Rutgers Exam - Study Guide

A law that increased access to care by expanding Medicaid coverage and establishing state marketplaces.

Affordable Care Act (ACA)

How has the Affordable Care Act (ACA) increased access to care?

Expanding Medicaid coverage and establishing state marketplaces; narrowing racial and ethnic disparities

Contributed to by the use of medical technology and prescription drugs, reimbursement systems, inadequate preventive services, the aging population, increased prevalence of chronic diseases, and high administrative costs.

Rising cost of healthcare

Includes ambulatory patient services, emergency services, hospitalization, maternity and newborn care, mental health and behavioral health, prescription drugs, rehabilitative services and devices, laboratory services, preventive and wellness services, and chronic disease management.

Aspects of healthcare covered by ACA

Conditions under which people are born, live, work, and age, influencing access to quality healthcare, including lack of nutritious food, stable housing, employment, and personal safety.

Social determinants of health

Health promotion, disease prevention, diagnosis and treatment of illness, rehabilitation, and chronic care.

categories of healthcare services in U.S.

Comprehensive safety net of primary and preventive care providing medical, dental, and mental health services, serving low-income, minority, and homeless individuals in urban and rural underserved areas.

Federally Qualified Healthcare Centers

Include Medicare and Medicaid, public health, biomedical research, food and drug safety, disease control and prevention, Indian health services, and mental health services.

Department of Health and Human Services agencies

Responsible for the quality of health care while controlling cost.

Medicare and Medicaid

Responsible for the protection of the environment, including air, food, and water, and improvement of community health.

Public health agencies

Responsible for research to advance medical knowledge and improve human health.

Biomedical research

Responsible for the safety, effectiveness, and security of drugs, vaccines, medical devices, food supply, cosmetics, and dietary supplements.

Food and drug safety

Responsible for providing healthcare services for Native Americans and Alaskan Natives.

Indian health services

Responsible for diagnosis and treatment of patients with mental or emotional illnesses, including alcohol or substance abuse.

Mental health services

Created to replace the Patient Bill of Rights, focusing on high-quality hospital care, a clean and safe environment, patient involvement in their own care, protection of patient privacy, help when leaving the hospital, and help with billing claims.

Patient Care Partnership

Funded by public programs like Medicare and Medicaid, government taxes at federal, state, and local levels, and private payers such as insurance companies and individuals.

Funding of public health care system

Covers specific populations, providing various health services.

Medicare coverage

A federal health insurance program for people 65 and older, individuals with certain disabilities younger than 65, and those with end-stage renal disease or amyotrophic lateral sclerosis.

Medicare

Hospital insurance that covers hospital care, skilled nursing facility care, hospice, and home health care.

Part A

Medical Insurance that requires a monthly premium and covers benefits at 80%, including services from doctors and health providers, outpatient care, and home health care.

Part B

Medicare Advantage, which is optional, requires a payment of a monthly premium, and replaces benefits and services under Parts A, B, and usually D.

Part C

Prescription Drug Coverage that is optional, requires monthly premiums, and covers prescription drugs.

Part D

Permanent kidney failure.

End-stage renal disease

Also known as ALS or Lou Gehrig's disease.

Amyotrophic Lateral Sclerosis

A system hospitals use to receive a fixed payment based on a patient's diagnosis, which helps control costs and encourages efficient care.

Diagnostic Related Groups (DRG)

Fixed amounts patients pay for services that reduce unnecessary use and shift some cost to patients.

Copays

The amount patients pay before insurance starts covering costs, encouraging mindful use of healthcare.

Deductibles

A form of prepaid health insurance that only covers care provided by providers and healthcare facilities inside the HMO network, requiring a referral from a primary care provider to see a specialist.

Health Maintenance Organizations (HMO)

Expected changes in the US include an increasing aging population and decreasing birth rates, impacting the healthcare system by increasing demand for geriatric care, chronic disease management, and long-term care.

Demographic Changes

Complex self-care activities used to evaluate the independence of disabled persons or older adults, such as shopping, preparing meals, managing finances, and medications.

Instrumental Activities of Daily Living (IADL)

Basic skills required to independently care for oneself, including bathing, dressing, toileting, and self-feeding.

