Health Systems Flashcards
Habeus cortis
allows a person to report unlawful restriction
Habeus cortis
allows a person to report unlawful restriction
Horizontal integration
expansion of core products or services at the same part of the production process in the same part of an industry.
ex. hospital acquires a nerby hospital
Divestiture
elimination of product s or services, closure of facilities, or withdrawal from a market area
Retrenchment
reduction of the scope or intensity of services or products
Vertical integration
offering a broad range of patient care and support services in a functionally unified manner by operating more than a single point on the chain of production.
Ex. hospital adding a fitness center.
Interorganizational relationships
joint venture, mergers, and consolidations. Can be combined with other strategies.
Value based purchasing
payment strategies that offer financial incentives based on defined measure to achieve greater value in halth care while slowing spending.
Risk corridor
Provision in the ACA that intends to promote accurate premiums int he health care exchange
What are the 9 major domains in the National Committee on Quality Assurance Recognition Module for Patient Centered Medical homes.
Access and Communication
Patient Tracking and Registry functions
Care Management
Patient Self management support
E prescribing
test tracking
referral tracking
Performance reporting and improvement
Advances electronic communication
Utilization Management
Set of techniques used by or on behalf of purchasers of health care benefits to manage health care cost by influencing patient care decision making through case my case assessment of appropriateness of care before its provision.
Organization continually evaluating the medical necessity and appropriateness using evidence based criteria
How long do laboratory have to comply with patient request for labs
and what is the CLIA exception
30 days
If it may cause harm to patient or others by judgement of HCP, then it can be denied
“Final Rule” related to labs
Allows individuals to receive lab results directly from the lab.
Medicare Access and CHIP reauthorization Act
Eliminated the sustainable growth rate formula
Antikickback law
Requires proof of intent
What is the Federal Food, Drug, and Cosmetic Act and when was it enacted
Enacted in 1938, FDA responsible for public health in the areas of food saftey, drugs, dietary supplements and medical devices
What does the Resource Conservation and Recovery Act regulate
Generation, transportation, treatment, storage, and disposal of hazardous waste
Passed in 1976. known as cradle to grave
which health service had the greatest growth from 1997 to 2007
prescription drugs
What is the primary objective of utilization management
cost containment.
What are the three components of measuring health care quality proposed by donebedian
Structure: the attributes of the settings in which care occurs.
2. process: What is actually done in actual giving and receiving of care
3. outcome measures: capture the effect of an intervention on health status specific clinical finding, or patients perception of care.
What part of medicare is based on prospective payments. explain
Medicare A. Hospital payment is based on diagnosis related groups which provide a schedule for payments before they are delivered.
HMO group vs network model
Group is when on one group is contracted to provided covered services. In a network model, more than one multispecialty group is ontracted.
What does the comprehensive energy response, compensation and liability act do
Provides for liability that is joint, several and retrospective. Legislation that established a “superfund” for clean up of abandoned or active sites contaminated by hazardous waste.
What does the clean water act of 1977 do
Provides for regulation of discharge of pollutants into water. Goal of making surface waters swimmable or fishable
What did the safe drinking water act of 1974 do
Established standards for public water systems and provided protection of ground water.
