Health Care Systems Flashcards
Medical Assistants
members of a health care team that perform administrative and clinical procedures and responsibilities
- often screen patients, before initial provider enters
Roles of a Medical Assistant
- work alongside a provider in an outpatient or ambulatory setting (medical office)
- greet patients, handle correspondence , answer telephones
- obtain medical history from patients, explain treatments or procedures, draw lab tests, prepare and administer immunizations
Allopathic Providers
MD’s
Medical Doctor Roles
- diagnose illnesses
- provide treatments
- perform procedures, such as surgical interventions
- write prescriptions
Osteopathic Providers
DO’s
Doctor of Osteopathy
use a more holistic form of treatments
EX (change diet, instead of trying medication)
- diagnose illnesses
- provide treatment plans
- perform procedures, that can be surgical
Nurse Practitioners
- provide basic care services
- can diagnose and provide medication for common illnesses
- require advanced academic training beyond the RN degree, and have a great amount of clinical experience
focus on preventive care and disease prevention
Physician Assistants
- practice medicine under a MD or DO license
- able to make clinical decisions and be responsible for services
Medical Laboratory Technician
perform diagnostic testing on blood, bodily fluids, and other specimen under the supervision of a medical tech
Medial Receptionists
- check patients in and out
- answer phones
- perform filing, faxing and other tasks
Occupational Therapists
assists patients who have developed conditions that disable them developmentally, emotionally, mentally, or physically
Pharmacy Technicians
assist pharmacies with duties that do not require the expertise or judgement of a licensed pharmacist
Physical Therapists
assist patients in regaining their mobility and improving their strength and range of motion
Radiology Technicians
use various types of imaging equipment to assist the provider in diagnosing and treating certain diseases
Professionalism
consists of the skills, behavior, and appropriate judgement that represent the best qualities of a person in a specific profession
What type of professionalism should a medical assistant show?
must exhibit a courteous, conscientious, and a businesslike manner
What type of professionalism would be considered to have, at a high-level?
dependability, initiative, flexibility, confidentiality, a good attitude
Appropriate Attire in a medical field:
- good personal hygiene
- avoid perfumes and colognes
- wear makeup conservatively
- keep nails clean (no acrylics) and at a reasonable length
- clothing should fit appropriately
When should you take a personal phone call?
during scheduled work breaks or lunch hours
Why is punctuality important in the work place?
Arriving to work on time and performing all assigned duties each day are essential to being a reliable employee
- need to have good time management
Why is respecting boundaries important in the work place?
by setting appropriate boundaries in the workplace, you can avoid awkward situations with co-workers and patients
- be aware of nonverbal communication from patients, that might indicate if they feel invaded of personal space
Scope of practice
only do the tasks that you are 100% percent sure you are allowed to do
Standard of care
the degree of care or competence expected in a particular circumstance or role
- applies to all health care professionals who provide care to patients
Additional credentials for medical assistants:
- certified phlebotomy technician
- certified EKG technician
- certified billing and coding specialist
-certified electronic health records specialist
Certified health coach or navigator
often directs patients through the health care system
- help organize patient care, connect patients to additional resources, help patients understand the health care system
- specialize on a certain chronic disease area
EX - cancer, heart disease, diabetes
Health Care Licensure
the licensure is regulated by state statutes through the medical practice acts
What profession is mandatory for license?
Physician
- mandatory and controlled by the state board of medical examiners
- can be accomplished by examination, reciprocity, or endorsement
What does every state require for an MD to get their license?
a written exam
Some states require this profession to get a license….
medical assistant
CPOE
computerized physician order entry
As a medical assistant, what are the advantages of getting your license?
increased initial job placement, higher wages, and career advancement opportunities
Health Care Delivery is also known as…
health care system
Health Care Delivery
the organizations of individuals, establishments, and resources to deliver health care services and meet the health needs of specific populations
The Affordable Care Act
promoted newer health care system and payment models by testing new methods of health care delivery and moving from reimbursement structure to a method established on the value of care
Accountable Care Organizations (ACOs)
these groups of physicians, hospitals, and other health care providers come together voluntarily to provide coordinated high-quality care to their medicare patients.
What happens when the ACO succeeds?
it will share in the savings it achieves for the Medicare program
Capitation (partial or full)
patients are assigned a per-member, per-month payment based on their age, race, sex, lifestyle, medical history, and benefit design
- like bundled payment models, providers have an incentive to help patients void high-cost procedures and test to maximize their compensation
(under partial, only specific types of categories of services are paid on a basis of competition)
Global Budget
a fixed total dollar amount paid annually for all care.
