Chapter 1 - The US Healthcare Delivery System Flashcards
Accountable care organization (ACO)
A group of service providers that work together to manage and coordinate care to Medicare fee-for-service beneficiaries.
Accreditation
- A voluntary process of institutional or organizational review in which a quasi-independent body created for this purpose periodically evaluates the quality of the entity’s work against preestablished written criteria
- A determination by an accrediting body that an eligible organization, network, program, group, or individual complies with applicable standards
- The act of granting approval to a healthcare organization based on whether the organization has met a set of voluntary standards developed by an accreditation agency
Acute care
Medical care of a limited duration that is provided in an inpatient hospital setting to diagnose and treat an injury or a short-term illness
Allied health professional
A credentialed healthcare worker who is not a physician, nurse, psychologist, or pharmacist (for example, a physical therapist, dietician, social worker, or occupational therapist)
Ambulatory care
Preventative or corrective healthcare services provided on a nonresident basis in a provider’s office, clinic setting, or hospital outpatient setting
Biotechnology
The field devoted to applying the techniques of biochemistry, cellular biology, biophysics, and molecular biology to addressing practical issues related to human beings, agriculture, and the environment
Centers for Medicare and Medicaid Services (CMS)
The Department of Health and Human Services agency responsible for Medicare and parts of Medicaid. Maintains oversight of the survey and certification of nursing homes and continuing care providers and makes information about these activities available to beneficiaries, providers and suppliers, researchers, and state surveyors
Certification
- The process by which a duly authorized body evaluates and recognizes an individual, institution, or educational program as meeting predetermined requirements
- An evaluation performed to establish the extent to which a particular computer system, network design, or application implementation meets a prespecified set of requirements
Chief executive officer (CEO)
The senior manager appointed by a governing body to direct an organization’s overall long-term strategic management
Clinical Privileges
The authorization granted by a healthcare organization’s governing board to a member of the medical staff that enables the physician to provide patient services in the organization within specific practice limits
Continuum of care
Patients are provided care by different caregivers at several different levels of the healthcare system
Deemed status
An official designation indicating that a healthcare facility is in compliance with the Medicare Conditions of Participation
For-profit
Healthcare organizations are privately owned. Excess funds are paid back in to the managers, owners, and investors in the form of bonuses and dividends
Health maintenance organization (HMO)
Entity that combines the provision of healthcare insurance and the delivery of healthcare services, characterized by: 1. An organized healthcare delivery system to a geographic area, 2. A set of basic and supplemental health maintenance and treatment services, 3. Voluntarily enrolled members, and 4. Predetermined fixed, periodic prepayment for members’ coverage
Health savings account (HSA)
Savings accounts designated to help people save for future medical and retiree health costs on a tax-fee basis; part of 2003 Medicare bill; Also called medical savings account
Home healthcare
A wide-range of healthcare services that can be delivered in the home and it is the fastest-growing sector to offer services for Medicare recipients
Hospice care
An interdisciplinary program of palliative care and supportive services that addresses the physical, spiritual, social, and economic needs of terminally ill patients and their families
Hospital
A healthcare entity that has an organized medical staff and permanent facilities that include inpatient beds and continuous medical or nursing services and that provides diagnostic and therapeutic services for patients as well as overnight accommodations and nutritional services
Hospital outpatient
A patient who is provided with room, board, and continuous general nursing services in an area of an acute care facility where patients generally stay at least overnight
Inpatient
A patient who is provided with room, board, and continuous general nursing services in an area of an acute care facility where patients generally stay at least overnight