Chapter 2 - Healthcare Delivery Systems Flashcards
chiropractor
someone who focuses on the diagnosis, treatment, and prevention of disorders of the neuromusculoskeletal system; they primarily focus on physical therapy; some people consider them alternative medicine practitioners and not actual doctors
optometrist
a doctor who focuses on vision and visual systems and is trained to prescribe and fit lenses to improve vision
osteopathy
a type of alternative medicine that emphasizes physical manipulation of the body’s muscle tissue and bones
ophthalmology
a branch of medicine and surgery that deals with the diagnosis and treatment of disorders of the eye
optometrist vs ophthalmologist
an optometrist provides general eye care but cannot do surgery; the ophthalmologist is trained to do surgery; they also go to different schools
osteopath
one who practices osteopathy
hospitalist
a physician who specializes exclusively in the care of inpatient hospital patients; they oversee the patient’s care until discharge; then the patient returns to the care of their primary care physician
physician assistant
a healthcare professional who can diagnose illnesses, develop and manage treatment plans, prescribe medications, and may also serve as a principal healthcare provider; but, they must be under the supervision of a physician
registered nurse (RN)
a nurse that typically has 2-4 years of education (associates or bachelor’s)
nurse practitioner
an advanced nurse who can assess patient needs, order and interpret diagnostic and laboratory tests, diagnose disease, formulate and prescribe treatment plans; must have a master’s degree at least
licensed practical nurse (LPN)
a nurse who provides more basic care and who is subordinate to a registered nurse (RN); also called licensed vocational nurse (LVN)
nurse anesthetist
a nurse who administers anesthesia for surgery or other medical procedures
nurse
a person trained to care for the sick or infirm, especially in a hospital, and subordinate to the medical doctor
ancillary
(adjective) providing necessary support to the primary activities or operation of an organization, institution, industry, or system
(adjective) of lower or secondary class or rank
ancillary care
the wide range of healthcare services provided to support the work of a primary physician
ASAHP
acronym for: Association of Schools of Allied Health Professions; an organization that promotes allied health education
allied health professional
health professionals (other than registered nurses, physicians, and physician assistants) who have received a certificate, an associate degree, a bachelor degree, a master’s degree, a doctorate, or postdoctoral training in a healthcare-related science
audiology
the branch of science that studies hearing, balance, and related disorders. Audiologists treat those with hearing loss and proactively prevent related damage.
clinical laboratory technician
people who perform a wide array of tests on body fluids, tissues, and cells to assist in the detection, diagnosis, and treatment of diseases and illnesses
anatomic pathology
laboratory work that deals with human tissues and provides surgical pathology, autopsy, and cytology services
clinical pathology
laboratory work that involves the analysis of body fluids—principally blood, but also urine, gastric contents, and cerebrospinal fluid
cytology
the branch of biology concerned with the structure and function of plant and animal cells
pathologist
a physician who specializes in performing and interpreting the results of pathology tests
diagnostic medical sonography
the use of imaging by medical ultrasound for medical diagnosis
ultrasound
an imaging test that uses sound waves to create a picture (sonogram) of organs, tissues, and other structures inside the body
emergency medical technicians (EMT)
people who have the basic knowledge and skills necessary to stabilize and safely transport patients
occupational therapy
therapy that helps a person restore bodily function by performing activities
pharmacotherapist
a pharmacist who is highly trained in the treatment of disease with medications; they work closely with physicians
respiratory therapist
a person who provides care for patients who have trouble breathing
speech-language pathologist
people who specialize in the evaluation, diagnosis, and treatment of communication disorders (speech and language impairments), cognitive-communication disorders, voice disorders, and swallowing disorders
voice disorders
medical conditions involving abnormal pitch, loudness or quality of the sound produced by the larynx and thereby affecting speech production
cognitive communication disorders
disorders characterized by difficulty with any aspect of communication that is affected by disruption of cognition. Some examples of cognitive processes include: attention, memory, organization, problem solving/reasoning, and executive functions. Problems in these areas can affect verbal and nonverbal communication.
