lead 4 Flashcards
____ coverage includes durable and nondurable goods, structures, and services
Sectoral coverage
US life expectancy is
lower than in many other developed countries
The biggest source of healthcare financing is from
the govt
Almost 75% of government spending is at the ___ level
federal
Medicare Part: hospital, hospice, home health, skilled nursing
A
Medicare Part: provider, medical equipment, diagnostics
B
The primary payer of health insurance is
Medicare
Medicaid is a ____-level program
state (with costs shared between the state and the federal government)
a term that means third-party payers have surveyed providers in the area to establish what the payer will pay
Usual and customary
What does Managed Care mean for nursing
We must be able to do “financial thinking.”
DMAIC
Define opportunities. Measure performance. Analyze opportunity. Improve performance. Control performance.
QM most effective in a
flat, democratic, organization
Goal of QM is to improve systems and processes, not to
assign blame
Principles of QM and QI: _____ define quality
Customers
QI focuses on
outcomes
QA Goal
Improve quality
QA Focus
Discover/correct errors
QA Major tasks
Inspection of nurse activities;
Chart audits
QA Quality team
QA or department personnel
QA Outcomes
Set by QA team with input from staff
QI Goal
Improve quality
QI Focus
Prevent errors
QI Major tasks
Review nurse activities;
Innovation;
Staff development
QI Quality team
Multidisciplinary team
QI Outcomes
Set by QI team with input from staff and patients
Identify needs. Assemble multidisciplinary team. Collect data. Establish outcomes and quality indicators. Select and implement plan. Evaluate.
Steps in the QI Process
Malpractice: Duty:
Nurse has responsibility to patient
Malpractice: Dereliction:
Nurse did not carry out duty
Malpractice: Damage:
Patient was injured
Malpractice: Direct cause:
Injury secondary to the nurse’s failure to carry out duties
