PTSD What was the AMA created? *ANS* 1846; set national practice standards and overseeing licensing of doctors and physicians What was the first government run healthcare program? *ANS* UD Department of War Freedmans' Bureau Established Medicare Part A and Part B, which covered hospitalization and doctors' visits for persons age 65 and older, with some limited coverage for post-hospitalization skilled nursing care. *ANS* Title XVIII of the Social Security Act. E Established Medicaid, which provided public health coverage to poor families receiving Aid to Families with Dependent Children (AFDC) *ANS* Title XIX of the Social Security Act Under what president, did the amendment to social security act provide coverage to disabled individuals *ANS* nixon; added chronic kidney disease In the health maintenance act of 1973, what type of health insurance was promoted? *ANS* prepaid private group, HMO (in addition to fee for service plans) Health Information stored electronically which could be used to identify a patient is required to retain the utmost confidentiality, and providers are legally responsible for protecting this information. *ANS* security rule Patients retain full access to their health records and can restrict their disclosure and use. *ANS* privacy rule What is one of the most important court cases impacting healthcare delivery? *ANS* Tarasoff V Regents of University of California (duty to warn) What year was health maintenance organization act passed? *ANS* 1973 What year was Consolidated Omnibus Budget Reconciliation Act PASSED? *ANS* 1985 What was the main focus of COBRA? *ANS* allowing former employees to keep health insurance for a period after termination from job When was the balanced budget act passed? *ANS* 1997 When was medicare part D passed? *ANS* 2003 What is the duty to warn? *ANS* doctors can break confidentiality to warn person threated and law enforcement Who was the first social worker to challenge the mental health stigma? *ANS* Dorthia dix What was a major accomplishment for Dorthia Dix? *ANS* 32 state hospitals; creating a institution where mental health individuals can be treated by professionals In the 1940s and 1950s, what was a common treatment of hysteria? *ANS* lobotomy; destroying the frontal lobe and leaving individuals severely impacted and unable to function without assistance When did abuse in mental institutions become known to the public ? *ANS* 1960s during the civil rights movement Welsh v Likins year?` *ANS* 1972 Where was Welsch v Likins located? *ANS* Minnesota What was argued in Welsch V Likins? *ANS* confining people was cruel and unusual punishment and unlawful prisonment Rogers V Okin year? *ANS* 1975 Where did Rogers V Okin occur? *ANS* Boston State Hospital What did this case argue? *ANS* patients argued not to be involuntarily medicated in non/violent situations Olmested V LC? *ANS* 1990 What does this case argue? *ANS* mental illness is now defined as a disability by the Americans with Disabilites Act Olmested V LC results? *ANS* just because someone is mentally ill they do not have to be in a mental institution What reviews the design of scientific studies using human study subjects to ensure the safety and ethical responsibility of research proposals? *ANS* institutional review board Who makes up the IRB? *ANS* individuals in science, medicine, law and ethics Who signed in the National Research Act? *ANS* Nixon What are the three main principles of National Research Act? *ANS* respect for persons, beneficence, justice which disabled children were injected with radioactive minerals to study the effects of radiation sickness *ANS* Fernald State School Experiment Which act was created to offer provisions to protect the healthcare coordinator and other whistleblowers? *ANS* Health Information Technology for Economic and Clinical Health Act protect medical professionals from peer review-related lawsuits and encourage them to file official complaints after encountering unprofessional or dangerous peer conduct. *ANS* Healthcare Quality Improvement Act Where was the term death with dignity originate? *ANS* Oregon Active Voluntary Euthanasia *ANS* person A consents to Person B actively bringing death Active nonvoluntary euthanasia *ANS* Person B actively bringing person A deaTH. person A cannot consent Active involuntary euthanasia *ANS* person B brings death against person As wishes passive voluntary euthanasia *ANS* person A consents to person B withdrawing treatment Passive nonvoluntary euthanasia *ANS* person B withdraws treatment from person A (cannot consent_ Passive involuntary euthanasia *ANS* person B withdraws life saving treatment against Person A wishes Advocating for the right of terminal patients to refuse treatment. *ANS* right to die What is the legal document that sometimes is called a living will; that provides instruction on patients medical treatment wishes? *ANS* advanced directive What act created in 1990 requires health care providers to provide patients with the opportunity to have an advanced directive? *ANS* patient self-determination act When is a living will enacted? *ANS* when the patient cannot think/care for themselves What year was the first living will introduced to the house? *ANS* 1968 Karen Ann Quinlan case year?` *ANS* 1976 What did the Karen Ann Quinlan case encounter? *ANS* battle between medical professionals and the patients family to remove patient from breathing tube after a drug overdose. patients family wanted her off breathing tube and the medical professionals wouldn't remove it When did the Nancy Beth Cruzan case occur? *ANS* 1983 What did the Cruzan case consist of? *ANS* patient dependent on feeding tubes in which they were removed and it took 11 days for patient to pass by starving to death When did the Michelle Martin case occur? *ANS* 1987 What was the point of Martin case? *ANS* patient was not in a comatose state but could not function on his own. wife and friends wanted patient to be removed from feeding tubes and parents and family did not; court denied the wife and friends because the advanced directive was not in writing Theresa (Terri) Maria Schiavo case year? *ANS* 1990 What happened in the Schiavo case? *ANS* could not function and needed feeding tubes; Terri's parents wanted her on life support and husband did not want to continue this way; feeding tubes were removed 15 years after the accident What was the result of Karen Ann Quinlan's drug and alcohol overdose? *ANS* persistent veg state patient must be able to self-administer the life-ending medication, without assistance, prior to obtaining treatment. *ANS* physician assisted suicide Euthanasia occurs during a physician-assisted suicide and the patient must be fully *ANS* competent