Exam 2 Book Chapters Flashcards
Pay for performance is?
A strategy using financial incentives to reward providers for the achievement of a range of pure objectives, including:
- delivery efficiencies
- submission of data & measures to the payer
- improved quality and patient safety
How is it for performance measured?
HEDIS
Healthcare Effectiveness Data and Information Set
Higher quality care not just now care
Multiplayer system
What the US has
Multiple private insourances companies and he government pay for healthcare
Single-payer System
Only the government pays for healthcare
This would greatly reduce administrative waste
Primary, secondary and tertiary levels of healthcare
Primary = preventative medicines
Secondary= specialized care MI, or stroke
Tertiary= management of complex and rare disorders like cancer
Multi specialty group practice
Physicians from different specialties share equipment to reduce costs
Community health centers
Regionalized services for vulnerable geographic populations with an emphasis on primary care and education
Health Maintenance Organizations
Pre-paid, group managed care plans that allow subscribers to receive all the medical services they require through a group of affiliated providers
A group of doctors. You don’t know which doctor will deliver your baby but one will be there and they want to prevent illness
Preferred provider organization (PPO)
Allow a third party payer (health insurance company) to contract with a group of health care providers to provide services at a lower fee in return for prompt payment and guaranteed volume of patients and services
Accountable Care Organization
Affordable Care Act
Provides incentives for organizations that provide well integrated patient centered care
Medical Home
A model for patient care
Patient -Centered Medical Home
Medical neighborhood
A whole bunch of services that keep patients out of the hospital
keeps patients out of the hospital with preventative care. Social services, ambulatory care ect.
Can be used to maintain and study public health
Care coordination
Deliberately facilitating pt care btn 2 or more healthcare services
Employee- Based Private Insourance
Covers 51% of people by being their direct employee, 49% by being employees dependent
Medicare
Amended social security act to provide state and national healthcare to people over the age of 65
Medicare has classification categories called
Diagnosis related group
Now, the government only pays the amount if preassigned to a diagnosis and there hospital has to absorb the rest
No longer reimbursed for preventable errors like a pressure ulcer
Medicaid
Federally funded public assistance for the disabled
CHIP
Childrens health insurance program
For kids who don’t qualify for Medicaid but can not afford private insourance
Hospital Outpatients
Those who are hospitalized overnight but who require diagnosis or treatment
Respite care
For the caretakers of Home bound, disables, or older patients give them a break
Hospice
For people who are dying
Palliative Care
Outside of hospice but on the road to it
Voluntary agencies
Alcoholics Anonymous
Cancer support groups
original how to give report/ “handoff”
Situation- Background- Assessment-Recommendation
More advanced way of giving report
ISBARQ Introduction - people involved, yourself included Situation Background- V/S mental status Assessment-current providers assessment Recommendations- Q-questions and answers
Basically adds I and Q
Discharge planning, factors to assess
Health data Personal data Caregivers Environment Financial and support resources
