Final Flashcards
A fixed payment plan of health insurance offers coverage for…
Complete medical care
Third-party payers are…
Insurance companies
The purpose of the gatekeeper is to…
Approve all non emergency services, approve hospitalization, and approve tests before they are given
In a managed care organization, financial risk is shared by….
Organizations, hospitals, and physicians
A gag clause, considered illegal in contracts between physicians and managed care organizations…
Prohibits the physician from discussing financial incentives given by the organizations.
Managed care organizations may attempt to limit a patient’s…
Choice of hospitals, referrals to specialists, length of stays in a hospital.
A health maintenance organization provides
Healthcare services available for a predetermined fee per member by a limited group of providers.
Capitation is
A fixed monthly fee paid to the healthcare provider for providing patient services.
Medicare is a federal program of
Healthcare coverage in which rationing of care might occur in the future and coverage for the elderly and disabled.
Medicaid is a
Federal program of care for the poor implemented by the states
A medicare-instituted method of hospital payment is
DRG(Diagnosis-related groups)
Diagnosis related groups refer to
The classification of patients of illness by diagnosis
Those persons most likely to receive the best care under a managed care system are
Those who understand the system
Medicare and Medicaid prohibit physicians from
Referring to services they own
Different methods of medical practice, such as partnership and corporations, are the result of
Increased insurance coverage costs, a desire to better serve patients’ needs, and increased patient-initiated malpractice lawsuits.
A practice in which the physician employs other physicians and pays them a salary is called
Sole proprietorship
An associate practice is a legal agreement in which the physicians
Share a facility and staff
A business operation of a medical practice in which two or more physicians are responsible for the actions of each, including debts, is called…
Partnership
A medical practice consisting of three or more physicians who practice the same specialty and share expenses and income is a
Group practice
The members of a professional corporation are known as
Shareholders
Benefits of a corporation include all of the following except…
Protection from the lawsuits for the corporation
Which form of medical practice ends with the death of the owner?
A solo practice
Fee splitting occurs when
One physician pays another physician for the referral of patients.
Allied health professionals who are certified include all of the following except
Pharmacists
A person with the appropriate education who practices as a doctor of medicine or doctor of osteopathy is called a
Physician
Decision based on emotion
Gut feeling
Medical etiquette
Standards of professional behavior
R/O
Rule out diagnosis
Ethics
Branch of philosophy
Applied ethics
Practical application of moral standards
Laws
Binding rules determined by an authority
Medical ethics
Moral conduct to regulate behavior of medical professionals
Beneficence
Principle of doing good
Veil of ignorance
Justice based
Three step ethics model
Kenneth Blanchard and Norman Vincent Peale’s approach to ethics
When you are trying to solve an ethical dilemma, it is necessary to?
Use logic to determine the solution
An illegal act is almost always
Unethical
An utilitarian approach to solving ethical dilemmas might be used when?
Allocating a limited supply of donor organs
Three step approach to solving ethical dilemmas is based on what?
Asking ourselves how our decision would make us feel if we had to explain our actions to a loved one, asking ourselves if the intended action results in a balance decision, asking ourselves if the intended action is legal
How can embezzlement be prevented?
Checks and balances
Order for a person or document to appear in court?
Subpoena
Person who is being sued
Defendant
Give up the right to something
Waive
Law that covers harm to another person
Tort
Earlier ruling applied to present case
President
Failure
Breach
Person who sues another party
Plaintiff
Less serious crime such as a traffic violation
Misdemeanor
Oral testimony to be used in court
Deposition
Serious crime such practicing medicine w/out a license
Felony
Subpoena duces tecum means?
“Under penalty, take with you”
Stare decisis means?
“Let the decision stand”
A threat of doing bodily harm to your patient by stating, “if you won’t allow us to continue the procedure, we will have to tie your hands” is…
Assault
A patient comes in for an exam, they remove their clothing and put on a gown. This would be?
Implied consent
Endorsement
Sanction
Guardian ad liter
Court appointed representative
Revoked
Medical license taken away
Respondeat superior
Let the master answer
Statute of limitations
Period of time that patient has to file a lawsuit
Discovery rule
Begins at the time the injury is noticed or should have been noticed
Reciprocity
One state granting a license to a physician in another state
Standard of care
Ordinary skill that medical practitioners use
Good Samaritan law
Law to protect the healthcare professional
Nonrenewal of license
Practicing medicine without a license
According to the Medical Patients Rights Act, patient information
Can never be given out to a third party
The term used for a court appointed person to represent a minor or unborn child in litigation is?
Guardian ad litem
The prudent person rule refers to?
