ABQUARP
5 basic principles of ethical practice for CM - ANS J-justice ( treat all fairly)
A-autonomy-respect pt right to make own decision
N-non-malfeasance-do no harm
F-fidelity-keep your promise
B-beneficence-to do good
\6 major aims of health care - ANS safe, effective, patient -centered, timely, efficient and
equitable.
\AAAHC accreditation assoc for ambulatory health care - ANS accredits over 5k
ambulatory health care orgs.
\AAAASF-American ass for accreditation of ambulatory surgery facilities - ANS - improve
the quality of medical and surgical care in ambulatory surg facilities
\ACA- Affordable Care Act - ANS March 2010- 10 Titles
1-mandate health care coverage
3-test new ways to deliver care to pts-better care, lower cost
\ACO-accountable care org - ANS created under Medicare Shared Savings Program, of
the PPAC (patient protection and affordable care act)
-effective organization will lead to heath care system maximize their resources and
minimize their dysfunction
-network to manage at least 5k Medicare for at least for 3 years
-Needs own governing body
-receive shared savings, held liable for losses
\ACR-American college of radiology - ANS -medical imaging
\Active Error - ANS whose effects are felt immediately
-sharp end
\Adverse Events- stats: - ANS 1991-in 3.7% of hospitalization
27.6% due to negligence
70.5% of adverse events gave disability of >6m,
2.6% permanent
13.6% death
\Anti-Markup Rule - ANS Medicare Diagnostic tests- prohibits the markup of the technical
component and professional component
if the CPT codes exists on the CMS list, it is a diagnostic test
\APSF- anesthesia patient safety foundation - ANS First org to develop just to improve pt
safety
Dr. Pierce "40 y behind the mask" 1982
The Deep Sleep-6000 will dies was on 20/20 1982
\Avedis Donabedian MD - ANS Brought modern quality assurance techniques to modern
medicine.
\BBA-balanced budget Act - ANS 1997-comprehensive revision of federal statutes
governing Medicaid
, Revised 1999. Uses QISMC to set quality assurance provisions.
\C-SNP Chronic Special Needs plan - ANS Listed special conditions,
Others D-SNP dual eligible Medicare and Medicaid
\CAP-college of pathologists - ANS laboratories
\Capitated payment - ANS Enrollee is at full risk
\CARF-commission of accreditation of Rehab facilities - ANS disability, addiction and
substance abuse facility
\CER-comparative effectiveness research - ANS goal is to improve health outcomes by
developing and disseminating evidence based info to pt, providers of different health
treatment options.
\CHAP-community health accreditation prog - ANS not for profit accrediting body for
health hospice and DME
\claims made - ANS only during the time the policy was in effect
need tail coverage
\CMSA- Case Mgt Society of America - ANS 1995- put forth first standards of practice for
CM.
-communication, coordination and collaboration of health care
\CNC-Compromised Number Checklist - ANS 2011-Updated monthly of Medicare
beneficiary and provider ID # looking if any have been compromised
-appx 5000 providers and 280K beneficiaries were compromised.
\Continuous Quality Improvement - ANS uses a systematic process, enhance
performance. Looks at processes, not individual. ( ex laparoscopy, less hospt stay)
\CPI=center for program integrity - ANS 2010-integrate prevention, detection, recovery
and transparency and accountability
\credential vs competency - ANS credential-peer recommendation and aggregated info re
performance
competency- direct observation
\Credentialing - ANS Key part of QM.Make sure the right person , right knowledge in the
right position
\Data Sources Available for Profiling - ANS Administrative Date- billing, membership mgt,
pharm benefits-widespread availability
Medical Records-accurate clinical data, but high cost
Pt Derived Data-meaningful for pt outcomes, pt satisfaction (need non-responders)
\Demand Mgt - ANS 24 h hotlines and triage service
\Demings 7 deadly diseases - ANS lack of consistency, emphasis on short term profits,
eval of performanmce,job hopping, excessive medical cost, excessive liability
\disability - ANS alteration of an individuals capacity to meet personal, social or
occupational demands to d/t impairment
\Dr, Lucian Leape - ANS "Error in Medicine"
Promoter of pt safety
Culture change that to error is inevitable.
