week 5 Flashcards
difference between quality assurance vs quality improvement
quality assurance = bare minimal
CHAP, community health accreditation program
- independent non profit accrediting body
- deeming authority” by CMS for home health and hospice
- follows medicare requirments
covers:
- agencies providing HH and hospice services
- determines whether they meet the medicare conidtions of participations (COPs)
voluntary
is CHAP voluntary or involuntary
voluntary
CARF
accredidation of medical rehabiliation
includes treatments for poeple who have services in a hospital and OP clinics
voluntary but a sign of pride of IRF in particular
Is CARF voluntary or involuntary
voluntary
JHACO
accreditation and certification services
general, psychiatric, childrens and rehab services
nursing homes and LTACH
private org but only group authorized by MC to accredit hospitals and accreditation is mandated by MC
medicare state surveys
state surveys
CMS maintains oversight for compliance with MC health and safety standards
acute and contining care providers
- hospitals
- nursing homes
- HH
- ESRD facilities
- hospices
CMS contracts with states to perfrom
what was the original use for teleheath
- rural areas with poor access to speciality care
- mental health care
CO law definition
a mode of remote health care delivery through telecommunincations systems to facilliate the assesment, dx, consultations, treatment, education, care management or self management of a pt while he or she is located at an originating site and a provider is located at a distance site
originating site
a site where the pt is located at the time health care services are provided to him or her by means of telehealth.
originating providor
on site with the patient
- originally designed where the pt goes to/or is at another HC site (nursing home, PCP, NP office) and specialist
- now done with pt in home and no other provider there
distant site
site where the provider is located while providing healthcare services by telehealth
distant provider
is providing the consultation
types of telehealth
asynch
synch
remote pt monitoring
asynch
synch
remote pat monitoring
asynch: most used by specialist physicians for pts who dont have access to the specialist due to distance; also used to describe electronic access to HEP in PT
synch: most similar to regular visit but without travel
remote pat monitoring
remote pt monitoring: use of technology to monitor pts in their home (automatic download of daily blood pressures)
medicare approved providers
- physcians
- NPs
- PAs
- nurse midwives
- clinical nurse specialists
- certified nurse anesthestists
- clinical psychologists and clinical social workers
- registered dietitations or nutrition professionals
does medicare pay for asynch or synch sessions? does it include PT
synch only
no PT
T/F
Do providers have to demonstrate that a barrier to in person care exists before engaging in tele-heath
False. They do not have to demonstrate
Who pays for all 3types of healthcare delivery
Kaiser
VA
fair labor standards act, FLSA
- est. minimums that emplyers must follow
- many states have chosen to add worker protections above and beyond FLSA
examples:
- time keeping and overtime compensation requirements
- breals/meal periods: complicated bc typically combined with state laws
- min wage - current;y $7.25 federal
exempt vs non-exempt
what are the exempt categories for FLSA
colorado example
the min salary required to qualify for the executive/supervisor, admin and proessional exemptions under CO state law increased to $778.85 per week
in CO, exempt employees salary generally must also be sufficeint to satisfy the min wage for all hours in a workweek
independent contractor
consider behavioral control, financial control and type of relationship. An independent contractor:
- is free from control and direction by you in the performance of the service under the contract agreed upon by you and the worker
- is customarily engaged in an independent trade, occupation, profession, or business for others related to the service performed for you
contractor
- controls own work - sets own hours and uses own tools - pay/benefits/rights
- assumes risk for profit/loss
- bid for jobs - other companies too
- impermanent relationship
difference between independent contractor and employee
family and medical leave act, FMLA
who qualifies as family under the FMLA
employee’s parent, child (including adult children who are incapable of caring for themselves), spouse when they have a serious medical condition and the emplyee’s next of kin but only in situations for an injured service memenr
DOMA, defense of marriage act, same sex couples were not covered but now they are (some states vary)
under FMLA, employees are eligible for leave if:
- they have worked for their employer at least 12 months AND
- have worked 1,250 hours over the past12 months AND
- work at a location where the company emplys 50 or more employees within 75 miles
what is the FMLA benefit length
12 workweeks of leave in a 12 month period
employer option
employers may require employes to use accrued sick or vacation pay during FMLA leave
OSHA
unemployment insurance
“no fault of their own”
progressiv discipline
have written up prior about their actions/behaviors at work.
