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49 Cards in this Set
- Front
- Back
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What ways are five ways Hospitals are categorized?
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1. By the level of care they provide.
2. By their ownership 3. By their geographic location 4. By their payer mix 5. As teaching facilities or academic medical centers |
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What does MSA stand for?
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Metropolitan Statistical Area, which is defined as those areas with more than 50,000 residents.
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What does LTC stand for?
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Long Term Care facilities which include Skilled Nursing Facilities (SNFs) and Intermediate Care Facilities (ICFs). A typical stay in a LTC is categorized by a stay of 30 days or greater.
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What is the difference between a SNF and an ICF?
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SNF provide medical services under the full-time care of a registered nurse (RN).
ICF provide broad-based health maintenance, personal care and services to support the activities of the elderly, chronically ill, disabled or mentally handicapped patients. |
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What does NHS stand for?
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National Health Services
These are public hospitals (primary, secondary or tertiary) which are owned by a government. |
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What does NHI stand for?
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National Health Insurance.
The gov't reimburses providers for delivered care to patients. In Canada, private providers bill the gov't for services. |
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What does IDN stand for?
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Integrated Delivery Network, aka Integrated Delivery System (IDS).
It is an organization made up of a variety of healthcare service providers offering a wide range of services. Importantly, all of the service providers in this organization share administration, information (via interoperability or same system) and other functions. An organization that is accountable for the costs and clinical outcomes associated with delivery of a continuum of health services to a defined population. |
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What is the single advantage of an IDN?
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They have the advantage of the model for the economy of scale in which several functions, positions, systems are centrally owned and therefore overhead is avoided by separate contracts for each healthcare provider (facility).
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What does true integration require?
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It requires provider organizations have interoperable information systems.
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Who does Medicare provide healthcare coverage to?
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Anyone over the age of 65.
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Who does Medicaid provide coverage for?
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Anyone who falls below a pre-defined income level.
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What does CPOE stand for?
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Computerized Prescriber (Provider) Order Entry system
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Who are Mid-Level Practioners?
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They work under the direction of physicians.
Examples: -Physician Assistants (PAs) -Clinical Nurse Specialists -Nurse Midwives -Nurse Practitioners -CRNAs (Certified Registered Nurse Anesthetists) |
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What does ANA stand for?
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American Nursing Association
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What is the role of a CIO?
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Chief Information Officer, lead the IT department in a general direction in-line with the overall mission of the healthcare organization.
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What is the role of the CTO?
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Chief Technology Officer researches technologies which can potentially "improve" the delivery of care and oversee the maintenance of the current infrastructure environment.
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What is the role of the CSO?
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Chief Security Officer, is responsible for privacy and security of systems and information.
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What is the role of the CMIO?
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Chief Medical Information Officer, represents physicians in the design and implementation of systems.
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What does JC stand for?
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Joint Commission, an independent regulatory organization that regulates and accreditates hospitals
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What does HIPAA stand for?
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Health Insurance Portability and Accountability Act, provides directives on how medical information which is stored or transferred electronically is protected for patients, regardless of their ability to pay.
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What does EMTALA stand for?
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Emergency Medical Treatment and Active Labor Act, requires hospitals to treat all persons presenting at emergency rooms, regardless of their ability to pay.
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What does ICD 9 or 10 stand for?
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International Classification of Disease version 9 or 10. This was created by WHO.
It is designed to promote international comparability in the collection, processing, classification and presentation of mortality stats. |
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What does CDC stand for?
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Center for Disease Control and Prevention
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What does JCI stand for?
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Joint Commission International, same purpose as The Joint Commission. They set achievable expectations in quality of care provided.
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Which of the following issues do healthcare providers face wherever they function globally?
1. high, rapidly rising costs and highly variable clinical quality 2. lack of domestic, knowledgeable management to lead the effort 3. patient safety issues and the need for evidence-based decision making 4. the lack of common standards for information sharing A. 1, 2, and 3 only B. 2, 3 and 4 only C. 1, 2, and 4 only D. 1, 3, and 4 only |
D. Healthcare providers face a wide array of issues relative to the ongoing and future provision of medical services. A complex administrative environment and regulatory requirements compound all of these.
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In quality improvement initiatives, root cause analysis is the process that requires
A. an analysis of the key indicators for quality improvement B. an investigation of the cause of a reportable error. C. a process for data gathering and analysis of clinical processes. D. an assessment and plan of correction for data gathering processes. |
B. a root cause analysis calls for investation of the cause of a problem or error. Not only does the sentinel event policy call for the reporting of such errors, but also for determining how the error happened and the the development of corrective action.
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Which of the following describes properties of tertiary level services?
A. basic services such as those provided by a family physician, OB/GYN, pediatrician or general internest. B. certain specialized services including surgical procedures and intensive care. C. highly specialized, complex and technologically advanced medical services. D. services that are supportive of patients who need a slightly longer stay. |
C. Service categorization starts at a primary care level as described in 'A' and advances through secondary care as described in 'B' and tertiary level care as described broadly in 'C'. Sub-acute care units provide supportive care to patients needing a slightly longer stay.
