Chapter 2

Question 1

National Priorities Partnership

Answer 1

28 joined organization that will transform healthcare

Question 2

6 priorities of NPP

Answer 2

(PaPoSCaPo )

1. Patient and family engagement
2. Population Health
3. Safety
4. Care of coordination
5. Palliative CAre
6. Overuse

Question 3

PSRO ( professional std review org )

Answer 3

review the quality, quantity, and docket of hospital case

Question 4

Utilization Review

Answer 4

done by Md’s to review admissions and eliminate overuse dx

Question 5

DRG’s

Answer 5

adjusted by : severity, regional/urban/rural cost, and teaching cost

Question 6

Capitation

Answer 6

aims to build a payment plan consists of best standards at lower cost

Question 7

Managed care…

Answer 7

receives a predetermined captained payment

Question 8

Managed care focuses on….

Answer 8

prevention, early intervention and outpatient care

Question 9

Goals of Public Law 111-148

Answer 9

healthcare services for all
reducing healthcare costs
improving healthcare quality
reduction in mortality rate	advancement in sanitation
prevention on infectious disease
patient teaching
injury prevention program

Question 10

Tertiary Care

Answer 10

intensive care

subacute care

Question 11

Secondary Care

Answer 11

acute care
emergency care
acute medical-surgical care
radiological procedures

Question 12

Primary Care

Answer 12

prenatal and well-baby care
nutrition counseling
family planing
exercise class

Question 13

Preventative Care

Answer 13

BP and CA screening
immunizations
mental health counseling
community legislation

Question 14

Restorative Care

Answer 14

cardiopulmonary rehab
sports medicine
home care
continuing care	
ALF
adult day care

Question 15

8 dimensions of patient centered care

Answer 15

CRIP ATIE
coordination of care
respect of values
information
physical comfort
access to care
transition and continuity
involvement of family
emotional support

Question 16

5 components of review Magnet model

Answer 16

transformational leadership
structural empowerment
new knowledge
exemplary professional practice
empirical quality results

Question 17

Managed Care Organization MCO

Answer 17

Provides comprehensive preventative and treatment services to a specific group of voluntarily enrolled people.

Question 18

Preferred Provider Organization PPO

Answer 18

Type of managed care plan that limits an enrollee’s choice to a list of “preferred” caregivers.

Focus is on primary care

Question 19

Medicare

Answer 19

Federally administrated program by the Commonwealth Fund of the CMS; for people 65+

Question 20

Medicare Part A

Answer 20

provides basic protection for medical, surgical, and psychiatric care costs based on DRGs; limited skilled nursing facility care, hospice, and home health care

Question 21

Medicare Part B

Answer 21

a voluntary medical insurance; covers physician, certain other health professional services, and certain outpatient services

Question 22

Medicare Part C

Answer 22

managed care provision that provides a choice of the three insurance plans

Question 23

Medicare Part D

Answer 23

voluntary prescription drug improvement

Question 24

Medicaid

Answer 24

Federally funded, state-operated program that provides

1. health insurance to low-income families
2. health assistance to low income people
3. supplemental coverage and LTC assistance to older adults in nursing homes

Question 25

Private Insurance

Answer 25

traditional fee-for-service plan; payment after services are received

Question 26

LTC Insurance

Answer 26

Provide a set amount of dollars for an unlimited time or for as little as two years; REALLY expensive

Question 27

State Children’s Health Insurance Programs

Answer 27

Federally funded, state operated program for uninsured children; for children not poor enough for medicaid