surgical technologist
a person who assists a surgeon during surgery, often by doing things such as sterilizing equipment and passing tools to the surgeon
internal medicine
the medical specialty dealing with the prevention, diagnosis, and treatment of internal diseases
internist
a physician who specializes in internal medicine
hyperthermia
has two meanings: (1) therapy performed with heat; (2) a dangerously high body temperature
chemotherapy
therapy performed with drugs
integrated delivery systems (IDS)
healthcare systems that combine the financial and clinical aspects of healthcare and use a group of healthcare providers, selected on the basis of quality and cost management criteria, to furnish comprehensive health services across the continuum of care
furnish
(verb) to provide with what is needed, often in reference to furniture
continuum of care
a term that means maintaining continuity of the medical care delivered to the patient, especially when switching between caregivers or care institutions
managed care organization (MCO)
a type of healthcare organization that delivers medical care and manages all aspects of patient care or the payment for care by limiting providers of care, discounting payments to providers of care, or limiting access to care
integrated delivery network (IDN)
a group of hospitals, physicians, other providers, insurers, or community agencies that work together to deliver health services
integrated healthcare system (IHCS)
a group of affiliated doctors, hospitals, and facilities, organized together under one parent company
inpatient
a person who spends more than 24 hours in a hospital
bed capacity
the maximum number of inpatients for which the hospital can care
licensed beds
the number of beds that the state has authorized the hospital to have available for patients
staffed beds
the number of beds for which the hospital has nursing staff to cover patient treatment
small hospital
a hospital with a bed capacity of under 100; most hospitals in the country fall into this category
adult bed
a hospital bed for adults
pediatric bed
a hospital bed for children
maternity bed
a hospital bed for expecting mothers
rehabilitation hospital
hospitals that provide long-term care services to patients recuperating from debilitating or chronic illnesses and injuries such as strokes, head and spine injuries, and gunshot wounds. Patients often stay in rehabilitation hospitals for several months.
psychiatric hospital
hospitals that provide inpatient care for patients with mental and developmental disorders.
general hospital
hospitals that provide a wide range ofmedical and surgical services to diagnose and treat most illnesses and injuries
specialty hospital
hospitals that provide diagnostic and therapeutic services for a limited range of conditions such as burns, cancer, tuberculosis, and obstetrics
long-term acute-care hospital (LTACH)
hospitals that specialize in the treatment of patients with serious medical conditions that require care on an ongoing basis. These patients do not require intensive care or extensive diagnostic procedures but require more care than they can receive in a rehabilitation center, skilled nursing facility, or home.
obstetrics
the branch of medicine and surgery concerned with childbirth and the care of women giving birth
government-owned hospital
a hospital owned by a specific branch of federal, state, or local government as a not-for-profit organization; profits are typically reinvested back into the hospital; one example is the Department of Veterans Affairs (VA)
proprietary hospital
hospitals owned by private foundations, partnerships, or investor-owned corporations. Large corporations may own a number of for-profit hospitals, and the stocks of several large US hospital chains are traded publicly; profits are typically given to managers and investors
voluntary hospital
not-for-profit hospitals owned by universities, churches, charities, religious orders, unions, and other not-for-profit entities. They often provide free care to patients who otherwise would not have access to healthcare services.
safety net hospital (SNH)
A hospital with the highest number of inpatient stays paid by Medicaid. Uninsured safety net organizations play a major role in providing services to medically and socially vulnerable populations. When compared with non-SNHs, SNHs are more likely to be teaching hospitals, have a large number of inpatient beds, and just over 27 percent are located in large central metropolitan areas
critical access hospital
a special designation given to eligible rural hospitals by the Centers for Medicare and Medicaid Services (CMS
inpatient prospective payment system (IPPS)
a system in which each medical case is categorized into a diagnosis-related group to determine the base rate of pay. Payment also is adjusted for differences in area wage costs – and depending on the hospital and case – teaching status, high percentage of low-income patients, the use of new technology and extremely costly cases; in other words, it determines how much hospitals get paid by Medicare for inpatient care
outpatient prospective payment system (OPPS)
the system through which Medicare decides how much money a hospital or community mental health center will get for outpatient care to patients with Medicare. The rate of reimbursement varies with the location of the hospital or clinic.
committee
a group of people appointed for a specific function, typically consisting of members of a larger group
aggregate
a whole formed by combining several (typically disparate) elements
disparate
essentially different in kind; not allowing comparison
medical staff bylaws
a document approved by the hospital’s board, treated as a contract in some jurisdictions, that establishes the requirements for the members of the medical staff (which includes allied health professionals) to perform their duties, and standards for the performance of those duties
chief financial officer (CFO)
the senior manager responsible for the fiscal management of an organization
chief operating officer (COO)
the executive responsible for high-level, day-to-day operations
chief information officer (CIO)
the senior manager responsible for the management of the information resources.
