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74 Cards in this Set
- Front
- Back
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THE RISING COST OF HEALTH CARE IS FUELED BY
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-A GROWING AGING POPULATION
-INCREASED TECHNOLOGICAL ADVANCES |
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PHRASE THAT CHARACTERIZES MUCH OF THE HEALTH CARE DELIVERY IN THE U.S.
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MANGED CARE
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CARE THAT IS PROVIDED UNDER A FIXED OR PRESET BUDGET
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MANGED CARE
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ALLOWS FOR GREATER COST MANGEMENT AND COST CONTAINMENT
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MANGED CARE
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THE MANGED CARE ENVIRONMENT IS ENVIRONMENT CHARACTERIZED BY
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MANGED COMPETITION
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VARIOUS HEALTH CARE ORGANIZATIONS COMPETE WITH EACH OTHER IN TERMS OF COST AND THE QUALITY OF THE SERVICE
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MANGED COMPETITION
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PHYSICANS WORKING IN THIS TYPE OF CARE ARE ENCOURAGED TO PROVIDE THE MINIMUM AMOUNT OF CARE
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MANGE CARE
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HAS THE POWER TO DENY THE REQUEST FROM PHYISIANS OR TO PROVIDE A WRITTEN REQUEST FOR SERVICES THAT A PHYSICIAN RECOMMAND
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PATIENT MANGER OR CASE MANGER
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OFTEN SEEM TO BE AN INSURANCE COMPANY OR MANGED CARE ORGANIZATION REPRESENTATIVE THAT HAVE THE POWER TO DENY REQUESTS
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PATIENT MANGER OR CASE MANGER
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A NONPROFIT ASSOCIATION THAT EDUCATES NURSES ABOUT MANAGED HEALTH CARE
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AMERICAN ASSOCIATION OF MANGED CARE NURSES
(AAMCN) |
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TO BE RECOGNIZED AS A RESOURCE IN MANGED HEALTH CARE STANDARDS
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AMERICAN ASSOCIATION OF MANGED CARE NURSES (AAMCN)
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ESTABLISH STANDARDS FOR MANGED CARE NURSING PRACTICE
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AMERICAN ASSOCIATION OF MANGED CARE NURSES (AAMCN)
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INFLUENCE PUBLIC POLICY REGARDING MANGED HEALTH CARE DELLIVERY
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AMERICAN ASSOCIATION OF MANGED CARE NURSES (AAMCN)
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ASSIST TO EDUCATE THE PUBLIC ON MANGED CARE
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AMERICAN ASSOCIATION OF MANGED CARE NURSES (AAMCN)
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WORK IN A VARIETY OF MANGED CARE SETTINGS TO COORDINATE CARE OF PATIENTS
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CASE MANGEMENT
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CASE MANGERS ARE TYPICALLY WHO
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NURSES
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A TYPE OF CASE MANGEMENT THAT FOCUS OF PEOPLE WITH COMPLEX CARE NEEDS
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DISEASE MANGEMENT
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PEOPLE THAT WORK WITH PATIENTS THAT ARE HIGH RISK FOR COMPLICATIONS FROM THIER DISEASE
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DISEASE MANGEMENT
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THEY COORDINATE HEALTH CARE OPTIONS AND EDUCATIONAL SERVICES FOR HIGH RISK PATIENTS
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DISEASE MANGEMENT
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DEVELOP AND IMPLEMENT CARE PLANS
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DISEASE MANGEMENT
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COORDINATE RESOURCES FOR PATIENTS
MAKE REFERRALS |
DISEASE MANGEMENT
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MONITOR AND EVALUATE PROGRESS
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DISEASE MANGEMENT
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THE GOAL OF PREVENTIVE SERVICES
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TO KEEP PEOPLE IN THE COMMUNITY RATHER THAN IN HOSPITALS AND LONG-TERM CARE SETTINGS
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ASSOCIATED WITH RESOURCE ALLOCATION OR THE FAILR DISTRIBUTION OF GOODS AND SERVICES
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RATIONING
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THE TRADITIONAL SYSTEM OF PAYMENT FOR HEALTH CARE IN THE U.S.
