Exam 3 Flashcards
ORBA
Omnibus Reconcilation Budget Act
OD
Doctor of Optometry
OMB
Office of Management and Budget
OPPS
Outpatient Prospective Payment System
OSHA
Occupational Safety and Health Administration
OT
Occupational Therapist
P4P
Pay-for-Play
PA
Physician Assistant
PACE
Program of All-inclusive Care for the Elederly
PCM
Primary Care Manager
PCP
Primary Care Provider
PET
Positron Emmision Tomography
PharmD
Doctor of Pharmacy
PhD
Doctor of Philosopy
PHI
Personal Health Information
PHO
Physician-hospital organization
PHS
Public Health Service
PMPM
payment per member per month
POS
Point-of-service plan
PPM
physician practice management
PPO’s
Prespective Provider Organizations
PPS
Prospective Payment System
PRO’s
Peer reviewed organizatioons
PTA
Physical therapy assistant
PTCA
percutaneous transluminal coronay angioplasty
PT’s
Physical therapists
QALY
Quality-Adjusted Life Year
QMB
Qualified Medicare Beneficiary program
R & D
Research and Development
RBRVS
Resource-based relative value scales
RN
Registered Nurse
RUG’S
Resource Utilization Groups
RVU’s
relative value units
SAMHSA
Substance Abuse and Mental Health Services Administration
SARS
severe acute respiratory syndrome
SAV
small area variations
SCHIP
State Children’s Health Insurance Program
SES
Socioeconomic Status
SHI
socialized health insurance
SNF
skilled nursing facility
SSI
Supplemental Security Income
SMI
supplementary medical insurace
SLMB
specified low-income Medicare beneficiary
STD’s
sexually transmitted diseases
TANF
Temporary Assistance for Needy Families
TEFRA
Tax Equity and Fiscal Responsibilty Act
TPA
third-party adminstrator
TQM
Total Quality Management
UCR
usual, customary, and reasonable
UR
utilization review
VA
Department of Veterans Affairs
VHA
Veterans Health Administration
WHO
World Health Organization
WIC
Women, Infants and Children
The most commonly used measure of disability. Determine whether individuals need assistance to perform basic activities
ADL
Short-term, intense medical care for an illness or injury ususally requiring hospitalization
Acute care
Community-based, long-term care service that provides support care for elderly adults
Adult day care
Care rendered to patients who come to physicians offices, outpatient departments of hospitals and health centers to receive care
Ambulatory care
Hospital or other inpatient servies other than room and board and professional medical services
Ancillary Care
Case Management
An organized approach to evaluating and coordinating care, particulary for patients who have complex problems
Case Mix
An aggregate of the severity of conditions requiring medical intervention
Medical condition that persits over time
Chronic condition
Standardized guidlines in the form of scientifically established protocols, representing preferred processes in medical practice
Clinical practice guidelines
Local nonprofit, community owned health care providers serving low-income and medically underserved areas
Community health center
Medicare designation for small rural hospitals with 25 bed or fewer that provide emergency medical services besides short-term hospitalization for patients with non complex needs
Critical Access hospital
Outcome based, patient centered case management tools that are interdisciplinary, facilitating coordination of care among multiple clinical departments and caregivers
Critical Pathways
Nonmedical care provided to support and maintain the patients condition and the essentials of daily living
Custodial Care
Excessive medical tests and procedures performed as a protection against malpractice lawsuits
Defensive medicine
Part of the overall treatment plan designed to facilitate discharge from an inpatient setting
Discharge Planning
Advance directives telling medical professionals not to perform CPR
Do-not-resuscitate (DNR)
A written document that provides a legal means for a patient to delegate authority to another to act on the patients behalf
Durable Power of Attorney
Endemic
A disease restricted to a local region
An outbreak of an infectious disease that spreads rapidly and affects many individuals within a population
Epidemic
A list of acceptable prescription drugs approved by a health plan
Formulary
The application of information science to improve the efficiency, accuracy, and reliability of health care services.
Health informatics
A federal designation indicating an area has shortages of primary medical care, dental, or mental health services.
HPSA’s Health professional shortage area
A person’s own sense of health, ability to function, role limitations stemming from physical or emotional problems and personal happiness during or subsequent to disease experience
Health-related quality of life (HRQL)
A cluster of special services for the dying
Hospice
The number of new cases of a disease in a defined in a defined population within a specified period
Incidence
A legal entity that physicians in private practice can join so that the organization can represent them in the negotiation of managed care contracts
Independent practice association (IPA)
A fundemental patient right to make an informed choice regarding medical treatment based on full disclosure of medical information by the providers
Informed consent
A person’s ability to perform household and social tasks.
Instrumental Activities of Daily Living
A network of organizations that provides or arranges to provide a coordinated continuum of services to a defined population and is willing to be held clinically and fiscally accountable for the outcomes and health status of the population serviced
Intergrated delivery system (IDS)
A legal document in which a patient puts into writing what his or her preferences are regarding treatment during terminal illness and the use of life-sustaining technology.
Living will
A special designation by the American Nurses Credentialing Center, to recognize quality patient care, nursing excellence and innovations in professional nursing practice in hospitals
Magnet hospital
An imbalance of the distribution of health professionals
Maldistribution
A distribution principle according to which health care is most equitably distributed through the market forces of supply and demand rather than government interventions
Market justice
US Census has defined a geographic area that includes at least one city with a population of 50,000
Metropolitan statistical area (MSA)
Sickness
Morbidity
Death
Mortality
Certain new drug therapies for conditions that affect fewer than 200000 people
Orphan drugs
Serving to relieve or alleviate, such as pharmacologic pain management and nausea relief
Palliative
