ANSWERS(RATED A+)
Sarbanes Oxley - ANSWERUS federal law that set new or expanded requirements for
all US public company boards, management and public accounting firms. Cover
responsibilities of a public corporation's board of directors, adds criminal penalties and
required SEC to create regulations
FMLA - ANSWER1993: law requiring covered employers to provide employees with job-
protected and unpaid leave for qualified medical family reasons
Purpose of any HCO - ANSWERto provide care to individual patients and is usually
stated in organization's "mission"
Population Health - ANSWERdefining the population (by geography, sociodemographic
factors, disease state, risk, insurance coverage or in some other way), measuring the
current state of health in the population, setting goals for improvement and directing
resources to making improvements. US HSS specifies national goals and objectives for
population health in the Healthy People 2020 program
Caregiving/Clinical/Logistic/Strategic Teams - ANSWERCaregiving Teams: Provide
care to patients with similar needs (PCP, ACUTE, rehab)
Clinical Support Teams: provide specific clinical services to Caregiving Teams (clinical
laboratory, pharmacy, imaging, cardiopulmonary)
Logistic Support Teams - provide trained personnel, information, facilities, accounting,
cash, management and supplies
Strategic Support Teams: provide marketing, governance, internal consulting, finance,
stakeholder relations management and strategic positioning
Service Lines - ANSWERPatient care teams coordinated around a set of similar
diseases or patient needs
Premise of a Healthy Community - ANSWERCosts tend to rise and benefits to decline
as care moves away from the healthy state. Therefore, optimum care maximizes use of
prevention, health maintenance, and health improvement
PCP, Acute inpatient or specialty outpatient care, rehab, continuing care in home or
nursing home setting, continuing care in home or nursing home setting, palliative care
and death
Stakeholders - ANSWERIndividuals or groups who have a direct interest in the
organization's success and shape its mission and strategies. Include buyers, workers,
suppliers, regulators and owners. Patients are the MOST important HCO stakeholders.
They expect and deserve care that meets the goals summarized in IOM's report:
Crossing the Quality Chasm
, Patient-centered care - ANSWERcare that is respectful of and responsive to individual
patient preferences, needs and values and involving patients and families in care
planning and decision making
Fiscal intermediaries - ANSWEROutside contractor that processes claims for US
government programs such as medicare and medicaid and provide most of the revenue
to HCOs, making them essential stakeholders
Patient Protection and Affordable Care Act (ACA) - ANSWERA federal law providing for
a fundamental reform of the US healthcare and health insurance system, signed by
President Obama in 2010. It includes: increase insurance coverage for many patients,
new approaches to support those with chronic disease, and a greater accountability for
the cost and quality of care. Part of the "Triple Aim" - improving the individual patient
experience with healthcare, improving the health of the population, and reducing per
capita cost of care
Value-based purchasing - ANSWERLinking financial incentives to the quality of care
provided - reward HCOs for quality and sustained patient health
Certificate-of-need laws - ANSWERCertificate or approval of new services and
construction and renovation of hospitals or related facilities; issued in many states.
Require that HCOs seek permission for construction or expansion.
EMTALA - Emergency Medical Treatment and Active Labor Act - ANSWERRequires all
HCOs providing emergency care to accept all patients, regardless of ability to pay, until
they are stabilized and can be safely moved
The Joint Commission - ANSWERA voluntary consortium of professional provider
organizations that evaluates and accredits a wide range of different HCOs. HCOs
MUST have an accreditation by a CMS deemed-status organization in order to receive
funds from Medicare. Some insurance plans are accredited by the National Committee
for Quality Assurance (NCQA)
Associates - ANSWERPeople who give their time and energy to the organization. They
can be employees, trustees and other volunteers and medical staff members.
Licensed Independent Practitioners (LIPs) - ANSWERCaregivers granted legal status to
provide specific kinds of healthcare, categorized as primary care or specialist providers
who are usually physicians or advanced practice nurses (NPs, nurse midwives)
Primary Care Practitioners (PCPs) - ANSWERphysicians and advanced practice nurses
specializing in family medicine, general internal medicine, pediatrics, obstetrics, and
psychiatry and are the most common initial contacts for patients and specialize in family
medicine, general internal medicine, peds, OB/GYN, and psychiatry