Activities of Daily Living (ADL)

ADLs are _______________, while IADLs are ___________________________________________.

basic tasks; more complex and require more cognitive function

Long-term care facilities are funded by the federal government.

Long-term care facilities funding

A professional who analyzes and inspects the work environment to identify practices with potential harm to employees, designs preventive programs, and trains workers to respond to emergencies; typically requires a bachelor's degree.

Occupational Health and Safety Specialist

Impacts overall health and the healthcare system by causing worse health outcomes and higher costs.

Health Literacy

Differences in access to or availability of healthcare services among different populations; involve variations in access to medical facilities and services, as well as differences in rates of disease occurrence and disabilities among population groups.

Healthcare Disparities

A broad concept that encompasses an array of technologies to record, store, retrieve, protect, share, and analyze health information.

Health information technology (HIT)

A specialist who organizes and evaluates health records for completeness and accuracy.

Health information technician

A variety of technologies that provide healthcare practitioners with tools to improve the quality of care through diagnostic and treatment recommendations.

Clinical Decision Support Systems (CDSS)

Clinical outcomes (eg, improved quality, reduced medical errors), organizational outcomes (eg, financial and operational benefits), and societal outcomes (eg, improved ability to conduct research, improved population health, reduced costs).

Advantages of electronic health record (EHR)

High upfront acquisition costs, ongoing maintenance costs, disruptions to workflows, and losses in productivity that are the result of learning a new system.

Disadvantages of electronic health record (EHR)

Hospitals, offices of health practitioners, nursing and residential facilities, home health services, outpatient laboratories, and ambulatory services.

Workplace settings of healthcare workers

Obtained through a 2-year college, 4-year college, universities, vocational trade schools, and/or military.

where someone can obtain an education in healthcare

Medical terminology, anatomy and physiology, ethics, communication, infection control, and basic patient care.

Components of common core knowledge

Empathy, dedication, integrity, sociability, teachability.

Characteristics of a healthcare professional

A right conferred by a governmental body to practice an occupation or provide a service.

Licensing

A process by which an external entity reviews an organization or program of study to determine if the organization or program meets certain predetermined standards.

Accreditation

The process or action of providing an individual with an official document attesting to their status or level of achievement.

Certification

Professional misconduct.

Malpractice

The failure to do something that a reasonably prudent person would do in the same or similar situation; alternatively, doing something that a reasonably prudent person would not do in the same or similar situation.

Negligence

Needed because the healthcare field evolves rapidly and frequently, requiring healthcare professionals to learn the most recent information in their professional field.

Continuing education (CE) courses

Determined by the state licensing board or professional association.

Requirements for CE courses

Specific duties, procedures, and responsibilities defined by law, education, and certification for different healthcare professions.

Scope of practice

everyone above technologist and nurses will have a ________________________________

masters and/or doctorates.

The profession that requires a bachelor's degree in order to provide healthcare. Ex: Registered nurses (BSN), dietitians, health educators, medical laboratory technologists, and recreational therapists.

Technologist and Nurses

Medical assistants, peer navigators, or community health workers in states, territories or jurisdictions.

Healthcare Professionals without Licensure

Healthcare Professionals expected to decline are ______________

Physicians, nurses, healthcare educators, and midwives.

Work in hospitals, clinics, and nursing care facilities; use activities like games, music, and arts to improve physical and mental well-being in patients with disabilities or illnesses.

Recreational Therapists

A professional trained to provide services that help restore function, improve mobility, relieve pain, and prevent or limit permanent physical disabilities.

Physical Therapist (PT)

Works under the direction and supervision of physical therapists and provides part of a patient's treatment.

Physical Therapy Assistant (PTA)

Provides link between the community and health educators; implements strategies to improve health of individuals and communities; Serve as a bridge between the community and the healthcare, government, and social service systems.

Community Healthcare Workers

Collect data and discuss health concerns with members of specific populations or communities.

Job Function of Community Healthcare Workers

Diagnostic medical sonographers, cardiac sonographers, abdominal sonographers, breast sonographers, neurosonographers, vascular sonographers, musculoskeletal sonographers, cardiopulmonary sonographers, and obstetric and gynecologic sonographers.

Types of Sonographers

May alleviate back pain and improve the quality of life for individuals with depression, cancer, and HIV/AIDS.

