Exam 2 Book Chapters

Question 1

Pay for performance is?

Answer 1

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

Question 2

How is it for performance measured?

Answer 2

HEDIS
Healthcare Effectiveness Data and Information Set

Higher quality care not just now care

Question 3

Multiplayer system

Answer 3

What the US has

Multiple private insourances companies and he government pay for healthcare

Question 4

Single-payer System

Answer 4

Only the government pays for healthcare

This would greatly reduce administrative waste

Question 5

Primary, secondary and tertiary levels of healthcare

Answer 5

Primary = preventative medicines

Secondary= specialized care MI, or stroke

Tertiary= management of complex and rare disorders like cancer

Question 6

Multi specialty group practice

Answer 6

Physicians from different specialties share equipment to reduce costs

Question 7

Community health centers

Answer 7

Regionalized services for vulnerable geographic populations with an emphasis on primary care and education

Question 8

Health Maintenance Organizations

Answer 8

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

Question 9

Preferred provider organization (PPO)

Answer 9

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

Question 10

Accountable Care Organization

Affordable Care Act

Answer 10

Provides incentives for organizations that provide well integrated patient centered care

Question 11

Medical Home

Answer 11

A model for patient care

Patient -Centered Medical Home

Question 12

Medical neighborhood

Answer 12

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

Question 13

Care coordination

Answer 13

Deliberately facilitating pt care btn 2 or more healthcare services

Question 14

Employee- Based Private Insourance

Answer 14

Covers 51% of people by being their direct employee, 49% by being employees dependent

Question 15

Medicare

Answer 15

Amended social security act to provide state and national healthcare to people over the age of 65

Question 16

Medicare has classification categories called

Answer 16

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

Question 17

Medicaid

Answer 17

Federally funded public assistance for the disabled

Question 18

CHIP

Answer 18

Childrens health insurance program

For kids who don’t qualify for Medicaid but can not afford private insourance

Question 19

Hospital Outpatients

Answer 19

Those who are hospitalized overnight but who require diagnosis or treatment

Question 20

Respite care

Answer 20

For the caretakers of Home bound, disables, or older patients give them a break

Question 21

Hospice

Answer 21

For people who are dying

Question 22

Palliative Care

Answer 22

Outside of hospice but on the road to it

Question 23

Voluntary agencies

Answer 23

Alcoholics Anonymous

Cancer support groups

Question 24

original how to give report/ “handoff”

Answer 24

Situation- Background- Assessment-Recommendation

Question 25

More advanced way of giving report

Answer 25

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

Question 26

Discharge planning, factors to assess

Answer 26

Health data
Personal data
Caregivers
Environment
Financial and support resources