Finals Flashcards
Police Power and Public Health
authority, to enact measures, to preserve and protect (safety, health, welfare, morals of the community)
-State and local power only
● Inspect (ex. Flint, Michigan water supply, EPA must wait to be invited)
● Quarantine (ex. Ebola, CDC could not set national quarantine standards)
● Regulate (ex. Highway safety)
Centers for Medicare and Medicaid – role in health equity and in quality of care
Updating the requirements that hospitals and critical access hospitals (CAHs) must meet to participate in Medicare and Medicaid:
- Reducing readmissions
- Reducing barriers to care
- Reducing the incidence of hospital-acquired conditions (including healthcare-associated infections)
- Improving the use of antibiotics (including the potential for reduced antibiotic resistance)
- Addressing workforce shortage issues
- Improving patient protections
Challenges in immigrant health care
- epidemics blame
2. language and cultural barriers
AOT
Assisted Outpatient Treatment
●AOT allows courts to order individuals with mental illness to stay in treatment as a condition of living in the community.
●It is only applicable to the most seriously ill who have a history of violence, incarceration, or needless hospitalizations.
●AOT is proven to keep patients, the public, and police safer.
○The Department of Justice has certified AOT as an effective crime-prevention program. But mental-health departments are reluctant to implement AOT because it forces them to focus on the most seriously ill.
Management
Using resources to reach objectives linked to the mission
●The mission depends on the organization and what they hope to accomplish
○Ex. For the Bureau of Communicable Disease =
■To recognize and rapidly respond to communicable disease threats, to prevent or control ongoing transmission, and to strengthen and coordinate emergency preparedness, response and recovery in the New York City (NYC) healthcare community
●Objectives are what you do in the interim (they help you get to the mission)
○Ex. identify source of infection, determine if additional cases have occurred, stop further transmission
Hospitals depend on payments from
●Government and commercial insurances
●Patient bills
●Federal and state subsidies→ disproportionate share hospitals: larger subsidies for hospitals with poor patients
Voluntary Nonprofit hospitals
Model 1: Used to have fee for service, now rely on insurance DRG payments which puts pressure on hospital to discharge patient quickly and only take care of issues related to primary diagnosis.
Model 2: Integrated system that includes prepaid health insurance plan and salaried physicians. Good care, better outcomes, and lower deliverance price. (Kaiser Permanente, Mayo Clinic)
Voluntary profit hospitals
●Make as much money for investors as possible
●Patients have to have very good insurance
●Rare in NYC
Advanced Primary Care
co-locations, special licenses, agency coordination, integrated team care, better outcomes and lower costs.
FFS
Fee for service
The more the doctor or the hospital does, the more money they earn.
● Under fee-for-service, the longer a hospital kept a patient, the more money it collected.
● If there were complications like hospital acquired infections, the hospital also got more money.
● And if the patient had to be re-admitted over and over again for the same thing, the hospital continued to get more and more money.
● In the same way, the more tests the doctor did, the more procedure he or she did, the more money he or she earned. It didn’t matter if the tests or the procedures were needed.
VBS
Value based purchasing
The better the quality of care, the more money the doctor and hospital earn.
Healthcare for undocumented immigrants in NYC
- Undocumented immigrants are ineligible for the major federally funded public insurance programs: Medicaid, Medicare, CHIP
- New York has granted limited exemptions allowing some undocumented immigrants to enroll in Medicaid or CHIP
- Undocumented children are eligible for Child Health Plus and pregnant women are eligible for PCAP
- Patients will not be reported to Immigration
Inpatient settings
●Skilled nursing facilities (SNF) – Medicare pays
●Nursing homes (custodial care) – MediCARE does NOT pay, MedicAID MAY pay
●Assisted living centers
●Rehabilitation centers – Medicare pays
●Substance abuse treatment centers – private insurance, sometimes Medicaid
Ambulatory Care Sites
●Urgent Care Centers ●Community health centers ●Private practices ●School-based health care ●Geriatric day programs ●Day programs for substance abuse and mental illness
