health care systems and settings Flashcards
Health care licensure
Licensure is state-regulated and issued upon graduation from a medical or chiropractic institute. This is mandatory for physicians. Medical assistants are not required to be licensed, but some states require licenses for specific services.
Common roles and responsibilities of medical assistants
Administrative duties: greeting patients, handling correspondence and answering telephones.
Clinical duties: obtaining medical histories from patients, explaining treatments/procedures, drawing laboratory tests, and preparing/administering immunizations.
Certification
Is generally optional, but some states require official education and training for a medical assistant to administer medication, perform phlebotomy procedures, or enter prescriptions into the computerized physician order entry program, Requires continuing education to keep current. Advantages can include increased initial job placement, higher wages, and career advancement opportunities.
Accountable care organizations (ACOs)
Group of physicians, hospitals, and other health care providers that provide coordinated care to medicare patients. Shares savings with the medicare program
Capitation
Payment model in which patients are assigned per-member , per-month payment based on age, race, sex, lifestyle, medical history, and benefit design. Under partial- or blended-capitation models, only specific types or categories of services are paid on a basis of capitation.
Global budget
A fixed total dollar amount paid annually for all care. Providers determine how much money is spent. This model limits the level and rate of health care cost increase.
Health maintenance organization (HMO)
A plan that contracts with a medical center or group of providers for preventative and acute care. HMOs generally require referrals to specialists, as well as precertification and preauthorization for admissions, procedures, and treatments.
Patient- centered medical home (PCMH)
Care delivery model in which the primary care provider coordinates treatment to ensure patients receive and understand the needed care.
Pay for performance
Reimbursement model in which providers only get paid if they meet a benchmark for quality and efficiency of care provided.
Preferred provider organization (PPO)
Flexible plan in which patients can go directly to specialists without being referred. Patients can see any provider, but providers in-network usually cost less.
allopathic
homeopathic medicine; categorized by an effort to counteract the symptoms of a disease by administration of treatments that produce effects opposite to the symptoms
ambulatory
able to walk
computerized physician order entry (CPOE)
a process of electronic data entry of provider instructions for treatment
managed care
an umbrella term for plans that provide health care in return for preset scheduled payments and coordinated care through a defined network of providers and hospitals
osteopathic
a type of medicine based on the concept that disturbances in the musculoskeletal system affect other bodily parts, causing many disorders that can be improved by various manipulative methods in combination with conventional medical, surgical, pharmacologic, and other therapeutic procedures.
professionalism
the skills, behavior, and appropriate judgement that represent the best qualities of a person in a specific profession
scope of practice
delegated clinical and administrative duties consistent with education, training, and experience
standard of care
the degree of care or competence expected in a particular circumstance or role
work ethic
a set of values based on the moral virtues of hard work and diligence
general practitioners (GPs)
are medical doctors who treat acute and chronic illnesses and provide preventive care and health education to patients. a GP may take holistic approach of general practice that takes into consideration the biological, psychological, and social aspects relevant to the care of each patient’s illness.
family practitioners
offer care to the whole family, from newborns to older adults. they are familiar with a range of disorders and diseases. however, preventative care is their primary concern. this is one of the specialties most often chosen by physicians.