The information that a reasonable patient would need
When the Physician places an ambiguous order, you the healthcare professional…
Can decline to carry out the order and should immediately notify the physician
Physicians and employees are?
Liable in a lawsuit, have the same responsibility to protect patient’s confidentiality, operate under a standard of care, and must be trained to perform a procedure before attempting it
What does JCAHO mean?
Joint Commission of Accreditation of Healthcare Organization
The contract for services with a physician includes…
An agreement to pay for services for as long as they are received by the patient, truthful disclosure of conditions by the patient, and an agreement to provide services by the doctor
Physicians may…
Refuse to treat patients, except emergencies, and withdraw from a contract if the patient is uncooperative
An increase in malpractice insurance premiums has caused
Physicians to charge more for services than in the past
A physician can turn away patients that
They have not agreed to treat.
An indigent patient is one who
Is unable to pay for medical care
Abandonment can be avoided by
Giving formal notice of withdrawal from a case.
The physician, by law, must report to the state any person who…
Is HIV or AIDS positive
The physician who believes that his or her AIDS patient may place the health of others in jeopardy has an ethical obligation to…
Persuade the patient to inform his or her partners
Testing for HIV first requires
The patient’s informed consent.
A report of HIV or AIDS diagnosis must be completed by the
Physician
Patient confidentiality does not apply in the case of
The life or safety of the patient.
Medical ethicists currently encourage healthcare providers to
Focus on the consequences of an action while protecting the patient and apply the principles of justice
The patient has a right to
Deny any treatment, give informed consent for any treatment, and expect the appropriate standards of care
Minor children may receive life-saving treatment
Even though the parents refuse
A breach of confidentiality is considered unethical and illegal, and is prohibited by
HIPAA
Confidential information that has been told to a physician by the patient is called
Privileged communication
A statement of the patient’s intentions for healthcare-related decisions is called
An advanced directive
A patient request to either use or not use life-sustaining treatments and artificial nutritional support is known as
A living will
The authority of a healthcare agent to act on behalf of the patient
Continues even if the patient is physically or mentally incapacitated
A minor is one who
Is less tha 18 and is not considered competent to give consent for most treatments
The patients signature on an informed consent form indicates
Understanding of treatment options, expressed consent, understanding of the limits or risks in the pending treatment
Patients who indicate by their behavior that they will accept a procedure are providing
Implied consent
Exceptions to obtaining consent may include
Commonly known risks
Refusal for medical or surgical treatment by the patient must be honored if
The patient is concerned about the success of the procedure, the patient is not confident in physician, religious beliefs against the procedure are expressed.
One of the best ways to prevent medical errors is for the patient to
Be a better informed consumer of medical services
Failure to perform an action that a reasonable person would have performed in a similar situation is
Negligence
Performing a wrong and illegal act is considered
Malfeasance
Professional misconduct or demonstration of an unreasonable lack of skill with the result of injury, loss or damage to the patient is
Malpractice
Negligence is composed of four elements
Duty, dereliction of duty, direct or proximate cause, and damages
The reasonable person standard refers to
Duty of due care
The standard of care for physicians and other healthcare professionals is determined by
What members of the same profession would do in a similar situation within the same geographic area
To prove dereliction of duty, a patient would have to prove the physician
Did not conform to the acceptable standard of care
The the things that speaks for itself applies to the law of negligence and is the doctoring of
Res Pisa loquitur
Monetary awards by a court to a person who has been harmed in an especially malicious or willful way are
Punitive damages
To win a wrongful death case, the plaintiff must prove
Negligence
The most common defense provided by the defendant in a medical malpractice case is called
Denial defense
Assumption of risk the legal defense
That prevents the plaintiff from recovering damages if he or she accepts a risk associated with the activity
When an employer lends an employee to someone else, this is called
The borrowed servant doctrine
The statute of limitations for a case begins to run
When the injury is discovered
Deliberate concealment of the facts from a patient is
Fraud
Res judicata means
The thing has been decided
The legal relationship formed between two people when one person agrees to perform work for another person is called
The law of agency
Protection for the physician/employer by the healthcare professional is best accomplished by
Having a job description with clearly defined responsibilities, duties, and necessary skills, using extremes care when performing his or her job, and carrying out only those procedures for which he or she is trained
Responsibility for action in employment is ultimately assigned to the
Employer
A contact by which one person promises to compensate or reimburse another if he or she suffers a loss form a specific cause or a negligent act is
Liability insurance
Coverage of the insured party for all injuries and incidents that occurred while the policy was in effect, regardless of when they are reported is
Occurrence insured
A general liability policy that covers any negligence on the part of the physician’s staff would include
A rider of the malpractice policy
Submitting a dispute to a person other than a judge is called
Arbitration
An important reason for arbitration of civil cases is to save
Time and money
The only health professional who not usually employed by the physician is the
Pharmacist
Data, such as birth and death dates, are used by the government to
Determine population trends and needs
Public duties for the physician include reporting
Births and still births, deaths and injuries, and communicable illnesses or diseases,
The live birth certificate must be signed by the
Physician who delivered the child and person in attendance in a home birth
A death certificate must include the
Date and time of death, name of the parents of the deceased, and location of the place of death.
