Module 1: Health Care System Flashcards
Roles and Responsibilities
Medical Assistant
Medical Personnel are Ultimately Responsible for Care/Well-Being of their Patients
administrative: greeting, correspondence, answer phones
clinical: medical history, explaining treatments/procedures, drawing labs, prep/give immunizations
Screen Patients Before Provider, Help Allied Health Services
Where: Hospital, Ambulatory Care Center, Home Health Agency, Hospice, Medical Office
Administrative and Clinical Duties
Medical Assistant
Health Care Providers
Greetings, Handling Correspondence, Answering Telephones
Responsible for Clinical Task: Medical Histories, Explaining Treatment, Drawing Labs, Prep/Admin Shots
Medical Doctors (MD)
allopathic providers
Health Care Providers
Diagnose Illnesses, Provide Treatments, Perform Procedures (surgical, interventions, and write prescriptions)
Osteopathic Providers (DOs)
similar to MD
Health Care Providers
Addition to Modern Medicine, Surgical Procedures, Use Osteopathic Manipulative Therapy (OMT)
Nurse Practitioners
below MD and beyond RN
Health Care Providers
Provide Basic Patient Care Services (diagnosing, prescribing medications), Focus on Preventive Care/Disease Prevention
Physician Assistants
supervised by MD or DO
Health Care Providers
Able to Make Clinical Decisions/Be Responsible for Variety of Services
Medical Laboratory Technicians
under supervision of medical technologist
Allied Health Personnel
Perform Diagnostic Testing
(blood, bodily fluids, other specimens)
Medical Receptionists
works for provider
Allied Health Personnel
Check Patients In & Out, Answer Phones,
Perform (filing, faxing, other tasks)
Occupational Therapists
Allied Health Personnel
Assist Patients Who Have Developed Conditions that Disable Them
Developmentally, Emotionally, Mentally, Physically
Pharmacy Technicians
Allied Health Personnel
Assist Pharmacists with Duties that DO NOT require expertise or judgement of a licensed pharmacist
Physical Therapists
Allied Health Personnel
Assist Patients in regaining their Mobility/Improving their Strength/Rang of Motion
Radiology Technicians
Allied Health Personnel
Use Various typed of Imaging Equipment to Assist the Provider in Diagnosing/Treating Certain Diseases
Professionalism
skills, behavior, appropriate judgment that represent best qualities of person in a specific profession
Exhibit Courteous, Conscientious, Businesslike Manner
Dependability, Initiative, Flexibility, Confidentiality, Good Attitude
Appropriate Dress
good personal hygiene, appropriate work attire, avoid perfumes, wear make up conservatively, keep nails clean
clothing should be comfortable/fit, no facial piercings, visible tattoos
Work Ethic
A set of values based on the moral virtues of hard work and diligence
Scope of Practice
Delegated clinical and administrative duties consistent with education, training, and experience
Standard of Care
Degree of care or competence expected in a particular circumstance or role
CPT
Additional Credentials
Certified Phlebotomy Technician
CET
Additional Credentials
Certified EKG Technician
CBCS
Additional Credentials
Certified Billing and Coding Specialist
CEHRS
Additional Credentials
Certified Electronic Health Records Specialist
CHC or PN
Additional Credentials
Certified Health Coach
Patient Navigator
Computerized Physician Order Entry
CPOE
Process of electronic data entry of provider instructions for treatment
Accountable Care Organizations
ACOs
Health Care Delivery Model
Groups of physicians, hospitals, other health care providers together voluntarily provide high-quality care to Medicare patients. ACO succeeds delivering high-quality care/spending health care dollars wise, share in savings achieves Medicare program
Capitation
(partial or full)
Health Care Delivery Model
patients assigned per-member, per-month payment based on age, race, sex, lifestyle, medical history, benefit design. payment rates tied expected usage regardless how often patients visits, like bundled payment models, providers incentive to help avoid high-cost procedures/tests max compensation, under partial/blended-cap models, only specific types/cat services paid basis of capitation
Global Budget
Health Care Delivery Model
fixed total dollar amount paid annually all care, providers determine how money spent, limit level/rate increase health care cost, typically include quality component
Health Maintenance Organization
HMO
Health Care Delivery Model
plan contacts medical center/group of providers to preventive/acute care for insured peron. HMOs require referrals speciaists precertification/preauthorization hospital admissions, outpatient procedures, treatments
Patient-Centered Medical Home
PCMH
Health Care Delivery Model
primary care provider coordinates treatment to insure patients receive required care when/where they need it, in way they can understand
Pay for Performance
Health Care Delivery Model
reimbursement model compensates providers only if they meet certain measures quality/efficiency, generating quality benchmark measures connects provider reimbursement directly quality care provide
Preferred Provider Organization
PPO
Health Care Delivery Model
these plans have more flexibility than HMO plans, insured person doesn’t need PCP, but can go directly to specialist without referrals, although patients see providers in or out their network, an in-network provider costs less