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FEE FOR SERVICE (FFS)
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A FEE IS CHARGED FOR EACH SERVICE DELIVERED BY A PROVIDER
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FEE FOR SERVICE (FFS)
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FEDERAL GOVERNMENT HEALTH INSURANCE PROGRAM
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MEDICARE
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WHO IS RESPONSIBLE FOR REGULATING AND ADMINSTERING MEDICARE
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CENTERS FOR MEDICARE AND MEDICAID SERVICES (CMS)
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COVERAGE THAT IS THE SAME IN ALL STATES
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MEDICARE
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FOR PEOPLE 65 YRS OR OLDER AND SOME YOUNGER WITH DISABILITIES
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MEDICARE
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MEDICARE CONSTIST OF WHAT PARTS
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PART A
PART B |
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MEDICARE HOSPITAL INSURANCE
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PART A
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MEDICARE SUPPLEMENTAL MEDICAL INSURANCE
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PART B
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FEDERAL PROGRAM THAT IS THE 3RD LARGEST SOURCE OF HEALTH INSURANCE IN THE U.S.
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MEDICAID
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DESIGNED TO ASSIST PEOPLE IF LOW INCOME AND THOSE THAT RECEIVE OTHER FORMS OF PUBLIC ASSISTANCE
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MEDICAID
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PROVIDES COMPREHENSIVE MEDICAL CARE AND MEDICALLY RELATED SERVICES TO VULNERABLE POPULATIONS
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MEDICAID
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COVERS BOTH IN PATIENT AND OUT PATIENT CARE
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MEDICAID
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INJURY ON THE JOB OR MAY REQUIRE A WORK RELATED ILLNESS AND BE UNABLE TO WORK FOR AN EXTENDED AMOUNT OF TIME IS
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WORKMAN'S COMPENSATION
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CLAIM TO RECEIVE MONETARY COMPENSATION FROM AN EMPLOYER UNDER A FEDERAL PROGRAM
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WORKMAN'S COMPENSATION
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A MONTHY PAYMENT IS MADE TO A PROVIDER OF HEALTH CARE
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CAPITATION PROGRAM
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A PROVIDER IS PAID IN ADVANCE FOR THE DELIVERY OF SERVICE WHETHER THE MEMBER USES THAT SERVICES OR NOT
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CAPITATION PROGRAM
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THE PRIMARY GOAL OF THE CAPITATION PROGRAM
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TO LOWER COST OF CARE BY ENCOURAGING MORE PREVENTIVE SERVICES BY PROVIDERS
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EXAMPLES OF CAPITATION PROGRAM
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-HEALTH MAINTENANCE ORGANIZATION (HMO)
-PREFERRED PROVIDER ORGANIZATION (PPO) |
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LEGAL CORPORATIONS THAT OFFER HEALTH INSURANCE AND A RANGE OF HEALTH SERVICES AT A FIXED PRICE
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HEALTH MAINTENANCE ORGANIZATION (HMO)
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PRIMARY GOAL OF HEALTH MAINTENANCE ORGANIZATIONS (HMO)
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TO HELP PEOPLE PREVENT DISEASE AND MAINTAIN HEALTH
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COVERS ACUTE HOSPITAL STAYS
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HEALTH MAINTENANCE ORGANIZATION (HMO)
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HEALTH MAINTAINANCE ORGANIZATION ARE A TYPE OF WHAT KIND OF CARE
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MANGED CARE
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WELL KNOWN HMO
LARGEST IN THE U.S. |
KAISER PERMANENTE
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AN ORGANIZATION NEGOTIATES LOWER RATES WITH CERTAIN HEALTH CARE INSTITUTIONS
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PREFERRED PROVIDER ORGANIZATION (PPO)
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MEMBERS ARE ENCOURAGED TO USE THE PROVIDERS WHO ARE WILLING TO GIVE LESS COSTLY SERVICES
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PREFFERED PROVIDERS ORGANIZATION (PPO)