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In a non-profit arrangement, the hospital
A. is not permitted to earn net revenue from patient care services. B. is owned by a corporation that pays a return on investment to individuals. C. is required to pay taxes on net earnings of any for-profit subsidiary it owns. D. does not make a profit on any of the services it offers. |
C. For-profit hospitals generally pay taxes on their income and on their property. Non-profits do not offer a return from net revenues to any individual or organization and do not pay taxes on their properties, income and services. If they own a for-profit subsidiary, they are required to pay any applicable taxes related to for-profit companies. Individuals or corporations own a for-profit or taxed hospital whose primary purpose is a return on investment for themselves or shareholders.
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Teaching hospitals are different from academic medical centers in that they
A. are affiliated with a medical school and/or other school of health professions and offer training to interns, residents and other clinicians. B. have a medical center and a medical school and/or other school of health professions under one organizational structure. C. offer training to interns, residents and other clinicians, such as nurses and technologists. D. offer training only to non-physician clinicians such as nurses and technologists. |
A. Teaching hospitals, through their affiliation with a medical school, offer training to medical interns, residents and other clinicians under the supervision of staff and teaching physicians, nurses or other allied health professionals. Answer 'B' defines an academic medical center, which is comprised of a tertiary level medical center and a medical school and/or school of health professions.
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An IDN is an
A. information systems data network B. international delivery network C. internally designated network D. integrated delivery network |
D. Known as an integrated delivery network (IDN) or integrated delivery system (IDS), the system of care is one that combines all levels of care to achieve continuity of care for patients in the same system.
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What does primary care include?
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Basic services like those provided by a family physician, OB/GYN, pediatrician or general internist
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What does secondary care include?
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Surgical procedures, intensive care, and neonatal intensive care units
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What does tertiary care include?
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Highly specialized, complex and technologically advanced services that will include trauma assistant and transplant programs.
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What is sub acute care?
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A level of support to patients in primary, secondary, or tertiary care that need a slightly longer stay. Sub-acute care units may be in a licensed skilled nursing facility or within a hospital setting. AKA transitional care.
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What are the hospital ownership types?
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for-profit or taxed hospital
non-profit or tax-exempt hospital |
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What are the three different types of hospitals categorized by their geographic locations?
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urban - in a metropolitcal statistical area (MSA)
community - less dense population and serve the immediate and surrounding communities rural - located in smaller communities and more remote locations. Not part of an MSA. Usually offer lots of primary care and some more advanced or secondary level diagnostic or surgical procedures. |
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What happens to assets when a merger and acquisition formation occurs?
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Assets are integrated among organizations.
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What happens to resources when a joint venture occurs?
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Two independent organizations pool their resource to create a new entity and pursue a common purpose.
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What happens to resources when an alliance is formed?
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An alliance is a joint agreement where resources are shared without being jointly owned.
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What is a virtual organization?
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A virtual organization has contracted arrangements between existing organizations to form a new organization such as an IPA
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What programs are offered through a mechanism where the government finances healthcare through general taxes, but the actual care is delivered by private providers?
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National Health Insurance
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What is the system called that funds care through taxes, and where the government also manages the infrastructure for the delivery of medical care?
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National Health System
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What roles might government play in healthcare delivery?
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They may be a provider of services (VA)
They may be a payor of services (Medicare) They may be a regulator of services (HIPAA) |
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A merger and acquisition formation is one in which
A. the resources of two independent organizations are pooled B. a joint agreement is entered into, to share resources without jointly owning assets C. the assets of the organizations are integrated under an agreed upon contract D. geographically dispersed entities are part of a loosely structured entity for mutual benefit |
C. In a joint venture, the resources of two organizations are pooled; an alliance implies that resources are shared, but not jointly owned; and the virtual network is one that is geographically dispersed, but loosely structured for specific, limited purposes.
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National health insurance programs are defined as those that offer:
A. government financing of healthcare through general taxes, although care is delivered by private providers B. both government financing of medical care and management of the infrastructure for the delivery of care C. a public/private system that provides healthcare coverage with funding from both the government and private employers D. socialized medicine in which the government finances healthcare and assigns the providers of care to individuals. |
A. In a national health insurance system, medical care delivery is financed through a central government using tax revenues for funding. Answer 'B' identifies a national health service.
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Professionals who serve as mid-level practitioners include:
A. registered nurses B. pharmacists C. physician assistants D. radiologists |
C. Mid-level practitioners include advanced practice nurses, such as nurse midwives, nurse practitioners and physician assistants. These professionals are authorized to perform basic diagnoses and to prescribe medications within certain limits.
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As a provider of healthcare services, the government:
A. provides funds for research into the development and distribution of new drugs B. owns and operates the facilities in which medical services are delivered C. provides and administers the laws that assure certain protections against medical errors D. uses general tax revenues or special taxes to provide financial coverage of medical care |
B. As a provider of care, governments own facilities such as the Veterans Hospitals in the United States and the hospitals that are part of the NHS in the United Kingdom.
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Which of the following organizations is responsible for standardization context of coding of the causes of illness and injury?
A. International Organization for Standardization B. World Health Organization C. Health Level 7 D. National Information Standards Organization |
B. The World Health Organization promulgates the ICD that is used globally. ISO, HL7, and the NISO are responsible for the standardization of technology.
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ICD-10 Ues:
A. Alphanumeric categories B. Numeric categories C. Alphanumeric and numeric categories D. Alphanumeric with sub-numeric categories |
A. The ICD has moved to using alphanumeric categories in the current version: ICD10
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