Chapter 12 Flashcards
fraud
knowing disregard of truth
upcoding
higher priced service is billed when a lower-priced service is actually delivered
defensive medicine
us healthcare - characterized by legal risks for providers
practive of defensive medicine leads t tests and service, that are not medically justified byt are performed by physicians tp [rptect themselves against potential malpractice lawsuits
certificate-of-need (CON)
state-enacted legislation whose primary purpose was to control capital expenditures by health facilities
IOM
institute of medicine
HRQL
health related quality of life - persons own perception of health, abilit y to function, role limitations, stemming from physical/emotional problems and personal happiness
quality assessment
measurement of quality against an established standard, includes process of defining how quality is to be determined
quality assurance
sysnonymous w/ quality improvement, process of institutionalizing quality through ongoing assessment for continuous quality improvement
underutilization
occurs when benefits of an intervention outweigh its risks or costs, and yet it is noticed i.e. low birth rate due to a lack of prenatal care
critical pathways
outcome-based and patient centered case management tools that are interdisciplinary, facilitating coordination of care among multiple clinical departments
risk management
proactive effots to prevent adverse events related to clinical care and facilities operations and is especially focused on avoiding medical malpractice
outcome measurers
effects or results obtained from utilizing the structure and processes of health care delivery
validity
extent to which a measurement scale of quality actually assesses what it purports to measure
reliability
reflects the extent to which the same results occur from repeated applications of a measure
