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Service Delivery Exam 2 > Inpatient, Outpatient, Primary Care, LTC > Flashcards

Inpatient, Outpatient, Primary Care, LTC Flashcards

0
Q

What types of facilities are considered inpatient?

A

Hospitals and skilled nursing facilities (SNF)

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1
Q

What constitutes an inpatient service?

A

Any service that requires an overnight stay

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2
Q

If a person goes to the ER is not admitted to the hospital and kept overnight is it considered inpatient?

A

No

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3
Q

What is a hospital?

A

An institution with at least 6 beds

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4
Q

What is the primary function of a hospital?

A

Deliver diagnostic & therapeutic services for particular or general medical conditions

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5
Q

Does a hospital have to be liscensed?

A

Yes

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6
Q

What other staff/services are required to be considered a hospital?

A

Organized staff of physicians & nurses
Maintain medical records, provide pharmacy & food services
Continuous nursing supervised by a RN
Governing body & CEO

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7
Q

What were the first/precursors to modern day hospitals?

A

Almshouses/Pesthouses

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8
Q

Why did Almshouses & Pesthouses evolve into hospitals?

A

Due to:

  • Evolution of the medical profession
  • Scientific discoveries & technological progress
  • Doctors needing a place to house patients
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9
Q

There was a transition from mainly government-run hospital institutions to __________.

A

community-owned

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10
Q

What are hospitals known for now?

A

Centers for high technology & medical research

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11
Q

What happened in the 1940s in regards to the expansion of hospitals?

A

Shortage of hospitals

Hill-Burton Act

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12
Q

What is the Hill-Burton Act?

A

Gave funds to cities to build hospitals.

Goal: 4.5 beds/1,000 population

Took 40 years to reach the goal, we have now exceeded

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13
Q

What happened in the 1950s in regards to the expansion of hospitals?

A

Rise in employer-based health insurance

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14
Q

What happened in the 1960s in regards to the expansion of hospitals?

A

Creation of Medicaid & Medicare

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15
Q

What happened in the 1970s in regards to the expansion of hospitals?

A

Many large hospitals & extended lengths of stay

Spiraling healthcare costs

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16
Q

What happened in the 1980s in regards to downsizing hospitals?

A

1983 - Social Security Amendments

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17
Q

What were the Social Security Amendments?

A

Required Medicare to switch from per diem to a PPS based on DRGs

Decreased lengths of stay

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18
Q

What happened in the 1990s in regards to the downsizing of hospitals?

A

Growth of managed care & outpatient services

  • Shift from inpatient to outpatient helped to decrease costs
  • Most MCOs and traditional insurers use DRGs
  • Medical System
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19
Q

What is an inpatient day?

A

A person that is registered as a patient at midnight

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20
Q

What is the average length of stay?

A

Average number of nights the entire hospital patients are there (average 4.8 days)

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21
Q

Are newborns counted in the average length of stay?

A

No

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22
Q

How is capacity determined?

A

By the number of beds

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23
Q

What is a hospital census?

A

Profile of all patients that are in the hospital on a particular day (# of people, diagnoses, etc)

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24
Q

What is the hospital occupancy rate?

A

People currently in beds divided by the number of available beds

Average is 66%

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25
Q

Who is more likely to frequent hospitals, men or women?

Who is more likely to stay longer?

A

Women more likely to frequent

Men are more likely to stay longer

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26
Q

Who can go to a community hospital?

Are they publicly or privately owned?

What is the average length of stay?

What percentage of all hospitals are community hospitals?

A

Anyone can go

Can be publicly or privately owned

Less than 30 days

85%

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27
Q

What are examples of a non-community hospitals?

A

Military hospitals
Jails
Psychiatric centers

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28
Q

What is a public hospital?

Can a public hospital also be a community hospital? General hospital? specialty hospital?

A

Government owned

Yes!
Community b/c it's open to anyone (ECMC)
Restricted (VA)
General (ECMC)
Specialty (Buffalo Psychiatric Center)
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29
Q

What is a private, nonprofit hospital?

What percentage of all hospitals do they make up?

What other types of hospital can they be?

A

Owned and operated by community organizations

60%

General or specialty

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30
Q

What is a private, for profit hospital?

What other type of hospital can it be?

What is HCA?

A

Owned by individuals, partnerships, or corporations

General or specialty

HCA - Health Corporation of America

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31
Q

What is a general hospital?

Do they typically have long term or short term stays?

A

Provide a broad range of services for a variety of conditions

Short term stays

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32
Q

What are specialty hospitals?