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PROVIDERS BENEFIT BECAUSE THEY ARE GUARANTEED A CERTAIN NUMBER OF PATIENTS AND ARE PAID QUICKLY
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PREFFERED PROVIDER ORGANIZATION (PPO)
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A PROVIDER WILL BE REIMBURSED FOR A SERVICE BASED ON A PREETERMINED AND FIXED REIMBURSEMENT AMOUNT FOR THAT SERVICE
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PROSPECTIVE PAYMENT PLAN
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TYPES OF PROSPECTIVE PAYMENT SYSTEM
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-DIAGNOSIS-RELATED GROUPS (DRGs)
-RESOURCE UTILIZATION GROUPS (RUGs) |
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REIMBURSEMENT RATES ARE BASED ON A REVIEW OF AVERAGE COSTS FOR SIMILAR DIAGNOSES, PROSEDURES, AND TREATMENTS IN THE PAST
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DIAGNOSIS-RELATED GROUPS (DRG's)
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FEDERAL GOVERNMENT COVERTED FEE-FOR-SERVICE SYSTEM TO THIS
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DIAGNOSIS-RELATED GROUPS (DRG's)
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A DISEASE THAT WORSENS OR AFFECTS A PRIMARY DISEASE
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COMORBIDITY
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A PERSON THAT EXCEEDS THAT MAXIMUM LENGTH OF STAY
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OUTLIER
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BASED ON THIS HOSPITALS HAVE AN INCENTIVE TO DISCHARGE PATIENTS AS QUICKLY AS POSSIBLE
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PROSPECTIVE PAYMENT SYSTEM
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DISCHARGE PLANNING IS LARGELY THE RESPONSIBILTY OF WHO
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THE NURSE
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TAKES PLAVE THE MINUTE THE PATIENT ENTERS THE HOSPITAL
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DISCHARGE PLANNING
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HOME CARE NURSES NEED TO BE MORE UP TO DATE ON WHAT
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-ACUTE CLINIAL ASSESSMENT
-TREATMENT SKILLS |
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MEANS COLLECTIVE LAWS
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LEGISLATION
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HOW CAN NURSES BE INVOLVED WITH LEGISLATION
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-AS ADVOCATES FOR PATIENTS
-AS ADVOCATES FOR THEMSELVES |
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SOMEONE WHO WRITES OR SPEAKS IN SUPPORT OF SOMEONE OR SOME CAUSE
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ADVOCATE
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STRATEGIES FOR NURSES WHO WANT TO AFFECT THE LEGISATION PROCESS
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-CULTIVATE POLIRICAL AWARENESS
-LOBBYING -WRITING LETTERS OR E-MAILS -TESTIFYING -NETWORKING WITH OTHER PEOPLE |
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INVOLVES BEING AWARE OF ISSUES THAT AFFECT BOTH CONSUMERS OF HEALTH CARE AND PROVIDERS OF HEALTH CARE
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CULTIVATE POLITICAL AWARENESS
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MEANS TO ELICIT SUPPORT FOR SOMETHING OF IMPORTANCE
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LOBBY
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MEANS TO BEAR WITNESS OR TO GIVE EVIDENCE
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TESTIFY
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ORGANIZED GROUPS THAT RISE MONEY TO ELECT OR DEFEAT CANDIDATES WHO ARE RUNNING FOR OFFICE
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POLITICAL ACTIONS COMMITTEES (PAC)
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LOBBY FOR OR AGAINST VARIES PIECES OF LEGISLATION
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POLITICAL ACTIONS COMMITTEES (PAC)
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ARE USALLY FORMED BY BUSINESSES, ASSOCIATIONS, OR ORGANIZATIONS INCLUDING FOR PROFIT AND NOT-FOR-PROFIT
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POLITICAL ACTIONS COMMITTEES (PAC)
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THE ANA HAS INFLUENCED THE LEGISLATION PROCESS THROUGH
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ANA POLITICAL ACTION COMMITTEE (ANA-PAC)
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ISSUES THAT THE ANA-PAC HAVE SUPPORTED
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-HEALTH CARE REFORM
-MEDICARE REIMBURSEMENT FOR RN's IN ADAVANCED PRACTICE -STRONGER NEEDLE STICK PRETECTION LAWS |
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SPECIAL INTEREST GROUPS CAN INFLUENCE WHO
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LEGISLATION
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