Outpatient Services
What type of care is described as “end of life care”?
Hospice
Pain and symptom management is known as palliative care but Hospice is also meant to meet the psychosocial and spiritual needs of the patient as well.
When did hospitals begin to attract well-to-do patients who could afford to pay privately?
When hospitals offered superior medical services and surgical procedures that could not be offered at home
This is part of the evolution of hospitals in the US
How does Managed Care differ from conventional insurance in the delivery of care?
An MCO must provide health care to their enrollees, they do this by organizing a network and contracting with physicians, hospital and other providers on behalf of their enrollees.
What is indicated when a patient has severe ADL limitations?
Institutionalization
What characteristics determine vulnerability?
Predisposing characteristics
Enabling characteristics
Need characteristics
There is section in your text defining each of these characteristics
How many visits per year does the average American make to see an office-based physician?
Three
Actually according to the text it is 2.78
Family practice accounts for the highest percentage (22.9%) followed by Pediatric visits (15.4%)
Remember-- there are more specialty physicians than primary physicians in the US-- it makes sense that there would be a decent portion of specialty visits in the total, yet Fam Practice is the highest.
Who opened the first proprietary hospitals?
Physicians
Evolution of hospitals-- there were 6 stages from almshouses to medical centers offering many services--physician owned hospitals occurred in stage 4
What is the name of the data set used to measure a health plan's quality?
HEDIS
Healthcare Effectiveness Data and Information Set
This data is published and used to rate health plans.
What is the main goal of long-term care as it relates to a patient’s function?
Promote Independence
What group of the population is more likely to be without insurance?
Young adults (25-40)
What type of outpatient center would you go to for surgery that would allow you to be discharged into the care of family instead of an inpatient hospital stay?
Free-standing facility
This group is not only surgical centers but also includes urgent care centers and walk-in centers
What payment system triggered the downsizing of US hospitals?
Prospective Payment systems
The DRG (Diagnosis Related Groups)-- tells the hospital what it will pay by group-- there was no longer an incentive to keep the patient additional days as it would not increase the payment.
Back in the 1990s-- the consumer had one major concern regarding managed care organizations. What was it?
Lack of choice of providers
The erosion of choice occurred during the period known as Managed Care Backlash
What are some challenged facing LTC facilities?
Staffing shortages
High turnover rates and burnout
Interdepartmental communication
What type of vulnerability specifically characterize childhood?
Developmental vulnerability
This is rapid and cumulative and results in physical and emotional changes.
This strategy includes patient-centered access, quality improvement and multidisciplinary practice-based teams and coordinated care
Patient centered medical home
This strategy is recognized by many quality organizations and requires robust quality monitoring and metrics.
What group has the largest number of federal hospitals?
Veterans
Federal hospitals represent only 3% of hospitals in the U.S.
Utilization Management was key to controlling cost for Managed Care organization. It can occur Prospectively, Concurrently and Retrospectively.
Whis is the stage associated with Pre-certification.
Prospectively
Another phase of Utilization Management is ongoing--that is Gatekeeping which requires a PCP to refer for specialty services.
Which of the following must be met before Medicare will pay for skilled nursing visits in the home?
1. Full time
2. Part time or intermittent
3. Full time and Rehabilitation
Part time or intermittent
Describe at least one of the efforts from your text "Eliminating Disparities" that will affect the vulnerability of individuals and populations
Beginning page 241
There are too many to list here
What are some examples of a mobile health care facility?
Telephone triage, hospice services, and home health
Can non-profit hospitals make a profit?
Yes, they can make a profit
The IRS requires a non-profit hospital to serve the community and not distribute profits to any individual.
The Medicare Advantage Plan (MA) is a managed care plan for Medicare beneficiaries, yet each person gets to choose to keep their original Medicare or trade it for an MA plan. Why would a beneficiary choose to move to a MA plan?
Many reasons - probably the most important to the consumer is cost compared to the cost of Medicare supplement.
It's important to note the MA plans are showing a higher quality of care over the original.
Define IADL (Instrumental Activities of Daily Living)
Activities necessary for living independently.
Using a telephone, driving a car, travelling alone with public transportation, meal prep or houseword
Referencing one of the two reasons given by the book, why should you care about the rising cost of health care?
•Rising costs mean that Americans must reduce spending on other basic goods and services such as education, housing, roads, public transportation and safety.
•Economic resources should be directed to their highest valued uses, even though consumers decide how much to spend on purchasing a product or service based on their perception of its expected value
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