worked with government officials and jail staff to divert mental health offenders from jail systems to community-based treatment facilities. *ANS* Dorthea Dix work led to the creation of the National Mental Health Association and started the mental hygiene movement, which aimed to improve the treatment of patients in psychiatric institutions. *ANS* Clifford Beers What act introduced civil rights for patients and significantly reduced experiments? *ANS* National Mental Health Act What states allow physician assisted suicide? *ANS* CAlifornia, colorado, DC, Hawaii, Oregon, vermont, montana and washington and maine HIPAA Title I coverage? *ANS* health care access, protability, and renewability **same premium for all members HIPAA Title II coverage *ANS* administration simplification When was the transaction and code sets rule? *ANS* 2000; under HIPAA Title II What did the transaction and code sets rule allow? *ANS* standardizes how healthcare transitions and related diagnosis are classified and billed (ICD CODES) When was the NPI rule enacted? *ANS* 2006; helped stimulate wider adoption of EMR by assigning identifying numbers to providers Health Information Technology for Economic and Clinical Health (HITECH) Act: *ANS* 2009; determines what a breach is and how to notify who is impacted HIPAA Omnibus Rules: *ANS* Enacted which expanded the definition of "covered entity" under HIPAA. Who are the covered entities under the HIPAA omnibus rule? *ANS* healthcare providers, hospitals and insurance What do covered entities do? *ANS* assess risk and compliance gaps and maintain appropriate administrative, technical, and physical safeguards and a formal complaint process When was Medicare and Medicaid established? *ANS* 1965 by pres johnson as an amendment to the social security act What is unique about Medicaid? *ANS* federal matches funds given by state gov audit post-payments procedures and claims. *ANS* medicaid recovery audits To avoid fraud, providers are required to submit all claims within *ANS* one year of service; bundle billing identifies diagnosing and treatment errors and recoups funds when errors are identified. *ANS* comprehensive error rate testing The insured person—the individual who purchases insurance from the insurance company *ANS* Layer I The insurance company and providers—the organization that manages the insurance policy *ANS* Layer II The insurance policy—the policy that is purchased by the first party and managed by the second party *ANS* Layer III Establishes new protocols for service and payment structures. *ANS* office of attorney general Represents the legality of third-party payments and offers legal enforcement of established practices. *ANS* department of justifce Regulates the accuracy of services rendered vs. services paid. *ANS* dept of health and human services What are third party audits regulated by? *ANS* 2005 deficit reduction act In substance abuse case planning, what should the care coordinator do? *ANS* chief gatekeeper and main support system for pt, facilitate services/resources, involve the client, be community based and be flexible What is the goal outcome for intensive case management? *ANS* employability, housing, mental health stability, and social status, education, food When did intensive based care originate? *ANS* inception of mass deinstitutionalization ICM has 5 main principles. what are they? *ANS* family based, individually tailored, strengths-based, sustanibility and goal focused What are the three main concepts of strength based care plans? *ANS* self-worth, self-determination, and self-regulation Where did the strength based care plan originate? *ANS* University of Kansas due to failing health system What are the six main strengths of the strength based care plan? *ANS* focus on patient not pathology, self-determination, community based resources, intervention should be aggressive, patients can learn/grown/change What is the goal of the brokerage case model? *ANS* assess client immediate needs and link them to community resources (broker a deal) What is the brokerage case model also known as? *ANS* generalist case management model What did the brokerage case model stem from? *ANS* substance and mental abuse (mandated treatment programs AA) What is the clinical case management model also known as? *ANS* rehabailitive model What is unique about the clinical case management model/ *ANS* highly unique per patient What are the four common care models? *ANS* patient centered medical home, population health management, guided care model, and accountable care organizations This care delivery model was developed and promoted by the Agency for Healthcare Research and Quality. *ANS* PCMH goal of PCMH *ANS* create a team of care providers who work together to provide comprehensive, coordinated care to patients via a dedicated primary-care team and connected specialists. Developed and licensed by Johns Hopkins University School of Medicine, this unique model of care delivery uses a proprietary set of tools, training, and methods for certified nurses to help manage and guide care for complex patients with multiple chronic conditions. *ANS* guided care model comprehensive health and clinical health outcomes of specific groups are studied, and this information is used to help understand why some populations are healthier/sicker than others. *ANS* population health management Accompanies a patient to meetings and appointments *ANS* intensive case management model clinical case manager may visit at-risk communities of substance abusers *ANS* clinical case management model originated due to a flooding of deinstitutionalized patients into the community who realized their right to refuse treatment. *ANS* strengths based case management Why did Public Law 92-603 expand the initial Medicare and Medicaid requirements for utilization review? *ANS* develop a professional standards review What is a benefit for providers using a fee for service system? *ANS* rewards provider based on volume of services provided What body is responsible for approving/disapproving human subject related activities? *ANS* institutional review board review Which law lowers the cost of healthcare for households under the poverty level? *ANS* patient protection and affordable care act Which legislation prohibits the transfer of a patient due to inability to pay *ANS* emergency medical treatment and active labor acgt Why did Public Law 92-603 expand the initial Medicare and Medicaid requirements for utilization review? *ANS* Medicare hospice benefit Why was the prospective payment system established? *ANS* slow down the rate of spending in healthcare Which case management technique emerged with the advent of DRGS? *ANS* critical pathways