‘
if thy haves these, they do no qualify for unemployent insurance
CO paid family and medical leave insurance, FAMLI
- workers who earn 2500$ in yrly wages will be eligible for paid and medical leave
- after working in job 180 days
- employer cannot prevent employee from taking leace and cannot penalize or fire employee for taking leave
when can FAMLI leave be taken out
how much leave and how is it paid for - FAMLI
at will emplyement
A]n employer may terminate its employees at will, for
any or no reason … the employer may act peremptorily,
arbitrarily, or inconsistently, without providing specific
protections such as prior warning, fair procedures,
objective evaluation, or preferential reassignment …
The mere existence of an employment relationship
affords no expectation, protectable by law, that
employment will continue, or will end only on certain
conditions, unless the parties have actually adopted
such terms” CA Supreme Court
* No progressive discipline required
* No requirement to show “just cause”
gives the emplyee to leave at any time
disability redefined
and definittion
disability is the world largest minority group and it is one that anyone can join at any time
A physical or mental impairment that
substantially* limits one or more major life
activities* of the individual; or a record of such
an impairment; or being regarded as having
such an impairment, or known association or
relationship with a person with a disability
ex of “record of a disabilty”
Covers a person who has recovered
from cancer or mental illness
ex of “regarded as having”
individuals who are
regarded as having a
substantially limiting
impairment, even though
they may not have such an
impairment.
Example: a person with facial
disfigurement or discoloration
being denied employment
because an employer feared
the “negative reactions” or co-
workers.
What does this mean?
what is not covered by the ADA
minor, non chronic condition of short duration such as a sprain, broken limb or the flu
covered entity
an employer, employment agency, labor organization, joint labor action committee and state/local governmentns
reasonable accomodations
undue burden
An action necessary to provide a reasonable accommodation that would cause the employer or owner significant difficulty or expense.
essential functions
qualified indviduals with a disability
If the individual is qualified to perform essential job
functions except for limitations caused by a disability, the employer must consider whether the individual could perform these functions with a reasonable accommodation
what are the 5 titles of ADA
who is covered under title 1
what does employment discrimination mean under the ADA
- Limiting, segregating, or classifying a job applicant or employee in a way that adversely affects that person’s opportunities or status
- Participating in a contractual (e.g. Union, Contract Labor) or other arrangement or relationship that subjects a covered employee to discrimination prohibited by the act
- Utilizing standards, criteria or methods of administration that have the effect of discrimination or perpetuate the discrimination
- Denying equal jobs or benefits to a qualified individual because that individual associates with someone who has a known disability
- Not making reasonable accommodations to the known limitations of an otherwise qualified individual unless the accommodation would impose an undue hardship on the operation of the business
- Using selection criteria that screens out an individual with a disability or a class of individuals with disabilities unless the criteria are job-related and are consistent with business necessity
- Failing to select and administer employment tests in the most effective manner to ensure that results accurately reflect whatever factor the test purports to measure rather than reflecting a person’s disability
who is protected from employment discrimination
“qualified individuals” with disabilities
does the ADA require employers to develop written job descriptions
no.
does an employer have to give preference to a qualified applicant with disability over other applicants
no
an emplyer is free to select the most qualified applicant available and to make decisions based on reasons unrelated to a disabiity
stages of hiring process
can employers screen in a way to elimate those with disabilities?
no, the ADA prohibits medical examination of employees or applicants to inquire as to whether the person has a disability or to discern the nature and/or severity of a disbability HOWEVER they can have potential employees perform 2 tests
non-medical: physical agility/fitness test
medical examination
what are the 7 factors to be considered in deciding if a test constitues a medical examination?
what kind of questions are allowed (ADA)
- ask questions about the abiity to perform specific essential functions and may ask an ind. with a disability how they would perform
- ask about duties performed in a previous job
these are NOT considered a medical examination
if a person with a disability is not hired after post offer medical exam - the reasons for not hiring must be:
- job related
- consistent with business necessity (accomodation would impose an undue burden)
- no available reasonabke accomodation
when is an emplyer required to make a reasonable accomodation
- only when applicant or employee’s disability is known
- generally triggered by a request frm ind. with disability (may be able to suggest an app. accomodation)
- accommodations made on an ind. basis
must an employer modify existing facilities to make them accessible?
when can tests for illegal drugs be done
pre and post offer
ADA and workers comp
direct threat
a significant risk of substantial harm to the
health or safety of the individual or others, that
cannot be eliminated or reduced below the direct
threat level through reasonable accommodation
title 2
T/F
the ADA does not require modifications that
would fundamentally alter the nature of the
services provided by the public
accommodation.
true
titile 3: construction
for the public, non governmental
3 basic things organizations must do to comply with title 3
what does the ADA require in new construction
grandfather clause
what are some defenses among business against title 3
- undue burden to the business
- compliance poses a direct threat. often posed as an asumption abd is difficult to prove
- claim the accomodation will fundamentally alter the business
financial (tax) assistance
does the ADA cover private apts and private homes?
Does not cover strictly residential private
apartments and homes
Unless used as a place of public accommodation
who pays through FAMLI
state not employer
