chptr 1 healthcare in the US Flashcards
Accountable care organizations
ACOs
groups of doctors, hospitals,and other healthcare providers that come together voluntarily to give high-quality care using a fixed payment model; they work collaboratively and accept collective accountability for costs and the quality of care
accreditation
Voluntary assessment by an accrediting agency that proves a healthcare facility exceeds the minimum requirements set by licensing agencies
Affordable care act (ACA)
healthcare reform with the goal of improving quality of care and affordable healthcare coverage through health insurance exchange , new payment models, initiatives to improve-care and the expansion of Medicaid to millions of low income citizens; provides healthcare consumers with stability and flexibility of healthcare coverage
american college of surgeons (ACS)
A professional association of physicians specializing in surgery, founded in 1913, with the purpose of improving quality of care by setting patient care and surgical education standards
American Hospital Association (AHA)
a professionals association of hospitals with the purpose of improving medical care through advocacy, education of healthcare leaders, and tracking of trending healthcare related issues
american medical association (AMA)
a professional association of physicians founded in 1847 with the purpose of developing standards for medical education , improving public health, establishing medical ethics, and advancing the study of science
centers for medicare and medicaid services (CMS)
formerly known as the health care financing administration (HCFA), CMS manages medicare and medicaid claims and regulates medicare and medicaid programs
Clinician decision support (CDS)
case-specific computerized alerts, clinical guidelines, and current resources regarding diagnosis and treatment options, based on the data found in individual patient records
conditions of participation (CoP)
Regulations that healthcare facilities and providers must meet in order to receive reimbursement from medicare and medicaid
Deficit Reduction Act
Legislation passed with the intent to reduce growth in medicare and medicaid spending and decrease the number of fraudulent medicare and medicaid claims
department of health and human services (HHS)
the federal agency responsible for ensuring the provision of vital human services and health protection to americans
diagnosis related group (DRG)
a system that classifies orients into groups based on a patients principal and secondary diagnoses, procedures performed , and other factors and determines the amount reimbursed to hospital by medicare, medicaid, and other third party payers.
evidence based medicine (EBM)
diagnostic and treatment protocols based on proven research and documented best practice
fee for service
billing for healthcare services after the services have been provided (retrospectively) according to the facility’s or offices actual fees for each service
Healthcare facilities accreditation program (HFAP)
a voluntary accreditation program used by the american osteopathic association, which, like the joint commission, holds deemed status for medicare
health information technology
the framework on which health information is collected, stored, exchanged, and reported
health information technology for economic and clinical health act (HITECH)
legislation resulting from the ARRA that provides incentives to providers and hospitals that adopt or upgrade existing electronic health record (ehr) systems and associated technologies and use them in specified ways
health insurance portability and accountability act (HIPPA)
a law consisting of five rules- privacy, security, data sets, and electronic transaction standards, administrative simplification and enforcement and compliance; it impacted healthcare in general and the health information profession in particular more so than any piece of legislation since medicare and medicaid
Hill-Burton Act
legislation that supplied funding for the modernization of existing hospitals and the building of new ones, in exchange for which hospitals provided care at a reduced rate or for free to patients who did not have the ability to pay.
Independent Practice Association (IPA)
A group of physicians that contracts with a managed care organization to provide care at a pre-determined, pre-negotiated (often reduced) rate.
Informed consent
Patient consent required for invasive surgical procedures and any treatment or procedure that carries a risk to the patient; informed consent provides explanation of the procedure/treatment to be performed and the reason for it; in other words, the risks and benefits of the procedure/treatment , alternatives to the procedure/treatment and their risks and benefits, and the name(s) of the healthcare provider(s) performing the procedure/treatment.
Licensure
Regulations regarding the minimum requirements to practice medicine or provide medical services; they vary from state to state.
Managed care insurance plans
Insurance plans that promote quality, cost effective healthcare through the monitoring of patients, preventive care, and performance measures
Meaningful Use
the sections of HITECH meant to increase the effective use of electronic health records through monetary incentives to adopt and use certified technology.
Medicaid
Title XIX of the Social Security Act of 1935; Medicaid provides financial assistance for healthcare coverage to poor and indigent populations.
Medicare
Title XVIII of the Social Security Act of 1935; Medicare provides financial assistance for healthcare coverage to persons 65 years of age and over, to persons who are disabled, and to those with end-stage renal disease
Medicare Prescription Drug Improvement and Modernization Act of 2003(MMA)
this act provides Medicare beneficiaries with financial assistance in paying for prescription medications
mHealth
The sending and receiving of health information using a mobile phone, mobile device, or other wireless device
Office of the National Coordinator for health information technology (ONC)
Located within the office of the secretary of Health and Human services, the ONC is the federal agency promoting a national health information technology infrastructure and overseeing its development.
Omnibus Budget Reconciliation Act of 1986
The act that focused on substandard care and resulted in the requirement that PROs report substandard care to licensing agencies
Patient-centered medical home (PCMH)
A healthcare model that involves the patient and family in the care of the patient; care is rendered in a team approach.
patient-centric
Communications, information sharing, and decision making that includes the patient and is managed by both the patient and the provider
patients rights
patients have the right to know who their healthcare team consists of, the right to privacy and confidentiality, the right to be informed about their diagnosis and treatment, the right to refuse treatment , the right to actively participate in their care plan, and the right to be cared for in a safe environment, free from abuse. Patients also have the right to read or have a copy (paper or electronic)of their health record, the rught to know who has accessed their health record, and the right to request an amendment to their health record
physician quality reporting initiative (PQRI)
a voluntary pay for performance incentive program
Population health management (PHM)
Clinical and financial activities undertaken to improve health outcomes and to lower costs for a defined group of individuals
primary care physician (PCP)
a family practitioner, an internist, or a pediatrician who manages a patients basic healthcare needs and coordinates care with specialist la under a managed care insurance plan
Prospective payment system (PPS)
a fixed reimbursement system based on the diagnosis related group (DRG) assigned to each inpatient stay; used by Medicare and Medicaid reimbursement and some third party payers
Quality Improvement Organizations (QIO)
entities with which CMS contracts to review medical care , based on health record documentation, and to assist Medicare and Medicaid beneficiaries with complaints about quality of care issues and to implement improvements in the quality of care available throughout healthcare facilities try
Tax Equity and Fiscal Responsibility Act of 1982(TEFRA)
Legislation that resulted in a shift from fee for service reimbursement to a prospective payment system
The Joint Commision (TJC)
Formerly known as The Joint Commision on Accreditation of Hospitals, a voluntary accrediting agency holding deemed status by Medicare
