Healthcare Delivery Flashcards
What law was enacted in 2010 to improve healthcare quality while lowering costs and expanding the Medicaid program?
Affordable Care Act (ACA)
3 main goals of the ACA?
Make health insurance affordable.
Provide protection to people with ACA-funded services.
Expand the Medicaid program to people under 138% of the poverty level.
Sentinel event
Adverse event, shouldn’t occur
What org supports nurses to improve client care through education, certifications, and professional designations?
The American Nurses Credentialing Center (ANCC)
What program recognizes acute care facilities that demonstrate excellence in nursing based upon meeting standards in five categories?
The Magnet Recognition Program
What program is for long-term or outpatient facilities to recognize excellence in nursing?
Pathway to Excellence Program
The Magnet Program identifies-
Client care excellence
Orgs with quality outcomes
Innovations in professional practice
The Pathway to Excellence Program identifies-
Contributions that affect nurses’ well-being
A shared governance structure
A supportive practice environment
What survey tools are designed to evaluate a client’s perception of their experience within the outpatient setting of the healthcare system?
Press Ganey & HCAHPS
Press Ganey is administered =
HCAHPS is administered =
Press Ganey is administered = After visit
HCAHPS is administered = 48 hr to 6 weeks after visit
Press Ganey is administered to =
HCAHPS is administered to =
Press Ganey is administered to = Every client
HCAHPS is administered to = A random sample of clients
Press Ganey is administered by =
HCAHPS is administered by =
Press Ganey is administered by = Email
HCAHPS is administered by = Essentially everything other than an email. (Phone call, mail, mail with phone call follow-up, automated voice message)
Press Ganey is evaluating =
HCAHPS is evaluating=
Press Ganey is evaluating = Healthcare delivery, client satisfaction
HCAHPS is evaluating= Client satisfaction
Government healthcare coverage for a client who’s 65 or over, under 65 with disabilities, or any age with End Stage Renal Disease (ESRD) =
Medicare
What does Medicare consist of?
3 separate parts:
Part A = Hospitalizations, skilled nursing facilities, some hospice care, some healthcare
Part B = Dr’s services, physical therapy, occupational therapy, some healthcare
Part D = Prescription drugs
Government healthcare coverage for a client who meets eligibility requirements based on the client’s income in relation to the poverty level =
Medicaid
Insurance coverage that isn’t provided by a government agency =
Private insurance
Government healthcare coverage that provides for children who may not meet Medicaid’s requirements but need healthcare coverage =
Children’s Health Insurance Program (CHIP)
Blue Cross Blue Shield, Aetna, and Cigna are all examples of -
Private insurance
Government agency that oversees the healthcare delivery of government associated coverage =
Centers for Medicare and Medicaid Services (CMS)
Fixed payment system for reimbursement for healthcare services based upon client diagnosis and procedures performed =
Diagnosis-Related Groups (DRGs)
Method of standardized insurance reimbursement based on the client’s diagnosis and procedures performed within the acute care setting =
Inpatient Prospective Payment-System (IPPS)
Program instituted by the Centers for Medicare & Medicaid (CMS) to increase the quality of care in health care facilities. This program denies reimbursement for services associated with specific HAIs =
Hospital-Acquired Condition Reduction Program (HACRP)
Fixed payment system for reimbursement of healthcare services provided in the long-term care setting based upon client diagnosis and services required =
Resource Utilization Groups (RUGs)
Clinical assessment of a client’s physical + cognitive status required to be conducted on nursing home residents who receive Medicare & Medicaid benefits =
Minimum Data Set
Physical determinants =
Physical/ built structures that impact health
Social determinants =
Social + Community, education, economic stability, health + healthcare, neighborhood + built environment
Skilled Nursing Facility (SNF) =
Long-term care/ nursing home. May provide short-term care for rehabilitation care like occupational / physical therapy
Long-term care hospital (LTCH) =
Provides care for stable patients who need a lengthy period of treatment. (Severe burns, trauma, or ventilation needs)
Hospice Care =
End of life care. Less than 6 months left to live.
Goal = comfort + support services for the client and family, not curative.
Palliative Care =
Similar to hospice, but not end-of-life care, and patient can still be receiving curative meds
Respite Care =
Allows the client to be cared for when away from the caregiver for a short period of time. Allows the caregiver to have time for vacations, traveling, etc.
Home care can include =
Occupational therapy, physical therapy, and social work
Case manager =
Coordinates the healthcare team in addressing a patient’s needs
Social workers =
Identify discharge planning solutions and community resources for a patient
License Practical Nurse (LPN) =
Work under the supervision of the RN to provide basic care to a patient
Provider =
Prescribes the meds + therapies that patients need to achieve positive health outcomes
Occupational Therapists =
Assist clients with their ADLs that are due to illness, surgery, or injury
