ch 10 healthcare organizations Flashcards
what organizations are considered institutional providers (3)
-acute care hospitals
-long term care facilities
-rehab facilities
average length of stay for acute care hospital
<30 days
3 categories in spectrum of care services
- primary care - first access care
- secondary care - disease restorative care
- tertiary care - rehab/long term care
organizations that are classified as primary healthcare organizations (7)
-ambulatory care centers
-physicians’ offices
-preferred provider organizations
-nursing centers
-independent provider organizations
-health maintenance organizations
-school health clinics
organizations that are classified as secondary healthcare organizations (4)
-home health care
-ambulatory care centers
-free standing E.R.s
-nursing centers
organizations that are classified as tertiary healthcare organizations (5)
-home health centers
-long term care facilities
-rehab centers
-skilled nursing facilities
-assisted living programs/retirement centers
5 major characteristics that differentiate healthcare organizations
-type of services provided
-length of direct care services provided
-ownership
-teaching status
-accreditation status
ownership organizations that provide health services to individuals under the support and/or direction of local, state, or federal government
public institutions
federal service recipients of public institutions (4)
-veterans
-members of military
-native americans
-inmates of correctional facilities
ownership organizations that are controlled by voluntary boards or trustees and provide care to a mix of paying and charity patients
private nonprofit/ not-for-profit
ownership organizations that operate with the specific intent of earning a profit by providing healthcare services to individuals who can afford to pay for these services
for-profit
ownership organizations that coordinate care and chronic disease management and improve the overall quality of care provided to Medicare patients
accountable care organizations (ACO)
2 accrediting healthcare organizations
-the joint committee (TJC)
-national committee for quality assurance (NCQA)
form of group practice in which physicians in private offices are paid on a fee-for-service basis by a prepaid plan to deliver care to enrolled members
independent practice associations (IPA)
form of group practice in which contracts are developed with private practice physicians, but fees are discounted from their usual and customary charges. In return, physicians are guaranteed prompt payment
preferred provider organizations (PPO)
healthcare agencies that provide basic and supplemental health maintenance and treatment services to voluntary enrollees who prepay a fixed periodic fee without regard to the amount of services used
health maintenance organizations (HMO)
what does medicare part a cover (3)
-inpatient hospital stays
-SNF stays
-hospice care
(known as hospital insurance)
what does medicare part b cover (4)
-doctor services
-outpatient care
-medical supplies
-primary prevention care
(known as medical insurance)
what does medicare part c and d cover
-prescription drug coverage
(known as medicare advantage plans)
the approval, recognition, or certification by an official review board that an organization has met certain standards
accreditation
When organizations that provide similar services come together, the arrangement is referred to as ?
ex: group of acute care facilities that come together to provide coverage for an expanded region
horizontal integration
When organizations align to provide a full array or continuum of services, the arrangement is referred to as ?
vertical integration
theory that attempts to explain productivity in terms of a unifying whole as opposed to a series of unrelated parts
systems theory
four elements that make up a system within systems theory
- structure
- technology
- people
- environment
