Section 1
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AHRQ &NIH
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Last updated
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Date created
Mar 1, 2020
Cards (87)
Section 1
(50 cards)
AHRQ &NIH
provide financial support to private and public institutions for biomedical research, research on quality, cost, and access
Managed care
mechanism for providing health care services where a single organization takes on the management of financing, insurance, delivery, payment
osteopathic medicine
practiced by DOs, emphasizes the musculoskeletal system, such as correction of joint tissues
medical tourism
receiving healthcare abroad
Technicians and assistants
receive less than two years of post secondary education and are trained to perform procedures, require supervision from therapists or technologists, ensure that care plan evaluation occurs as part of treatment
RBRVS- resource based relative value
medicare developed the program to reimburse physicians according to a value assigned to each service. Based on time, skill, intensity
Holistic& preventative care
Needs to be adopted to significantly improve health of Americans
medical model
emphasizes illness rather than wellness
DRG diagnosis related groups
for acute hospital inpatients
veterans administration
the largest federal hospital system with 150 hospitals
pharmacist
the preparation and dispensing of prescriptions, drug product education, experts on specific drugs, drug interaction, and genetic drug substitution
RUG Resource utilization groups
a case mix method to reimburse skilled nursing facilites
technologists and therpists
evaluate patients, diagnose problems, and develop treatment plans/ skill development in teaching procedural skills to technicians
HDHP
combined with a health reimbursement arrangement
VISN-veterans integrated service networks
coordinates its own services and receives federal funds/ The hallmark of US healthcare industry
Required for holistic care
Individual responsibility and community partnerships
Access is restricted to those who
-Have health insurance through employer -are covered under a government program -can afford to buy insurance out of pocket -are abel to pay for services privately
OASIS
used to rate a patients functional status and clinical severity
comprehensive
addresses health problems at any stage of a patients life cycle
HEDIS data
incorporate a number of different measures on cost and quality amounts off the regular fees often range between 25-35%
public
government ownership (federal,state, local) 25% of us hospitals, only state/local hospitals are open to general public
use of tax exempt payments
qualified medical expensees
general hospitals
provide a variety and broad set of services for various conditions, general and specialized medical, obstetrics, diagnostics, treatment, surgery, most hospitals in the US
chronic
less severe, but long continuous. Can be controlled but can lead to serious complications ex: asthma, diabetes, hypertension
adult health day care
complements informal care provided at home at a center during the day
acute
relatively severe, episodic and ofte treatable ex:myocardial,infarct,lack of kidney function
MCOs
garnered enormous buyhing power by enrolling a large segment of the insured population and taking responsibility to procedure cost effective health care for enrollees
Telemedicine
integration of the telecommunication systems into distant care giving
Subacute
postacute treatment after discharge ex: head trauma, ventilator
Primary care
prevention, diagnostic, theraputic services, health education,counseling, and minor surgery, an approach to providing healthcare, not a specific services
Managed care
has become the primary vehicle for insurance and delivery, consolidation of purchasing power
discounted fees
a modified form of fee for service
Ambulatory care
care rendered to patients who come to the physicians office, clinics, outpatient surgery
community
a nonfederal short stay hospital whose services are available to the general public, 85%
Home health resources group
a fixed pre determined rate for each 60 day episode of care regardless of service given
medicare
65 years or older,disabled people who are entitled to SS benefits,those with end stage renal disease
copayment
money paid out of pocket each time health services are recieved
MCOS
accredited by the national committee for quality assurance NCQA
When do benefits end?
when the beneficiary has not been in a hospital or a skilled nursing facility for 60 consecutive days
tertiary care
most complex level of care for conditions that are uncommon, usually institution based, highly specialized, technology driven, rendered in large teaching hospitals, maybe long term care Ex: trauma, burn treatment, NICU, transplants, open heart surgery
capitiaiton
the provider is paid a fixed monthly sum per enrollee often called per member per month PMPM
FDA
agency of the US Department of health and human services, ensures that drugs and medical devices are safe and effective for their intended use
Holistic medicine
treast the whole person/ incorporates alternative therapies
medical center
a hospital that has achieved specialization and offers a wide scope of services, engage in teaching and research
American medical association
helped galvanize the profession and protect the interest of physicians
osteopathic
community general hospitals, holistic approach to treatment, in addition to traditional allopathic appproach
deductibles
amount the insured pay first before benefits are paid by the plan, paid annually
MDs
trained in allopathic medicine which views treatment as active intervention to produce a counteracting reaction in an attempt to neutralize the effects of disease
coordinated
combines health services to best meet the patients needs
When do benefit periods begin?
the day the beneficiary is hospitalized
Section 2
(37 cards)