Benefit of Massage Therapy

Individuals who work as part of a team to care for mentally impaired or emotionally disturbed individuals.

Psychiatric Aides

Works as part of a team to provide care and treatment of emotionally or mentally disabled patients.

Psychiatric Technicians

An associate of science (AS) or an associate of applied science (AAS) in veterinary technology.

Educational Requirement for Vet Techs

All veterinary technicians work under the supervision of a licensed veterinarian; they can help with a variety of tasks but cannot diagnose, prescribe, or perform surgery.

Scope of Practice for Vet Techs

Graduate from an accredited vet tech program, Pass the Veterinary Technician National Examination, apply for state licensure, certification, or registration, as well as complete continuing education to renew credentials, as required by the state.

Licensure requirements for vet techs

Requires in-network providers and referrals.

HMO

Covers ONLY in-network care but no referrals needed.

EPO

Covers in- and out-of-network care, no referrals.

PPO

Any plan not government-funded (e.g., through employers or self-purchased).

Private insurance

Came to exist under the Older Americans Act of 1965, which established the Administration on Aging and called for State Units on Aging to support older adults.

Area Agencies on Aging

The use of electronic communications and information technologies to provide or support clinical care at a distance.

Telemedicine

Healthcare appointments delivered by the clinician through telecommunication technologies. Also, communicating appointment reminders, visit summaries, and laboratory and diagnostic results through an electronic record.

Telehealth

Formed to coordinate and manage a patient's care across different specialties and services.

Care teams or interdisciplinary teams

Might include doctors, nurses, pharmacists, physical therapists, social workers, case managers, dietitians, and other healthcare professionals depending on the patient's needs.

Members of care teams

Government-issued permission to practice a specific healthcare profession legally.

Licensing of a healthcare professional

Recognition by a professional body that a person meets specific qualifications and standards.

Certification of a healthcare professional

Difficulty in speaking, understanding, or processing language.

Communication impairment

Manage or treat communication impairment issues

Speech-language pathologists.

To assess and treat mental, emotional, and behavioral disorders.

psychologist

Clinical psychologists, health psychologists, neuropsychologists, geropsychologists, counseling psychologists, developmental psychologists, educational psychologists, engineering psychologists, personal psychologists, experimental psychologists, industrial psychologists, psychometric psychologists, recreation psychologists, school psychologists, social psychologists, research psychologists, and forensic psychologists.

Areas of specialization in psychology

To set and carry out policies, goals, and procedures for their departments or facilities

Job function of a healthcare manager

To provide students with consistent quality monitoring of health informatics and health information management programs through their accreditation processes.

CAHIIM

what does CAHIIM stand for?

Commission on Accreditation for Health Informatics and Information Management Education

Duty, breach, causation, and damages.

Components of a malpractice case

The patient must prove negligence caused harm and the provider must prove appropriate care was given or that no harm occurred.

Proving negligence in a malpractice case

Physician educational requirement:

Doctoral degree; Doctor of Medicine (MD) or Doctor of Osteopathic Medicine (DO)

examine patients, obtain medical histories, and order, perform, and interpret diagnostic tests.

Physician

What are the two types of physicians?

Medical Doctor (MD) and Doctor of Osteopathy (DO)

MD's are known as __________________________, and DOs are known as __________________________________

allopathic physicians; osteopathic physicians

A physician offering medical care using pharmacologically active agents or surgical interventions to treat or suppress symptoms of diseases or injuries

Allopathic Physicians

Physicians with a Doctor of Osteopathy who place special emphasis on the body's musculoskeletal system, preventive medicine, and holistic patient care.

Osteopathic Physicians

Physician Assistant (PA) educational requirement:

Master's degree

A medical professional who may practice preventive, diagnostic, and therapeutic medicine under the supervision of a physician or surgeon. Responsibilities may include taking a medical history, conducting a physical exam, and ordering and interpreting lab tests and X-rays required for making a diagnosis.

Physician Assistant

Social Worker educational requirement:

Bachelor's for entry level or Master's for clinical roles

EMT educational requirement:

Certificate in Emergency Medical Services

The second level of a four-tier category of emergency medical technician who has more advanced training and can provide the most extensive prehospital care; however, what they are permitted to do varies by state.

EMT