A coroner or medical examiner must sign the death certificate of the deceased when
No physician was present at the time of death, a violent death occurred, and the death occurred when the deceased was in jail or or prison
A medical examiner is a
Physician
Which of the following is not a reportable communicable disease: Tetanus Tuberculosis Chicken pox Gonorrhea
Chicken pox
Which of the following is/are required by the National Childhood Vaccine Injury Act of 1986?
The polio virus vaccine, live and the measles, mumps, and rubella vaccine
A physician reporting possible child abuse
May not be sued by the parents of the child for defamation and may file an initial oral report followed by a written report.
Failure to report a suspected case of child abuse may result in a charge of
Misdemeanor
Elder abuse may legally include all of the following except
Verbal abuse
Injuries, fractures, pain in the genital area, and weight loss may be signs of
Physical abuse
Evidence gathered in an abuse case may include
Pictures of bruises or injuries, urine specimens, and clothing
Chain of evidence refers to all of the following except
Clothing evidence that is clean and dry
Conditions such as cancer, epilepsy, and congenital disorders of the newborn are often reported to government agencies in order to
Maintain accurate public health statistics
Enforcement of drugs sales an distribution is through the
Food and Drug Administration
The purpose of the DEA is to
Regulate the Controlled Substances Act of 1970
Registration for physicians who administer controlled substances must be renewed every
3 years
The proper method of destroying a controlled substance that needs to be disposed of “disposed of or wasted” is to
Flush it down a toilet as advised by the manufacturer.
The penalty for violation of the Controlled Substances Act is
A fine, loss of license to practice medicine, and a jail sentence.
DEA registration numbers are available to
Physicians
Prescriptions for Schedule 2 controlled substances can
Not be refilled
A program of management-financed and confidential counseling and referral service designed to help employees and/or their family members assess a problem is the
EAP
It is estimated that personal problems related to alcohol and/or drug abuse cost the U.S. economy more than_______ of it $70 billion budget yearly.
%50
Hazardous medical waste includes
Infectious waste from body fluid contract and radioactive waste.
Laws regulating employment relationships, recruitment, placement, pay plans, benefits, penalties and terminations are based primarily on
Job performance
Employment-at-will allows the
Employee to quit at any time, and employer to terminate the employee at any time
Discrimination in the form of unfair treatment in employment based on race, color, religion, sex or national origin is covered through
Title VII
Medicare and Medicaid forbid discrimination in
patient-care institutions
Sexual harassment includes
Unwelcome sexual advances, requests for sexual favors, and verbal or physical conduct of a sexual nature
The Civil Rights ACT of 1991 permits the court to award _______ to mistreated employees
Compensatory and punitive damages
The Age Discrimination in Employment Act of 1967 protects persons _______ or older against employment discrimination.
40 years
The Americans with Disabilities Act of 1990 requires the employer to make
Reasonable accommodations for disabled employees
OSHA represents the
Occupation Safety and Health Act
Rules to protect healthcare workers from blood borne pathogens are regulated by the
OSHA
The Health Maintenance Organization Act of 1973 requires that any company with 25 employees must provide
An HMO alternative to regular group insurance
COBRA of 1985 provides that a company with 20 or more employees must provide extended healthcare insurance to terminated employees fo up to
18 months, usually athe employee’s expense.
Through the Drug-Free Workplace Act, employers contracting to provide good or services to the federal government must certify that
A drug-free workplace is maintained
The Failr Labor Standards Act of 1938 regulates employee benefits such as
Minimum wage, payment for overtime work, and hours that are worked.
