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