Fundamentals Chapter 2 - Health-Care Delivery, Settings, and Economics

capitation

the payment system used by health maintenance organizations in which primary care physicians (PCPs) are paid a set amount per member per month to manage the health care of those members

patient-centered care

empowers the patient to take control of and manage their own care and is often seen in a rehabilitation facility

diagnosis-related groups

classifications of illnesses and diseases that are used to determine the amount of money paid by medicare to the hospital for the care of a patient with that particular disease or illlness

health maintenance organization

a cost-containment program featuring a primary care physician as the gatekeeper to eliminate unnecessary testing and procedures - may require the insured person to remain within the designated provider network

home health care

when care is provided to a patient in their homes because they are confined to their homes by an illness or disability

hospice

an interdisciplinary program of palliative care and support services that address the physical, spiritual, social, and economic needs of terminally ill patients and their family - patient has a prognosis of 6 months or less

inpatient

stay overnight or longer in a health-care facility

managed care

any method of financing and organizing the delivery of health care in which costs are contained by controlling the provision of benefits and services

medicaid

a federal-state program in which the federal government helps states pay for the health care of those with an income below the federal poverty threshold as well as certain other individuals like pregnant women, children, and individuals with disabilities who meet income-level requirements

medicare

the federal government’s health insurance program for people older than 65 years of age and may be available to some under the age of 65 if they have end-stage diseases or are mentally/physically disabled

outpatient

provided in many settings and is designed to meet the needs of a patient in 24 hours and then the patient can return home

point-of-service plan

in this plan, a primary care physician still serves a s a gatekeeper but is not capitated as insured people can seek care from people who both in are and out of the network and the patient pays part of the bill while the insurance company pays the rest

preferred provider organization

this is a type of plan in which a group of health-care providers contract with a health insurance company to provide services to a specific group of patients on a discounted basis

primary care nursing

one nurse is responsible for all aspects of nursing care for their assigned patients

referral

when the primary care provider cannot treat patients’ condition, they make a ______ to a specialist

rehabilitation

level of care in which the patient can receive intense physical, occupational, and speech therapy services

team nursing

uses a team consisting of nurses and certified nursing assistance or other assistive personnel to provide care for a group of patients

third-party payer

when the beneficiary is cared for by a health-care provider or hospital and the bill is sent to the insurance company, they are referred to as…

physicians, physicians’ assistants, and nurse practitioners

who are referred to as health-care providers?

Medical Doctor or Doctor of Osteopathy

responsible for diagnosing and treating diseases, illnesses, and injuries as well as ordering diets, tests, medications, treatments, therapies, and procedures - directs the overall care of patients

Physician Assistant

employed by a physician to work closely with them to assist in directing patient care

Nurse Practitioner

masters prepared registered nurse certified in a specific area of practice and identified with advanced practice license who diagnoses illnesses and prescribes medications and treatments

Registered Nurse

practices with a defined scope under the direction of a physician, provides direct patient care, manages departments, and supervises other nurses and assistive personnel

Licensed Practical Nurse

practices under a defined scope of practice under the supervision of a dentist, physician, or RN, provides direct patient care and supervises assistive personnel

Unlicensed Assistive Personnel

performs more complicated tasks than the CNA including sterile procedures in some states

Certified Nursing Assistant

performs patient care duties and assists nursing staff with patient care

Respiratory Therapist

evaluates, treats, and cares for patients with breathing problems due to heart and lung disease

Respiratory Therapist Technician

generally, work under the supervision of an RT

Physical Therapist

provides services to help restore or improve function and mobility, relieve pain, and prevent or limit permanent physical disabilities for patients suffering from injuries and disease

Physical Therapy Assistant

generally, works under the supervision of a PT and carries out their orders

Speech Language Therapist

assesses, diagnoses, treats, and helps to prevent disorders related to speech, language, voice, swallowing, and fluency

Occupational Therapist

assists patients with disabilities to develop, recover, or maintain their skills for daily activities and work

Pathologist

medical doctor who examines tissue and blood samples to determine the origin or existence of disease

Medical Laboratory Technologist

examines and analyzes body fluids and tissues, matches blood for transfusions, and tests for blood levels of medications

Phlebotomist

draws blood specimens from patients for testing

Radiologist

medical doctor who specializes in procedures involving x-rays and radiation therapy; reads radiographs and other radiological films

RAD Tech

operates x-ray machines and other radiological equipment, such as computed tomography (CT) scanners, as well as magnetic resonance imaging (MRI) and ultrasound equipment; assists the radiologist by performing ordered tests to determine diagnoses and treat certain diseases

Pharmacist

distributes prescription medications and advises patients and prescribers on the selection

Pharmacy Technician

assists pharmacist by helping to prepare prescribed medications

Registered Dietician

plans regular menus and develops special menus to meet the dietary needs of patients, works with health-care providers to meet special dietary needs, and instructs patients on special diets

Dietary Technician

assists the RD by distributing and picking up selective menus and monitoring patient food intake

medical necessity

services or items reasonable and necessary for the diagnosis or treatment of illness or injury or to improve the functioning of a malformed body member

appropriate level of care

it is important that the patient is cared for at the most cost-effective, yet safe and effective, level - may be either at an inpatient or outpatient level

acute care hospital or medical center

provide emergency care, surgeries, inpatient care, diagnostic testing, and usually some types of outpatient care

long-term acute care hospital

focuses on patients with serious medical problems that require intense, special treatment for a long period of time, usually from 20 to 30 days - patients often transfer from intensive care units in traditional hospitals

skilled nursing facility

provides a less intense level of care than that found in a traditional or long-term acute care hospital and usually is a transitional care setting - patients may stay for a few days or as long as 100 days, but they eventually move to a rehabilitation, nursing home, or home-care setting

rehabilitation facility

patient can receive intense physical, occupational, and speech therapy services - this may be part of a hospital, or it may be a freestanding facility

detoxification

removal of drugs and alcohol from a person’s body

residential care

used to describe care given in settings where the patients, or residents, stay for long periods of time

long-term care facility

nursing homes are an example of this, and residents live here for many years

assisted living facility

provide less nursing care than that found in long-term care facilities, offer 24-hour protective oversight

memory care facility

a secure facility for residents with cognitive issues who are likely to wander or to be unsafe unless they are in a protected environment

independent living facility

do not provide nursing care but have staff just in case of emergencies