Studied by 4 people
Long term care
Settings Include : Nursing home, snf, assisted living, respite care, adult day care
1930
Federal Emergency Relief Administration(FERA), Franklin Roosevelt initiates several FEAR programs
1948
Social Security Advisory Council promotes Old Age Assistance (OAA)
1954
Hill-Burton Act provides funding for nursing homes
1960s
Creation of Medicare
How many people annually are admitted into nursing homes?
4 million
How many people live in assisted living?
1 million
ADL’s - Activites of Daily Living
Routine activities every day, such as eating, bathing, getting dressed, toileting, transferring, and continence
IADL’s - Instrumental Activities of Daily Living
More complex sets of skills we need in order to live independently. These skills are: using the telephone, shopping, preparing meals, housekeeping, using transportation, taking medication(s), and managing finances
Food and Drug Administration (FDA)
The federal agency that regulates drugs in the United States before drugs can be made available to consumers, they must be approved. Clinical trials are generally divided into Four (4) phases. Each phase involves research conducted on human subjects.
FDA Stage I
tests on a small number of people, perhaps 20 to 100
FDA Stage II, III, and IV
trials involve a larger group of subjects
Pharmaceutical Companies
6 of the 10 are headquartered in the US
Brand name drugs
manufactured and distributed from the BRAND, patented and protected for 20 years, more expensive because the discovery phases take so long, US has no drug price control
Generic name drugs
not patented, not protected - can be remade and sold after the patent is up on brand name
Formulary Tiers
1 - lowest co pay
2 - middle
3 - middle
4 - middle
5 - highest co pay
PBM
Pharmacy Benefit Managers
What does a PBM do?
a PBM negotiates with pharmaceutical companies regarding price and which drugs will be covered by an insurance company
Medicaid
Joint federal and state program that gives health coverage to some people with limited income and resources
Medicare
Federal health insurance for anyone age 65+, and some people under 65 with certain disabilities or conditions
OTC
Over-the-counter
Inpatient care
stay is longer than 24 hours in a hospital
Outpatient care
without an overnight stay in a hospital
Acute care - Level 1 - Primary
Primary care is when you consult with your primary care provider. Most basic level of care.
Acute care - Level 2 - Secondary
Secondary care is when you see a specialist such as an oncologist or endocrinologist.
Acute care - Level 3 - Tertiary
Tertiary care refers to specialized care in a hospital setting such as dialysis or heart surgery.
Acute care - Level 4 - Quaternary
Quaternary care is an advanced level of specialized care.
For Profit
Must pay taxes, money goes to shareholders
Not for profit
Tax exempt, legally they can make profit but it must go back into the community
Government-Owned
Gov’t provides care (active duty or veterans)
Rural hospital
less than 25 beds
Urban hospital
greater that 25 beds
MHS
Military Health Services
VHA
Veterans Health Administration
The three “power bases” for hospital organization
governing body, chief executive/senior manager, and leadership of medical stall
What does the C in C-suite mean?
Chief
CEO - Chief Executive Officer
responsible for vision, strategic development
COO - Chief Operating Officer
responsible for daily operation
CFO - Chief Financial Advisor
responsible for leading the business and finance areas of a healthcare organization
CNO - Chief Nursing Officer
responsible for nursing and quality care
Inpatient beds
Adult beds, pediatric beds, birthing rooms, and newborn beds maintained in a hospital patient care area for patients needing acute or long-term treatment.
Inpatient licensed beds
The maximum number of inpatient beds for which a hospital holds a state license to operate.
Inpatient physically available beds
Beds that are licensed, physically set up, and available for use.
Inpatient staffed beds
Beds that are licensed and physically available for which staff are on hand to take care of patients who might occupy the bed.
Inpatient occupied beds
Beds that are licensed, physically available, staffed, and occupied by a patient
Patient day
The measurement of the time a patient remains in a hospital or other overnight facility
Allopathic medicine
focuses on alleviating the symptoms of the disease
Osteopathic medicine
oriented to treating the patient not the disease
MD
doctor of allopathic medicine
DO
doctor of osteopathic medicine
Clinical care positions include:
physicians (MD and DO)
physician extenders (nurse practitioners and physician assistants)
nurses (nursing profession has the different years of education from highest NP to RN and LPN)
allied health professionals
Primary care provider (PCP) role and inclusion
Administrative positions include:
management and administration
master of health administration (MHA)
master of business administration (MBA)
business and finance
health information management
health informatics
housekeeping
maintenance
dietary services
American Medical Association (AMA)
largest professional association of physicians and medical students in the United States
What did the creation of transportation do?
Facilitated better access to care
The three dimensions of the “iron triangle” are:
Quality
Cost
Access
The three dimensions of the “triple aim” are:
Population health
Experience of care
Per capita cost
Who historically has had more difficulty accessing healthcare services?
People of color
How does healthcare spending vary?
By geographic location
Note 
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