- the participating providers can determine how money is spent
- global budgets limit the level and the rate of increase of health care cost
- typically include a quality component as well
Health Maintenance Organization (HMO)
this plan contracts with a medical center or a group of providers to provide preventative and acute care for the insured person.
- HMO’s generally require referrals to specialists, as well as precertification and preauthorization for hospital admissions, outpatient procedures, and treatments
Patient-Centered Medical Home (PCMH)
in this care delivery model, a primary care provider coordinates treatment to make sure patients receive he required care when and where they need it, and in a way they can understand
Pay for Performance
this reimbursement model compensates providers only if they meet certain measures for quality and efficiency
- generating quality benchmark measures connects providers reimbursement directly to the quality of care they provide
Preferred Provider Organization (PPO)
these plans have more flexibility then HMO plans
- an insured person doesn’t need a PCP but can go directly to a specialist without referrals
- although patients can see providers in or out of their network, an in-network provider usually costs less
Generalist Provider
able to assess a wide range of symptoms, diagnoses and conditions while using a variety of resources to build a treatment plan
Specialist Provider
assesses a more specific set of symptoms, diagnoses and conditions
General Practitioners (GP)
medical doctors who treat acute and chronic illnesses and provide preventative care and health education to patients.
- may take a holistic approach of general practice that takes in the consideration of biological, psychological, and social aspects relevant to the car of each patient’s illness
Family Practitioners
offer care to the whole family, from newborns to older adults
- familiar with a range of disorders and disease
- preventative care is their primary concern
Internists
provide comprehensive care of adults, often diagnosing and treating chronic, long-term conditions
- they also offer treatment for common illnesses and preventative care
- must have a broad understanding of the body and its ailments to be able to diagnose conditions and provide treatment
Allergists
evaluate disease and disorders of the immune system
- includes adverse reactions to medications and food, anaphylaxis, problems related to auto-immune disease, and asthma
Anesthesiologists
manage pain or use sedation during surgical procedures
Cardiologists
specialize in diagnosing and treating diseases of the heart and blood vessels
Dermatologists
specialize in conditions of the skin
Endocrinologists
specialize in hormonal and glandular conditions. They often work with patients who have diabetes mellitus
Gastroenterologists
specialize in managing diseases of the gastrointestinal tract: the stomach, intestines, esophagus, liver, pancreas, colon, and rectum
Gynecologists
specialize in the female reproductive system and fertility disorders
Hematologists
deal with blood and blood-producing organs
- often work with patients who have anemia, leukemia, and lymphoma
Neonatologists
specialize in the care of newborns
Nephrologists
specialize in kidney care and treating disease of the kidneys
Obstetricians
specialize in the care of women before and after pregnancy
Oncologists
specialize in the treatment and care of patients who have cancer
Ophthalmologists
specialize in eye conditions
Orthopedists
specialize in bones, joints, muscles, tendons, and ligaments
Otolaryngologists
specialize in the ear, nose, and throat
Neurologists
specialize in the nervous system
Pathologists
specialize in body tissue, blood, urine, and other bodily fluids to diagnose and treat medical conditions
Pediatricians
specialize in newborn, infant, child, and adolescent health care
Psychiatrists
specialize in mental disorders and conditions
Radiologists
specialize in the use of x-rays, ultrasound, nuclear medicine, computed tomography, and magnetic resonance imaging to detect abnormalities throughout the body
Urologists
specialize in disorders of the urinary tract
Urgent Care
provide and alternative to the emergency department.
- cost less, shorter wait time, often conveniently located, flexible hours, walk-ins allowed
Laboratory Services
perform diagnostic testing on blood, bodily fluids, and other types of specimen to conclude a diagnoses for the provider
Diagnostic Imaging
machines such as x-ray equipment, ultrasound machines, magnetic resonance imaging (MRI), and computerized tomography (CT) take images of the body to further diagnose a condition
Acupuncture
involves picking the skin or tissue with needles to relieve pain and treat various physical, mental, and emotional conditions
Chiropractic
medicine diagnoses and treats mechanical disorders of the musculoskeletal system, particulary the spine
Energy Therapy
the calm method of clearing cellular memory through the human energy field promoting health, balance, and relaxation. it is centered on the idea of connection between the physical, emotional, mental states of life found in various holistic healing techniques
Dietary Supplements
contain one or more dietary ingredients including, vitamins, herbs, minerals, or other botanicals