chief executive officer (CEO)
the leader of all administrative staff
concurrent
existing, happening, or done at the same time
chief nursing officer (CNO)
also called Director of Nursing, Vice President of Nursing, or head nurse; they are the leader of all the nursing staff
managed care plan
a health plan, provided by MCOs, that works by creating service contracts with the physicians, hospitals, and other healthcare providers who provide medical services to enrollees in the plans
three basic types of managed care plans
they are HMO, PPO, and POS
HMO
acronym for: health maintenance organization; these plans provide healthcare within a closed network
PPO
acronym for: preferred provider organization; this plan will provide reduced costs if the plan member stays within the network but will contribute at a reduced cost if the member goes outside the network
POS
acronym for: point of service; this allows patients to choose between an HMO or PPO each time they have a medical encounter
accountable care organizations
groups of doctors, hospitals, and other health care providers, who come together voluntarily to give coordinated high-quality care to their Medicare patients; they use alternative payment models, normally, capitation; two such models in Medicare are Medicare Shared Savings and Advance Payment ACO
capitation
a payment arrangement for health care service providers. It pays a set amount for each enrolled person assigned to them, per period of time, whether or not that person seeks care.
ambulatory care
medical services performed on an outpatient basis, without admission to a hospital or other facility
medical home
also known as the patient-centered medical home (PCMH); a team-based health care delivery model led by a health care provider to provide comprehensive (definition: covering completely or broadly) and continuous medical care to patients with a goal to obtain maximal health outcomes
ambulatory surgery
any surgical procedure that does not require an overnight stay in a hospital
observation
in the context of healthcare, a special service or status that allows physicians to place a patient in an acute care setting, within the hospital, for a limited amount of time to determine the need for inpatient admission
surgeon general
a person who is appointed by the president of the United States and who provides leadership and authoritative, science-based recommendations about the public’s health
skilled nursing care
nurse-related care defined as technical procedures, such as tube feedings and catheter care, and skilled nursing observations
intermittent care
care defined as up to 28 hours per week for nursing care and 35 hours per week for home health aide care
home healthcare
limited part-time or intermittent skilled nursing care, therapy, and home health aide services
voluntary agency
an organization that provides healthcare and healthcare planning services, usually at the local level and to low-income patients (examples are battered women shelters, community health centers, and the Red Cross)
subacute care
care that offers patients access to constant nursing care while recovering at home
skilled nursing facilities (SNFs)
also called nursing homes; they provide medical, nursing, or rehabilitative care, in some cases, around the clock. Most SNFs have residents over the age 65 and provide care for those who can no longer live independently.
residential care facilities
also called board and care homes; they are living environments that are more homelike and less institutional; unlike nursing homes, they do not provide nursing care
hospice care
care that is provided mainly in the home to patients who are diagnosed with a terminal illness with a limited life expectancy of six months or less
palliative care
specialized medical care that focuses on providing patients relief from pain and other symptoms of a serious illness, no matter the diagnosis or stage of disease; often used to refer to care that relieves pain but does not cure the disease (as in the case of terminal illness)
adult day care
a planned program of activities in a professional care setting designed for older adults who require supervised care during the day, or for older adults who are isolated and lonely
telehealth
the distribution of health-related services and information via electronic information and telecommunication technologies. It allows long-distance patient and clinician contact, care, advice, reminders, education, intervention, monitoring, and remote admissions
remote patient monitoring (RPM)
the use of connected electronic tools to record personal health and medical data in one location for review by a provider in another location, usually at a different time
mobile health (mHealth)
a term used for the practice of medicine and public health supported by mobile devices
store-and-forward telemedicine
the act of collecting clinical information and sending it electronically to another site for evaluation. Information typically includes demographic data, medical history, documents such as laboratory reports, and image, video and/or sound files.
big data
a field that treats ways to analyze, systematically extract information from, or otherwise deal with data sets that are too large or complex to be dealt with by traditional data-processing application software
social determinants of health (SDOH)
conditions such as environment, socioeconomic conditions, and access to educational and job opportunities that impact a wide range of health, functioning, and quality-of-life outcomes and risks
Human Genome Project
(time period 1990-2003) the successful international research effort to determine the DNA sequence of the entire human genome
National Academy of Medicine (NAM)
an organization that provides national and international advice on issues relating to health, medicine, health policy, and biomedical science
Patient-Centered Outcomes Research Institute (PCORI)
a non-profit organization created through the 2010 Patient Protection and Affordable Care Act. It is a US government-sponsored organization charged with funding comparative effectiveness research that assists patients and healthcare professionals in making the right decisions
comparative effectiveness research (CER)
the direct comparison of existing health care interventions to determine which work best for which patients and which pose the greatest benefits and harms
Social Security Act of 1935
signed into law by President Roosevelt on August 14, 1935. In addition to several provisions for general welfare, the new Act created a social insurance program designed to pay retired workers age 65 or older a continuing income after retirement
Public Law 89–97 of 1965
legislation in the United States whose most important provisions resulted in creation of two programs: Medicare and Medicaid
Utilization Review Act of 1977
the law that made it a requirement for hospitals to conduct continued-stay reviews for Medicare and Medicaid patients
continued-stay review
a review that helps determine whether it is medically necessary for a patient to remain hospitalized
