Health Care Administration test 1 study guide
Health Care Administration test 1 study guide HCA 340 -002
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This 4 page Study Guide was uploaded by Loretta Hellmann on Saturday March 19, 2016. The Study Guide belongs to HCA 340 -002 at Western Kentucky University taught by Steven W. Maddox in Spring 2016. Since its upload, it has received 162 views. For similar materials see HEALTH CARE ORG/MGT in Nursing and Health Sciences at Western Kentucky University.
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Date Created: 03/19/16
HCA 340 Midterm Potential Topics Change of healthcare from 19 and 20 centuries to now Flexner Report o 1926: Carnegie Foundation released Flexner report reorganized dental education o Examined the following at each medical school: Entrance requirements Size and training of faculty Endowment fees Quality of laboratories Relationship between the medical school and hospital First Insurance Plans and the response to those plans Training requirements of physicians o Most states require at least one year for graduate medical education before licensing; most professional standards require a minimum of 3 year of residency training to practice a specialty o Residency may range up to 8+ years o Fellowships required for certification in 1 of over 100 subspecialty areas PPOs and HMOs o PatientsCentered Medical Homes Team based model of care led by a personal physician provide continuous and coordinated care throughout a patient's lifetime including linkages with other professionals for preventative, acute and chronic illness and endoflife assistance o HMO Act of 1973 Controlled costs NixonFord Era Decentralized, shifted support from public health, social programs Abilities of Nurse Practitioners o RNs with advances education and clinical experience o Primary and specialty care o In most states are allow to prescribe medicine Medicare o elderly Medicaid o poor Other Healthcare Providers Aging Population and how it affects Healthcare o By 2030, 20% of US population will be 65+, by 2050, 21% will be 85+ o Increased longevity, immigration, culturally diverse aged o Major gaps in traditional system for care of older, culturally diverse Americans o Financial gaps in Medicare and Medicaid payment for older adult basic needs, stat burden of nursing home o aging population; increasing pharmacists involvement in clinical decisions and physician/ nurse/ patient counseling, increasing practitioner jobs Epi Triangle and the Levels of Prevention o Primary Prevention Prevent disease, health education, nutrition, healthy life style o Secondary Prevention Attenuate disease progression, early diagnosis and prompt treatment o Tertiary Prevention Rehabilitate to highest achievable function, rehabilitation Discharge Planning o Process Review medication list with patient and caretakers Provide all followup appointment times in writing Provide emergency contact info ACOs o Accountable Care Organization o ACOs are designed to ensure care coordination o Ideally, PCMHs will be the primary care component of ACOs for Medicare patients PCMHs o PatientCentered Medical Homes o PCMH is a team based model of care led by a personal physician who provides continuous and coordinated care throughout a patient’s lifetime in order to maximize health outcomes Types of Ambulatory Care Centers o Patient Centered Medical Home (PCMH) o Accountable Care Organizations (ACO) o Emergency Rooms o Urgent Care Centers o Ambulatory Surgery Centers o Federally Qualified Community Health Centers (FQCHC) Academic Health Centers ICD9 Codes o Codes to report hypertension care DRG Codes o Diagnosis Related Groups o Reimbursement is set by DRGs Integration strategies o Horizontal hospital mergers under one or more corporate structures to allow economies of scale, enhanced expert recruitment and deployment, increased access to capital and stronger brand marketing, produce same goods and services o Vertical operation of a variety of related businesses, in health care, ideal vertical system encompasses full continuum Types of hospitals o Not for profit Charity care Exempted from federal, state, and local taxes Must provide some defined public good (service, education, welfare) Must not distribute any profit to individuals o For profit Owned by individuals, partnerships, or corporations Operated for the financial benefit of the individuals or entity that owns it o Public and government owned Owned by agencies of federal, state, or local government AARA and Meaningful Use o Meaningful use not being wasted, not repetitive, EFFICIENT EHRs and EMRs o Electronic health records VS electronic medical record o EMR digital version of patient medical chart, for a SINGLE physician/practice, NOT SHARED o EHR digital version of patients chart and medical history for multiple facilities SSA and Medicare and Medicaid Amendments Payment models (i.e. Feeforservice, Shared Savings, Capitation, ValueBased Payment, Bundled Payment) o Feeforservice: reimbursed for each service provided to patient o Shared savings: portion of dollars saved relative to predicted cost o Capitation: flat payments plus bonus and penalties o Valuebased: reimbursement based on the quality of care provided o Bundled payment Reimbursement is based on the cost of a procedure or diagnosis that includes both hospital and physician components All items discussed in class, in the book, or on the power points are fair game for the test.
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