Exam 1 Flashcards
% of Insurance claims that are denied
3%
How many Americans are insured vs. Not insured?
45m not insured and 250m have coverage
Public Sector
o Develop Policies and administration of these policies
o Health and Behavior Education
o Epidemiology
Use statistics and lab procedures to track disease
Private Sector
o Hospitals o Ambulatory Surgery o Clinics/medical group practices o Private urgent care facilities o Long term Care facilities
Four reasons that Bitter Pill identifies are driving healthcare costs higher than GDP
1) Routine Care costs
2) Medical Technology costs
3) Catastrophic Illness costs
4) Taxpayers are picking up the tab
Accreditation
A process of review that healthcare organizations voluntarily participate in to demonstrate the ability to meet predetermined criteria and standards.
An outside agency has determined the provider to be a credible and reputable organization dedicated to ongoing and continuous compliance with the highest quality.
Accrediting companies
HFAP, DNV, ACHC, and CLIA
Governing Board Definition and Responsibility
There primary goal is to Govern on behalf of the company’s shareholders
- Formulates policy
- Directs the hospital administrator
- Monitors how the policy is carried out and its outcomes
- Leave any personal agenda at the door
AMA
American Medical Association
This a large group of Physicians that:
- Create a network
- They want to get rid of the bad doctors that aren’t preforming their duties correctly
- Improve the educating process by providing schools with new equipment and trainings
Three levels of Medical Care
Primary
Secondary
Tertiary
What is Organized Health Care according to IHC?
organized
What is defensive medicine?
This is when the doctor says that he can do a certain procedure that may not even be necessary just so that the patient doesn’t come back later to sue him. It also gives the patient a more sound mind.
Kurt Thomson: He had prostate cancer and was treated with proton treatment. This treatment hasn’t even really been proved as working and yet he may not have even needed it.
Two Primary Functions of Governing Board according to Upper Valley Health
- Oversight
- Fundraising to build new buildings or get new tech
Difference in Privileging and Credentials
Credentialing is the process of assessing and confirming the qualifications of a health care practitioner.
Privileging is the process that health care organizations employ to authorize practitioners to provide specific services to their patients.
Physicians Values
Respect Control Fair Reimbursement Efficiency Improvement on patient care Time is Money
