Jen ch 2 Flashcards
National Priorities Partnership
- Patient and Family Engagement—Providing patient-centered, effective care
- Population Health—Bringing increased focus on wellness and prevention
- Safety—Eliminating errors whenever and wherever possible
- Care Coordination—Providing patient-centered, high-value care
- Palliative Care—Providing appropriate and compassionate care for patients experiencing advanced illnesses
- Overuse—Reducing waste to achieve effective, affordable care
IOM report - Nurses need to be transformed by:
- Practicing to the full extent of their education and training.
- Achieving higher levels of education and training through an improved education system that provides seamless progression.
- Becoming full partners, with physicians and other health care providers, in redesigning the health care system.
- Improving data collection and information infrastructure for effective workforce planning and policy making.
Federal government created professional standards review organizations (PSROs) to:
review the quality, quantity, and cost of hospital care
Medicare-qualified hospitals had physician-supervised utilization review (UR) committees to:
review the admissions and to identify and eliminate overuse of diagnostic and treatment services ordered by physicians caring for patients on Medicare
Prospective Payment System
Established by Congress in 1983, the PPS eliminated cost-based reimbursement. Hospitals serving patients who received Medicare benefits were no longer able to charge whatever a patient’s care cost
Diagnosis-related Groups (DRGs)
PPS grouped inpatient hospital services for Medicare patients into. Each group has a fixed reimbursement amount with adjustments based on case severity, rural/urban/regional costs, and teaching costs. Hospitals receive a set dollar amount for each patient based on the assigned DRG, regardless of the patient’s length of stay or use of services. Often used in rehab setting
Capitation
means that the providers receive a fixed amount per patient or enrollee of a health care plan. Capitation aims to build a payment plan for select diagnoses or surgical procedures that consists of the best standards of care at the lowest cost.
Resource Utilization Groups (RUGs)
Method of classification for health care reimbursement for long-term care facilities
Managed Care
describes health care systems in which the provider or health care system receives a predetermined capitated payment for each patient enrolled in the program. In this case the managed care organization assumes financial risk in addition to providing patient care
Integrated Delivery Networks (IDNs)
Set of providers and services organized to deliver a coordinated continuum of care to the population of patients served at a capitated cost.
Primary Health Care
Combination of primary and public health care that is accessible to individuals and families in a community and provided at an affordable cost. Focuses on improved health outcomes for entire population.
Work redesign
Formal process used to analyze the work of a certain work group and change the actual structure of the jobs performed. Because of this more services are available on nursing units, thus minimizing the need to transfer and transport patients across multiple diagnostic and treatment areas.
discharge planning
Discharge planning begins the moment a patient is admitted to a health care facility. Discharge planning is a centralized, coordinated, interdisciplinary process that ensures that the patient has a plan for continuing care after leaving a health care agency.
restorative care
Health care settings and services in which patients who are recovering from illness or disability receive rehabilitation and supportive care.
home care
Health service provided in the patient’s place of residence to promote, maintain, or restore health or minimize the effects of illness and disability