General V.S Speciality
Generalist Provider: assess wide range of symptoms. diagnoses, conditions to build treatment plan
Specialist Provider: assesses more specific set of symptoms, diagnoses, conditions
General Practitioners
GPs
General Providers
medical doctors who treat acute/chronic illnesses/provide preventive care/health education, GP may take holistic approach into consideration the biological, psychological, social aspects for care
Family Practitioners
FP
General Providers
offer care to whole family (newborn to older adults), familiar with range of disorders/diseases, preventive care primay concern
most often chosen by physicians
Internists
I
General Providers
provide comprehensive care of adults, often diagnosing/treating chronic, long-term conditions, offer treatment for common illnesses/preventive care. Internists must have broad understanding of body/ailments able to diagnose conditions/treat them
Allergists
Specialist Providers
evaluate disorders/diseases of immune system
medications, food, anaphylaxis, problems to autoimmune disease, asthma
Anesthesiologists
Specialist Providers
manage pain or use sedation during surgery
Cardiologists
Specialist Providers
diagnosing/treating diseases or conditions of heart/blood vessels
Dermatologists
Specialist Providers
conditions of the skin
Endocrinologists
Specialist Providers
hormonal/glandular conditions
often work with diabetes mellitus
Gastroenterologists
Specialist Providers
managing diseases of gastrointestinal tract
stomach, intestines, esophagus, liver, pancreas, colon, rectum
Gynecologists
Specialist Providers
female reproductive system/fertility disorders
Hematologists
Specialist Providers
deal with blood/blood producing organs
often work with anemia, leukemia, lymphoma
Hepatologist
Specialist Providers
study of body parts on right side of gastro
liver, biliary tree, gallbladder, pancreas
Neonatologists
Specialist Providers
care of newborns
Nephrologists
Specialist Providers
kidney care/treating diseases of kidneys
Obstetricians
Specialist Providers
care of women during/after pregnancy
Oncologists
Specialist Providers
treatment/care for cancer patients
Ophthalmologists
Specialist Providers
eye conditions
Orthopedists
Specialist Providers
bones, joints, muscles, tendons, ligaments
Otolaryngologists
Specialist Providers
ear, nose, and throat
Neurologist
Specialist Providers
nervous system
Pathologists
Specialist Providers
body tissues, blood, urine, other body fluids to diagnose/treat medical conditions
Pediatricians
Specialist Providers
newborn, infant, child, adolescent health care
Psychiatrists
Specialist Providers
mental disorders/conditions
Radiologists
Specialist Providers
use of x-rays, ultrasound, nuclear medicine, computed tomography, magnetic resonance imaging to detect abnormalities throughout body
Urologists
Specialist Providers
disorders of urinary tract
Urgent Care
Ancillary Services
alternative emergency department
cost less, shorter wait, location, flexible hours, offer walk-ins
Laboratory Services
Ancillary Services
diagnostic testing to help provider
blood, body fluids, other specimens
Diagnostic Imaging
Ancillary Services
take images of body to diagnose condition
x-ray, ultrasound, MRI, CT
Occupational Therapy
Ancillary Services
assist patients with conditions that disable to rebuild function/compensate for loss of function
developmentally, emotionally, mentally, physically
Physical Therapy
Ancillary Services
assist patient in regaining mobility/improving strength/range of motion
from accident, injury, result of disease
Acupuncture
Alternative Therapies
pricking skin/tissues with needles to relieve pain
physical, mental, emotional conditions
Chiropractic
Alternative Therapies
medicine diagnoses/treats mechanical disorders
musculoskeletal system, spine
Energy Therapy
Alternative Therapies
calm method of clearing cellular memory through human energy field
health, balance, relaxation
idea of connection between physical, emotional, mental states of life in holistic healing
Dietary Supplements
Alternative Therapies
contains dietary ingredients
vitamins, minerals, herbs, or other botanicals
a plant (flowers, leaves, bark, fruit, seeds, stems, root, amino acids)
Allopathic
Glossary Terms
homeopathic medicine; effort to counteract disease
Ambulatory
Glossary Terms
able to walk
Computerized Physician Order Entry
CPOE
Glossary Terms
process of electronic data entry of provider instructions for treatment
Managed Care
Glossary Terms
umbrella term for plans that provide health care in return for preset scheduled payments/coordinated care through defined network of providers/hospitals
Osteopathic
Glossary Terms
type of medicine based n concept that disturbances musculoskeletal system affect other bodily parts, causing many disorders improved various manipulative combination
medical, surgical, pharmacologic, other therapeutic
Professionalism
Glossary Terms
skils, behavior, judgement represent best qualities of person
Scope of Practice
Glossary Terms
delegated clinical/administrative duties
education, training, experience
Standard of Care
Glossary Terms
degree of care/competence expected in particular circumstance or role
Work Ethic
Glossary Terms
set of values based on moral virtues of hard work/diligence
