Quality and Payment
Under this payment system, providers receive payment for each individual service.
What is fee-for-service?
This process focuses on making healthcare systems safer, more effective and more efficient through ongoing changes.
What is quality improvement?
This type of liability occurs when one party is held responsible for another party's actions because of their relationship.
What is vicarious liability?
This federal law primarily protects employee benefit plans, including many employer-sponsored health plans.
What is ERISA?
In this type of plan, an employer purchases health insurance from an insurance company.
What is a fully insured plan?
Under this payment system, providers receive a set amount per patient for a defined period or arrangement.
What is capitation?
This principle requires healthcare organizations and professionals to take responsibility for meeting standards and addressing failures in care.
What is accountability?
This doctrine may hold an employer responsible for an employee's negligence within the scope of employment.
What is respondent superior?
This occurs when federal law displaces state law under the Supremacy Clause.
What is federal preemption?
In this type of plan, an employer pays covered healthcare claims using its own plan funds.
What is a self-funded plan?
This payment approach links payment to quality, patient outcomes and costs instead of paying solely for the number of services.
What is value-based purchasing?
State authorization to practice medicine, organizational recognition of quality standards and legal responsibility for medical negligence are examples of these oversight mechanisms.
What are licensure, accreditation and malpractice liability?
A hospital fails to maintain essential medical equipment, resulting in patient harm. What type of liability may apply?
What is corporate liability?
This type of preemption applies when state law conflicts with federal law.
What is conflict preemption?
This ERISA clause broadly preempts state laws relating to covered employee benefit plans, subject to applicable exceptions.
What is the preemption clause?
This type of quality refers to measurable clinical outcomes, safety and adherence to appropriate standard
What is actual quality?
A hospital reviews patient safety data, identifies recurring medication errors and retrains staff to prevent future incidents. Is this accountability or improvement?
What is improvement?
This type of liability focuses on an organization's own failures, such as poor credentialing or unsafe policies.
What is corporate liability?
This ERISA clause preserves qualifying state laws that regulate insurance.
What is the insurance saving clause?
A patient's employer-sponsored health plan denies treatment, and the patient seeks damages under state law. What federal law may limit the available state-law remedies?
What is ERISA?
This type of quality reflects how patients believe or experience the quality of care.
What is perceived quality?
Established under the Affordable Care Act, this national initiative provides a framework for improving healthcare quality, patient outcomes and population health across the United States.
What is the National Quality Strategy?
A hospital may be held responsible when it presents a physician as its representative and a patient reasonably relies on that representation. What legal concept may apply?
What is apparent or ostensible agency?
This ERISA clause prevents self-funded employee benefit plans from being treated as insurance companies for state insurance regulation.
What is the deemer clause?
Under ERISA, these legal remedies may be narrower than ordinary state-law tort remedies for patients harmed by certain health plan decisions.
What are available legal remedies?