The origin of the current unemployment insurance program for employees who are unable to work through no fault of their own is the
Social Security Act
The Equal Pay Act of 1963 makes it illegal for an employer to discriminate on the basis of
Gender
A fine imposed by the federal gov’t for employers not contributing to Social Security for their employees is mandated by the
Federal Insurance Contribution Act
The Workers’ Compensation Act protects workers and their families from financial problems resulting from
Employment-related injury, disease, or death
The Family and medical Leave Act of 1994 allows
The mom and dad to take a leave of absence of up to 12 weeks in any 12-month period when a baby is born and an unpaid medical leave for up to 12 weeks of leave for their own or a family member’s medical or family related situation
Guidelines for use of an individual’s credit information are stablished by the
Fair Credit Reporting Act of 1971
The fAir Debt Collection Practices Act prohibits phone calls for the purpose of debt collection
Before 8 am
The portion of a paycheck that may be paid directly to an employee’s creditors is established by the
Federal Wages Garnishment Law
Under the Family and Medical Leave Act, the employee
Must be returned to the same or equivalent position when he or she returns.
The Emergency Treatment and Active Labor Act relates to
Patient “dumping”
An unfair dislike or preference against someone is called
Bias
A private or public healthcare entity that facilitates the processing of nonstandard electronic transactions into HIPAA transactions is…
Clearinghouse
A healthcare organization covered under HIPAA regulations is
Covered entity
A number assigned to an employer for purposes of identification is the
Employer ID number
The individual or group that provides or pays for the patient’s medical care is the
Healthcare plan
A national source of reports of actions taken against healthcare providers, practitioners, and vendors who are in noncompliance or performing fraudulent activities is the…
Healthcare Integrity and Protection Data Bank
The use of communication and information in medical practice, research, and education is called
Medical informatics
the reasonable effort that a healthcare provider uses to limit disclosure of patient information is referred to as
The minimum necessary standard
The objective of the Health Insurance Portability and Accountability Act of 1998 is to
Combat fraud, abuse, and waste in healthcare, promote medical savings accounts, and simplify the administration of health insurance
The federal office that investigates violations of HIPAA is the
Healthcare Integrity and Protection Data Bank
Which title of HIPAA most affects confidentiality issues for healthcare providers?
Title 2: Administrative simplification
The privacy rule is meant o ensure that there are
Security of electronic transfer of information and disclosure of only the necessary information
Protected health information relates to
Past, present, and future individually identifiable health information
Those who would be covered under HIPAA include
Life insurers, information system vendors, universities
Healthcare fraud alerts are issued by the
Inspector General of the HHS
REsearchers who wish to obtain individually identifiable medical information must…
Obtain a patient authorization that complies with the rules set by HIPAA
An exception to the release of information policy under HIPAA would allow information to be released to
The police investigating a crime
Violation of HIPAA is a
Federal criminal offense
The original intent of HIPAA was to
Protect computerized medical records and billing and provide easier access of medical records for the patient
HIPAA allows all of the following except
Complete disclosure of patient information by an EMT
HIPAA law stipulates that the patient…
May sue over privacy violations and may register a complaint to the gov’t
Suggestions for physician and physician groups when implementing HIPAA include
Appointing and training a privacy officer, adopting procedures for handling patient requests, and implementing a notice of privacy practices.
Signed authorizations and any agreements with patient restricting disclosure of PHI should be retained for a period of
6 years
Wireless local area networks are used by physicians and nurses to
Access patient records from central databases and add patient observations and assessments to databases
The application of communication and information to medical practice, research, and education is called
Informatics
The use of communications and information technologies to provide healthcare services to people at a distance is known as
Telemedicine.
Branch of philosophy relating to morals or moral principles is
Ethics
Applied ethics relates to
Healthcare professionals
Issues discussed in the context of advanced medical technology are called
Bioethics
Illegal acts are
Usually unethical
The code of ethics dealings with experimentation on human subjects is
The Nuremberg code
The father of medicine, who wrote a statement of principles for his medical students to follow
Hippocrates
The issue of a warning or censure by the American medical Association to a physician occurs when the physician
Is accused of unethical behavior or conduct
An allegation of a criminal act by a physician requires that the
Act be reported to the state licensing aboard or gov’tal agency
The loss of a physician’s license is called
Revocation
The concern for the human subject in medical experimentation is the result of the
Nuremberg Code
The AAMA has developed a code of ethics for the
Medical assistant
The thick committees of a hospital serves ina n advisory capacity to patients, families, and staff to
Decide who gets donated organs, review difficult ethical issues, determine when care will be discontinued.
The Uniform Anatomical Gift Act
Permits competent adults to allow posthumous use of their organs through a written document
Giving organs to patients who will benefit the most is called
Social utility
The National Organ Transplant Law of 1984
Forbids the sale of organs
Allocating organs for transplants is handled through
The United Network for Organ Sharing
An employee should state a preference for not wishing to be involved in assisting with a procedure
Before being hired
Research that will not directly benefit the research subjects is
Nontherapeutic
An institutional review board in a hospital or university receiving federal research funds
Oversees any human research in the facility
Medical research that may directly benefit the research subject is
Therapeutic
Placing the researcher’s interests above the patient’s interests is considered
A conflict of interest
In a double-blind test
Neither the experimenter nor the patient knows who is getting the research treatment
Standards of professional behavior practice by physicians in their relationship or conduct with other physicians is called
Medical etiquette
A decision model for helping resolve ethical issues include asking
Who do we know? Who is involved? Where and when does the situation occur?