A

Provide services for specific illnesses

Rehabilitation hospitals, cancer hospitals, psychiatric hospitals, children’s hospitals

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33
Q

What is a rural hospital?

What are some of the problems they frequently experience?

What populations do they treat most?

A

Located in the country

Frequently in financial difficulty - frequent closures

Generally treat larger percentage of poor and elderly

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34
Q

What is a teaching hospital?

A

Offers one or more graduate residency programs approved by the AMA

Most are affiliated with a major university and have a research/teaching mission

35
Q

What is an osteopathic hospital?

How many are there in the US?

A

Offers full medical care, but has a more holistic focus

About 200 in the US

36
Q

What are the licensure requirements for a hospital?

A

Must be licensed by the state in order to operate

Must meet minimum standards by the state health department

Compliance with building codes, fire safety, climate control, space allocation, & sanitation

37
Q

What is a hospital certification?

A

Gives the hospital the authority to participate in Medicare and Medicaid

Must meet standards (Conditions of Participation) set by the US DHHS

38
Q

Is a hospital accreditation required?

What organizations can accreditate?

A

Not require, but most are.

Joint Commission (JCAHO) - if JCAHO accredited, they are automatically able to participate in Medicare & Medicaid

CARF (Commission on Accreditation of Rehabilitation Facilities) - not mandated, but a good sign of quality

39
Q

How is the hospital organized?

What does this mean?

A

Tripartite Structure

Triangle: Board of Trustees at the top, CEO and Chief of Staff are the base

The CEO is in charge of the administration: Senior VP, VP, Department heads, Supervisors

The Chief of Staff/Medical Director is in charge of the medical staff: Service chiefs and committee chairs

40
Q

Where do OTs fall in a hospital organization?

A 
Administration (documentation, productivity efficiency, trainings)
AND
Medical staff (treating patients)
41
Q

Who is usually the Chief of staff?

A

An MD

42
Q

What is beneficience?

What is nonmaleficience?

A

Do good!

Do no harm

43
Q

What is an outpatient service?

What is another term for outpatient?

A

Any services that do not require an outpatient stay

Ambulatory care (because you can ‘walk’ out)

44
Q

Why is primary care called the “point of entry”?

A

Because primary care is the first contact with the healthcare system

45
Q

What is gatekeeping?

A

The PCP regulates visits to specialists

46
Q

What is ‘coordination of care’?

A

The PCP coordinates health care among specialists

Acts as a case manager

47
Q

Why is primary care considered ‘essential care’?

A

Because everyone needs it, but not everyone has access to it

Preventative care

48
Q

What is ‘Integrated Care’?

A

Comprehensive, coordinated services

49
Q

What is the balance of accountability between the client & the clinician?

A

Clients and clinicians are accountable to each other. Clients are expected to show up to appointments, follow through with instructions, compliance, etc.

Clinicians are expected to provide accurate information, keep the patients best interests in mind

50
Q

The stronger the use of primary care, the lower the…(4 things)

A

Rate of hospitalization
Cost of healthcare
Rate of morbidity & mortality

51
Q

PCPs are not evenly distributed in the US. Where is there less availability?

A

Inner cities & rural areas

52
Q

What are some examples of freestanding facilities?

A 
Walk-in clinics
Urgent care centers
Surgical centers
Dental clinics
Optometric clinics
Rehabilitation Clinics
53
Q

What is the benefit of mobile facilities?

What types of services are available?

A

Can reach small towns, rural areas, malls

Diagnostic, medical, & screening services

54
Q

What is telephone triage?

A

Can call and talk to an expert (24 hour nursing lines)

55
Q

What types of services are provided by home health?

A

Nursing, aides, therapists

56
Q

What services at provided by Public Health Services?

A

Clinics for well baby care, STDs, family planning

57
Q

Why were community health centers & free clinics created?

A

To reach medically underserved populations - provide a safety net for those with limited or no insurance

58
Q

What is included in Complementary & Alternative clinics?

A

Chiropractic Clinics

59
Q

How have the following factors influenced the growth in outpatient services?

Reimbursement
Technology
Utilization Control
Social Factors

A

Reimbursement:
DRGs have shifted services from inpatient to outpatient
Quicker discharge from hospitals under PPS

Technology:
Shorter-acting anesthesia, less invasive procedures, fewer overnight stays

Utilization Control:
Insurers discourage inpatient stays whenever possible (through utilization review methods)

Social Factors:
Patients prefer to be at home

60
Q

What is the goal of LTC?