\Dr. Codman, Boston Surgeon - ANS started standards and accreditations in early 20th
century
5 basic principles of ethical practice for CM - ANS J-justice ( treat all fairly)
A-autonomy-respect pt right to make own decision
N-non-malfeasance-do no harm
F-fidelity-keep your promise
B-beneficence-to do good
\6 major aims of health care - ANS safe, effective, patient -centered, timely, efficient and
equitable.
\AAAHC accreditation assoc for ambulatory health care - ANS accredits over 5k
ambulatory health care orgs.
\AAAASF-American ass for accreditation of ambulatory surgery facilities - ANS - improve
the quality of medical and surgical care in ambulatory surg facilities
\ACA- Affordable Care Act - ANS March 2010- 10 Titles
1-mandate health care coverage
3-test new ways to deliver care to pts-better care, lower cost
\ACO-accountable care org - ANS created under Medicare Shared Savings Program, of
the PPAC (patient protection and affordable care act)
-effective organization will lead to heath care system maximize their resources and
minimize their dysfunction
-network to manage at least 5k Medicare for at least for 3 years
-Needs own governing body
-receive shared savings, held liable for losses
\ACR-American college of radiology - ANS -medical imaging
\Active Error - ANS whose effects are felt immediately
-sharp end
\Adverse Events- stats: - ANS 1991-in 3.7% of hospitalization
27.6% due to negligence
70.5% of adverse events gave disability of >6m,
2.6% permanent
13.6% death
\Anti-Markup Rule - ANS Medicare Diagnostic tests- prohibits the markup of the technical
component and professional component
if the CPT codes exists on the CMS list, it is a diagnostic test
\APSF- anesthesia patient safety foundation - ANS First org to develop just to improve pt
safety
Dr. Pierce "40 y behind the mask" 1982
The Deep Sleep-6000 will dies was on 20/20 1982
\Avedis Donabedian MD - ANS Brought modern quality assurance techniques to modern
medicine.
\BBA-balanced budget Act - ANS 1997-comprehensive revision of federal statutes
governing Medicaid
, Revised 1999. Uses QISMC to set quality assurance provisions.
\C-SNP Chronic Special Needs plan - ANS Listed special conditions,
Others D-SNP dual eligible Medicare and Medicaid
\CAP-college of pathologists - ANS laboratories
\Capitated payment - ANS Enrollee is at full risk
\CARF-commission of accreditation of Rehab facilities - ANS disability, addiction and
substance abuse facility
\CER-comparative effectiveness research - ANS goal is to improve health outcomes by
developing and disseminating evidence based info to pt, providers of different health
treatment options.
\CHAP-community health accreditation prog - ANS not for profit accrediting body for
health hospice and DME
\claims made - ANS only during the time the policy was in effect
need tail coverage
\CMSA- Case Mgt Society of America - ANS 1995- put forth first standards of practice for
CM.
-communication, coordination and collaboration of health care
\CNC-Compromised Number Checklist - ANS 2011-Updated monthly of Medicare
beneficiary and provider ID # looking if any have been compromised
-appx 5000 providers and 280K beneficiaries were compromised.
\Continuous Quality Improvement - ANS uses a systematic process, enhance
performance. Looks at processes, not individual. ( ex laparoscopy, less hospt stay)
\CPI=center for program integrity - ANS 2010-integrate prevention, detection, recovery
and transparency and accountability
\credential vs competency - ANS credential-peer recommendation and aggregated info re
performance
competency- direct observation
\Credentialing - ANS Key part of QM.Make sure the right person , right knowledge in the
right position
\Data Sources Available for Profiling - ANS Administrative Date- billing, membership mgt,
pharm benefits-widespread availability
Medical Records-accurate clinical data, but high cost
Pt Derived Data-meaningful for pt outcomes, pt satisfaction (need non-responders)
\Demand Mgt - ANS 24 h hotlines and triage service
\Demings 7 deadly diseases - ANS lack of consistency, emphasis on short term profits,
eval of performanmce,job hopping, excessive medical cost, excessive liability
\disability - ANS alteration of an individuals capacity to meet personal, social or
occupational demands to d/t impairment
\Dr, Lucian Leape - ANS "Error in Medicine"
Promoter of pt safety
Culture change that to error is inevitable.
\Dr. Codman, Boston Surgeon - ANS started standards and accreditations in early 20th
century
