Legal Issues, Healthcare Systems, Types of Reimbursement, & Evidence-Based Practice

This set of flashcards reviews key concepts related to legal issues, healthcare systems, types of reimbursement, and evidence-based practice, focusing on risk management and the implications for nursing and healthcare professionals.

What is the primary focus of Module 9 in the lecture?

Legal Issues, including Whistleblowing, Obligation to Report, and Risk Management.

What is one learning outcome related to risk management?

To examine the relationship between accountability and liability in professional practice.

What is whistleblowing in a healthcare context?

The act of reporting misconduct that violates state or federal law, done for the public's best interest.

Which act protects whistleblowers?

Whistleblower Protection Act of 1989.

What are common causes of human errors in healthcare?

Fatigue, ignorance, communication failure, and poorly designed equipment.

What is risk management in a healthcare setting?

A function aimed at identifying, evaluating, and correcting potential risks to prevent injury.

What are reportable incidents in healthcare?

Examples include medication errors, patient injuries, and unexpected deaths.

How many leading causes of death accounted for 72.3% of deaths in 2022 in the U.S.?

Ten leading causes.

What is a variance report?

A report documenting an accident or incident to help prevent future occurrences.

What does Medicare Part A cover?

Hospital insurance, including inpatient hospital care.

What is the primary purpose of root cause analysis?

To identify strategies for preventing errors and improving safety.

Define Medicaid.

A federally and state-funded program providing medical resources for low-income individuals.

What factors influence healthcare access and financing?

Community preferences, socioeconomic status, and insurance types.

What does QSEN stand for?

Quality and Safety Education for Nurses.

What types of reimbursement are discussed in the module?

Medicare, Medicaid, and private pay.

What should be included in an incident report?

Facts about the incident, including the description, location, date, and involved parties.

What is a high-risk issue in healthcare?

Examples include medication errors and patient safety concerns.

Name one strategy for risk management.

Implementing staff education and monitoring prevention strategies.

What are the four parts of Medicare?

Part A (Hospital), Part B (Medical), Part C (Advantage plans), and Part D (Prescription drug coverage).

What is the focus of Chapter 9 in Cherry & Jacob?

Ethical and Bioethical Issues in Nursing and Health Care.

Which organizations provide healthcare quality indicators?

Agency for Healthcare Research and Quality (AHRQ).

What role do stakeholders play in healthcare?

They include providers, employers, payers, and patients in the healthcare system.

How are community preferences related to evidence-based practices?

They influence the implementation of practices that best serve populations' health needs.

What is the significance of the percentage of deaths accounted by leading causes?

It highlights the major health challenges faced in a population.

What is one common personal factor contributing to human error?

Inattention.

What role does risk management play in healthcare?

It identifies and mitigates potential risks to enhance safety.

What should healthcare professionals avoid in variance reports?

Opinions regarding liability or assumptions.

How does private insurance work?

It is purchased by individuals or employers and provides coverage for a range of services.

How is Medicaid funded?

It is funded on both federal and state levels.

What did the lecture state about human errors in healthcare systems?

They are often a result of flawed systems that require perfect human performance.

What is included in the core measures of performance and quality indicators?

Distance indicators relevant to health outcomes and service effectiveness.