A

Promote maximum possible functional independence

61
Q

What are some characteristics of LTC? (6)

A
  1. Includes a variety of health care services
  2. Services must be well coordinated
  3. Services are individualized
  4. Services needed for an extended period
  5. Holistic approach
  6. Quality of life must be maximized
62
Q

What are the (4) objectives of community based LTC services?

A
  1. Deliver LTC in the most economical & LRE
  2. Supplement informal caregiving when more advanced skills are needed
  3. Provide respite to family members
  4. Delay or prevent institutionalization
63
Q

Who provides home health care?

What types of services?

The individual must be ________ to receive services.

A

Hospital home health division, private home health agency

Nursing & rehabilitation services

Homebound

64
Q

What is adult day care?

A

Run during business hours

Place for adults to go to receive supervision, food, social activities, therapeutic services

65
Q

What is adult foster care?

A

Small, family run homes for adults who need supervision & assistance with ADLs

Provide room, board, personal care

66
Q

What are home delivered and congregate meals?

A

Meals on wheels
Meals at senior centers

Sponsored by the Elderly Nutrition Program

67
Q

What is the focus of senior centers?

A

Socialization & activity

68
Q

What are homemaker & handyman services?

A

Organized services for seniors or disabled people - household chores, yard work, shopping, home repairs

Generally volunteer staffed

69
Q

What are PERS?

A

Personal Emergency Response System

Electronic device that enables people to call for help in an emergency (person carries it around)

70
Q

What does case management seek to do?

A

Link, manage, and coordinate services to meet the changing needs of elderly clients

71
Q

What are institutional LTCs?

A

Used for individuals whose needs cannot be met in community-based settings.

Includes a range of facilities from retirement facilities to specialized care facilities

72
Q

What types of facilities are considered retirement homes?
Personal care homes?
Nursing homes?

A

Retirement - Independent living facilities

Personal Care - Residential (personal care) facilities, Assisted living

Nursing homes - SNFs, Subacute care, Specialized care facilities

73
Q

What are retirement facilities?

A

Do not deliver nursing services
Provide security, independence, active lifestyle
May provide 1 meal/day

74
Q

What are personal care facilities?

A

Nonmedical custodial care

Provide routine assistance with certain ADLs

75
Q

What are assisted living facilities?

A

Fastest growing form of LTC

Provides personal care services for ADLs, 24 hour supervision, social activities, some nursing services

76
Q

What do SNFs provide?

A

Medically oriented care (nursing, therapy, ADL assistance)

77
Q

What is a subacute care facility?

A

Provide medically oriented care that is not long term in nature (20-90 days)

Examples: recovery & rehab after hip surgery

78
Q

What is a specialized care facility?

A

Some SNFs have specialized units for patients with specific needs

Ex. head injury unit, ventilator dependency unit, alzheimers unit

79
Q

What are the licensure & accreditation requirements for nursing homes?

A

Licensure - must be licensed by the state & meed minimum standards by the state health dept.

Accreditation - not required, but many do seek it (joint commission)

80
Q

How is a certified nursing home differ from one that isn’t certified?

A

The certified on can participate in medicare & medicaid

The certification identifies different types of nursing facilities

81
Q

Will medicare or medicaid pay for the following facilities?

  1. SNF
  2. Nursing Facility
  3. ICF/MR

What are their stipulations?

A

SNF - Medicare pays first 20 days (fully)
Up to 100 days (partially)
**ONLY if person was hospitalized at least 3 days prior to SNF admission

Nursing Facility - Medicaid, indefinite length of stay

ICF/MR - Facility for individuals with developmental disabilities who cannot live in the community; mainly medicaid

82
Q

Are nursing homes private/for-profit, private/not for profit, or public?

Examples?

Who pays for nursing home stays?

A

Can be any:

Private/for profit (ex. elderwood)
Private/not for profit (ex. brothers or mercy)
Public (ex. erie county home)

Medicaid is the largest payer
Medicare pays for eligible beneficiaries under part A, but for short duration

83
Q

What is respite care?

A

Gives informal caregivers time off, while still meeting the person’s needs

Ex. adult day care, home health

84
Q

What is restorative care?

A

Helps patients reach their maximum physical/mental functioning

Includes rehabilitation & therapy

85
Q

What is hospice care?

A

Comprehensive services for those with terminal illness

Emphasis on pain management, symptom management, psychosocial & spiritual support

Service Delivery Exam 2 (4 decks)

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