HEALTHCARE STANDARDS; CHAPTER 1: HEALTH CARE DELIVERY SYSTEMS - REVIEW

HEALTH INSURANCE PORTABILITY AND ACCOUNTABILITY ACT

mandates administrative simplification regulations that govern privacy, security, and electronic transactions standards for health care information.
#1 - T

ANTON VAN LEEUWENHOEK

Father of Microbiology; discovered microbes and bacteria; improved the microscope
#2 - F

TAX EQUITY AND FISCAL RESPONSIBILITY ACT

TEFRA / 1983 legislated implementation of the inpatient prospective payment system; diagnosis-related groups (DRGs) required hospitals to be reimbursed a predetermined rate for Medicare inpatient services instead of the previous per diem reimbursements
#3

HIPPOCRATES

The first physician to consider medicine a science and are, separate from practice of religion.
#4 - T

MEDICARE title 18

1965 - established to provide comprehensive health care for people 65 years of age or older, certain younger people with disabilities, and people with End-stage Renal Disease.
#5 - F

American Medical Association

was reorganized in 1901 as a national organization of state and local association.
#6 - T

MINIMUM STANDARDS FOR HOSPITALS

In 1918 American College of Surgeons ACS developed the minimum standards for hospitals to outline the protocol for on-site inspections of hospitals.
#7 - F

CMS

CENTERS FOR MEDICARE AND MEDICAID SERVICES, the federal agency responsible for maintaining and monitoring the Medicare program, beneficiary services, and Medicaid and state operations. ( formerly Health Care Financing Administration [HCFA]
#8 - T

JCAH

1951 THE JOINT COMMISSION An independent, nonprofit national organization who's primary purpose is to provide voluntary for accreditation health care organizations. <1953 published the Standards for Hospital Accreditation> (1964 started charging Hospitals

TERTIARY CARE CENTERS

Specialized medical care that involves advanced and complex procedures and treatments performed by medical specialists in state-of-the-art facilities - some examples of the type's of service.... Neurosurgery, Radiation Oncology, and Pediatric Surgery.
#10

GOVERNING BOARD

Membership is represented by professionals from the business community; has ultimate legal authority and responsibility for the hospital's operation and is responsible for the quality of care administered to patients; also called board of trustees, board

Ophthalmology

If a patient is seen in ED with glass in her eye... the attending would refer to a specialist in Ophthalmology
<Specializes in the study, diagnosis, and treatment of disorders of the eye>
#12 - C

Credentials Committee

A medical staff committee that reviews and verifies medical staff application data.
#13 - A

ADMITTING DEPARTMENT/Patient Registration

~ registers emergency patients, inpatients , and outpatients
~ obtains patient demographic and financial information
~ obtains patients signature and consent for treatment and release information to insurance
~ provides patient with the advance directive

Utilization Management

A person from this department works with case managers of insurance companies to determine the appropriateness of admissions.
#15 - D

Health Information Management Duties

~Maintains Patients records
~Transcribes medical dictation
~Assembles, analyzes, codes, abstracts patients records
#16 - B

INCOMPLETE RECORD PROCESSING

The assembly and analysis of discharged patient records
#17 - D

CPT CODING BOOK

published every year by the AMA to assign Procedure and Service Codes.
#18 - D

RISK MANAGEMENT DEPARTMENT

The department that troubleshoots potential hazards and develops an action plan
#19 - B

INFLUENCES ON THE US HEALTH CARE DELIVERY

Health care in the US is greatly impacted by escalating costs, resulting in medical necessity requirements, appropriateness of admissions, and lack of quality and effective treatments.
#20 B - C - D

NCQA

The private non-for-profit organization that assesses the quality of managed care plans in the U.S. and releases the data to the public.
#21

US HEALTH CARE DELIVERY FOCUS

Health care consumers are BETTER educated and DEMAND higher-quality, more cost-effective healthcare thus the focus is on primary and preventive care.
#22

MODERN MEDICINE

The implementation of standards for sanitation, ventilation, hygiene, and nutrition

Hippocratic Oath

An oath that was adopted as an expression of early medical ethics

Patient Care in In the middle ages

In the middle ages the care of patients was based on charity and managed by

Dr's Pierre & Marie Curie

...

Pennsylvania Hospital

The first Hospital founded by Benjamin Franklin

PRIMARY CARE

Services such as Preventative & Acute care, Performed by a General Practitioner

FOR-PROFIT

A hospital that is privately owned and whose excess income in distributed to shareholders and owners

Release of health care Information requirements

patients signature and consent