Health Care Delivery Flashcards
Which level do you begin at when initiating change?
Local level
ex: hospital–>community–>region–>state–>national
Which conditions are treated first, psychosocial or medical?
MEDICAL
What is the strongest method used to evaluate teaching?
Return demonstration
“show me” or “tell me what you understand based on wht i’ve just said”
If a patient needs to be transferred to a tertiary facility, what are your priorities?
- assess all injuries
- stabilize
- assess your facility’s capabilities
- transfer to tertiary as appropriate
If a patient is reluctant to undergo a diagnostic procedure, what is extremely important?
Full patient education regarding their condition
Should you delay discharge from an acute care facility for primary care screening exams?
No–they’re not absolutely necessary
What are 2 major health issues for health policy?
- access
2. improved health
What are the 2 goals of Healthy People 2020?
- Increase the quality and years of healthy life
2. Eliminate health disparities among Americans
What do the health objectives of Healthy People 2020 address?
Objectives involving equal access, availability, cost, quality of care, etc.
What is the use Healthy People 2020?
- to understand the health status of the nation
2. to plan PREVENTION programs
Who determine how to meet the Healthy People 2020 goals?
Individuals
Communities
Organizations
What are “reporting statutes”?
Require practitioners to report specific health-related information
Vary from state to state
List 4 categories for mandatory reporting under the state reporting statutes.
- Criminal acts and injury from a dangerous weapon (police)
- Reportable diseases
- Animal bites
- Suspected or actual CHILD or ELDER abuse
Which diseases are reportable in most states?
- Gonorrhea
- Chlamydia
- Syphilis
- HIV
- TB
Who should the NP report the reportable diseases to?
The Department of Health
Who should the NP report animal bites to?
Animal control (a subsidiary of the Department of Health and Human Services)
Who do you ask to help coordinate police contact due to actual or suspected child/elder abuse?
Social services, who often makes police contact
Are NPs legally mandated to report domestic violence?
No, not in most states
What are 2 reasons that collaborative care exists?
- Enhance the quality of care
2. Improve patient outcomes
How does ANA’s Nursing: A Social Policy Statement (1995) describe collaboration?
a TRUE PARTNERSHIP
in which all players have and desire power,
share common goals,
and recognize/accept separate areas of responsibility and activity
Issues Regarding Access to Care (usually 4 questions)
FYI :)
What does home health do?
o Some patient has a knee replacement, as soon as she has a BP they send her home. A home health nurse comes out with a flight attendant approach, and that’s it. (30 min session)
o Check vitals, do wound care, do a dressing change, how are you using your IS, how much pain meds are you taking, how about your meals (who is bringing you food and water)
o This happens for a few weeks (several times a week, not every day) then tapers off
What are 2 requirements for a hospice referral?
- Death dx of 6 mo or LESS
- On comfort measures
* *abx therapy is a gray area
What is a SNF?
For pts with major health care needs that do not require hospitalization
Includes multidisciplinary services such as PT
What’s wrong with the private duty option?
It’s very expensive!
What do E&M codes identify?
The level of care provided
ex: Level 1-5, new consults, followup, etc.
What do E&M codes match?
The level of service provided to the complexity of the patient’s presenting problem
List 5 categories of Third Party Payers.
- Medicare
- Medicaid
- Commercial indemnity insurers (more flexible choices than both PPOs and HMOs)
- Commercial management organizations (HMOs)
- Business or schools wanting health services for employees or students
In terms of third party payment, why is Medicare so significant?
It sets the standard for reimbursement and cutting costs
Billing Medicare for an E/M service requires the selection of an appropriate CPT code, what defines ___ (3)
- patient type (new vs established)
- setting of care (outpatient, inpatient, ED, NF)
- level of E/M service provided
What 3 components guide the selection of the level of service provided?
Which services are an exception to the rule and what guides E/M selection?
- history
- exam
- level of medical decision making
Counseling/coordination of care…E/M selection guided by TIME spent
The Levels of E/M service are based on 4 types of exam, what are they?
- Problem focused
- Expanded problem focused
- Detailed
- Comprehensive
What is a problem focused exam?
A LIMITED exam of the affected body area or organ system
What is an expanded problem focused exam?
A LIMITED exam of the affected body area or organ system + any other symptomatic or related body areas/organ systems
What is a detailed exam?
An EXTENDED examination of the affected body areas or organ systems + any other symptomatic or related body areas or organ systems
What is a comprehensive exam?
A general, multi-system exam –OR—
A COMPLETE exam of a single organ system + other symptomatic or related body areas or organ systems
What does Medicare A cover?
- Inpatient hospitalization
- Skilled nursing facility service
- Home health
- Hospice associated with an inpatient event
When do most people qualify for Medicare A benefits?
65
What does Medicare B cover?
- Physician services
- Outpatient hospital services
- Labs/diagnostics
- Medical equipment
- Some home health services
B = outpatient
Do you pay for Medicare A?
No
Do you pay for Medicare B?
Yes–it is a supplemental medical insurance program that requires ppl to pay a premium
What is the reimbursement for NPs and CNS under Medicare B?
85% of MD reimbursement for services provided in collaboration with a physician