The administration of a lethal agent by another person to a patient for the purpose of relieving intolerable and incurable suffering is
Euthanasia
In the stage of human development between the 2nd and 12th week, the developing life is
An embryo
The gestational period is the
Time from conception to birth
AIDS is the same as
Artificial insemination donor
The most common legal and ethical concern related to AIDS is
Legitimacy of the child and its support
AIDS records are
Confidential, not a public record, handled the same as adoption papers
In vitro fertilization occurs as a result of
Growth of the fertilized ovum in the lab and implantation of the fertilized ovum in the uterus.
Surrogate motherhood allows the
Surrogate mother to be paid for medical expenses
The use of fertility drugs
Increases the chance of multiple births
Any action taken to prevent pregnancy from occurring is
Contraception
A woman’s right to privacy, including the right to an abortion, is guaranteed by
Roe vs. Wade
The process of medically altering reproductive organs to prevent the possibility of producing children is
Sterilization
Sterilization requires
Written consent and a mentally competent adult
Voluntary sterilization of unmarried minors is
Forbidden in many states and allowed with authorization of the minor and parent or guardian in some states
Eugenic sterilization is
Considered unethical by many people
Castration or sterilization of another person without legal permission is considered to be
Assault and battery
The termination of a pregnancy before the fetus is viable is called
Induced and spontaneous abortion
Initially, Roe v. Wade said that during the third trimester of pregnancy, the state
May prohibit abortions except to save the life of the mother
Recommendations from Roe v. Wade decision included all of the following except
Viability of the fetus in not required
A person appointed by the court to speak on behalf of an incapacitated party is called the
Guardian ad litem
Pro-choice advocates believe that
Women have the right to choose what to do with their bodies, legalized abortions are safer for the woman, and a woman has the right to an abortion when she is the victim of rape or incest.
Right-to-life advocates argue all of the following except
The right of the unborn child take precedence over the right of the mother
The conscience clause refers to
Hospitals not choosing to perform sterilization procedures and physicians and hospital personnel not being required to participate in sterilization
The study of heredity and its variations was discovered by
Gregor Mendel
A means to detect couples who are at risk of passing on a genetic disease to their offspring is called
Genetic counseling
Criteria or standards that assist in the determination of death include
A significant drop of body temp and rigor Morris
A legal death is a
Cardiac death
Prolonged absence of oxygen can result in
Neurological damage, brain death, and cardiac death
According to the brain-oriented death definition, death occurs when
There is irreversible cessation of all brain functions
Discontinuing ventilation support for a patient who is brain dead will result in
Cardiac death
Most widely accepted legal definition of death in US?
Multi-organ death
Irreversible coma include all of the following criteria except
Spontaneous movement or breathing
Which action is considered active euthanasia
Intentionally foregoing life-sustaining treatment
Ethical considerations of the terminally ill patient include
Withdrawing versus withholding treatment, active vs. passive euthanasia, and ordinary vs extraordinary means
Withdrawing life-sustaining treatment refers to
Discontinuing artificial methods of maintaining life
Patients have the legal right to
Refuse treatment, food, and fluids
The intentional killing of the terminally ill is called
Active euthanasia
Justifications for euthanasia include
Individuals should have the right to determine the outcome of their lives
Active euthanasia
Is illegal and violates the medical profession’s ethics
Advice regarding the course of action taken for a dying loved one can be given by
The physician
The double-effect doctrine recognizes that an action may have
Two consequences: one desired, one undesired
A treatment or procedure that is morally required is considered
Ordinary and appropriate
Dr. Elisabeth Kubler-Ross is known for her study of
Stages of death and dying
A facility with a homelike atmosphere where terminally ill patients find comfort until death is called a
Hospice
The focus of hospice care is
Comfort measure, emotional support, relief from pain
The total care of patients whose disease is no longer responsive to curative therapy is
Palliative care
Viatical settlement allow terminally ill persons to
Obtain money from their life insurance policies
Healthcare facilities, in order to receive Medicare or Medicaid funding, must ask patients if they have
An advance directive
Persons who cannot exercise the fundamental right to self-determination include
Persons who suffer irreversible brain damage, such as those who Alzheimer’s disease
A DNR order can be place don the medical chart of a patient by the
Physician
