Health Care Systems And Settings Flashcards
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.
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.
Certification
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)
Groups 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 dollars amount paid annually for all care. Providers determine how 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 pre certification and pre authorization 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.
