HK 418 Cram

What is a healthcare provider?

A licensed person or organization that provides healthcare services.

What is the largest healthcare profession?

Nursing.

What are three major physician responsibilities?

Assess health, diagnose conditions, and prescribe or perform treatment.

Do primary-care physicians outnumber non-primary-care specialists overall?

No. Non-primary-care specialists collectively outnumber primary-care physicians.

What does an RN do?

Monitors, treats, educates patients, administers medications, and coordinates care.

What is an LPN/LVN?

A nurse who provides practical nursing care and assists RNs.

What is an APRN?

An advanced practice registered nurse with graduate-level training.

What is a nurse practitioner?

An APRN licensed to diagnose and treat illness, subject to state rules.

What is a physician assistant?

An APP licensed to diagnose and treat illness in collaboration with a physician, subject to state rules

What are Advanced Practice Professionals (APPs)?

Providers such as APRNs and PAs who perform duties traditionally done by physicians.

What is scope of practice?

The activities a licensed health professional is legally permitted to perform.

Who largely determines scope-of-practice rules?

State legislatures and licensing bodies.

Why does APP practice differ among states?

States have different scope-of-practice regulations.

What is specialization in healthcare?

Physicians focusing on particular fields, diseases, organs, or procedures.

What is a major downside of physician specialization?

It can increase fragmentation of care.

Why is care coordination important with specialization?

Patients may receive care from multiple specialists who must communicate and coordinate.

What is healthcare workforce supply?

The workforce and services it can provide.

What is healthcare demand?

Services patients or payers are willing and able to obtain.

What is healthcare need?

Services required for health regardless of ability to pay or access them.

What is a healthcare workforce shortage?

Supply is insufficient to meet population demand or need.

An aging population with more chronic illness affects what?

It increases demand and need for healthcare.

Large numbers of nurses retiring affects what?

It decreases workforce supply.

A patient medically needs care but cannot afford it. Is this demand or need?

Need.

Why can rural areas experience provider shortages?

Fewer healthcare professionals practice there relative to population needs.

What is a Health Professional Shortage Area (HPSA)?

An area officially identified as having too few healthcare professionals.

What is burnout?

Emotional exhaustion, depersonalization, and reduced accomplishment from chronic work stress.

What is moral injury?

Harm caused when systemic constraints prevent workers from providing care aligned with their values.

"I am exhausted and emotionally detached from my job."

Burnout.

"I know the patient needs better care, but the system will not allow it."

Moral injury.

Do yoga and wellness apps mainly fix moral injury?

No. They mainly address individual stress rather than systemic constraints.

What kinds of interventions better address moral injury?

Staffing, workload, resource, and organizational-system changes.

What is recruitment?

Bringing new healthcare workers into a workforce or location.

What is retention?

Keeping existing healthcare workers in their jobs or communities.

Why can recruitment-only workforce programs be insufficient?

They do not solve problems causing workers to leave.

What is inpatient care?

Care after a patient has been formally admitted to a hospital.

What is outpatient or ambulatory care?

Care provided without an overnight hospital stay.

What is emergency care?

Urgent, unscheduled care provided in an emergency department.

Does being treated in the ER automatically make someone an inpatient?

No. The patient must be formally admitted.

What is post-acute care?

Care that supports recovery or ongoing needs after hospitalization.

Name major hospital functions.

Clinical care, training, research, community economics, public health, and social roles.

What is a community hospital?

A short-term, nonfederal general or specialty hospital open to the public.

What is a nonprofit hospital?

A tax-exempt hospital that reinvests earnings rather than distributing them to shareholders.

Can a nonprofit hospital make a profit?

Yes. Earnings are reinvested into the organization or community.

What is community benefit?

Activities nonprofit hospitals provide to benefit the communities they serve.

How often must nonprofit hospitals conduct a CHNA?

Every 3 years.

What is a CHNA?

A Community Health Needs Assessment.

What is a for-profit hospital?

A hospital owned by shareholders with profit as an organizational goal.

What is a safety-net hospital?

A hospital serving many low-income, Medicaid, or uninsured patients.

Why are safety-net hospitals financially vulnerable?

They often operate on thin margins while serving patients with lower reimbursement.

What is a critical access hospital?

A rural hospital receiving special support to maintain access in underserved areas.

What is a microhospital?

A small inpatient hospital with relatively few beds.

Can hospital categories overlap?

Yes. Categories such as rural, nonprofit, teaching, and specialty are not mutually exclusive.

What is the hospital dual hierarchy?

Separate administrative and medical authority structures within hospitals.

What does the administrative hierarchy control?

Organization, staffing, finances, and resources.

What does the medical hierarchy control?

Clinical decisions and patient care.

Why are hospitals difficult to manage?

Administrators and physicians may have separate authority and priorities.

What is integration?

Bringing separate organizations or services into closer coordination.

What is consolidation?

Healthcare entities joining under common ownership through merger or acquisition.

What is horizontal integration?

Integration between organizations providing the same or similar services.

Two hospitals merge. What type of integration is this?

Horizontal integration.

What is vertical integration?

Integration between organizations providing different services along the care chain.

A hospital buys a physician practice. What type of integration is this?

Vertical integration.

Why do hospitals pursue integration?

To improve coordination, gain leverage, control services, and increase financial stability.

Why can hospital consolidation increase healthcare spending?

Larger systems may gain negotiating power and charge insurers higher prices.

What is the healthcare spending equation emphasized in class?

Spending = Price × Utilization.

Why is inpatient hospital care expensive?

It requires 24/7 staffing, specialized equipment, and care for complex patients.

What is outpatient care also called?

Ambulatory care.

What is a Community Health Center (CHC)?

A community clinic providing primary care regardless of income or insurance.

Who do CHCs primarily serve?

Medically underserved areas or populations.

Can uninsured patients use CHCs?

Yes.

How are CHC fees determined?

They are adjusted based on ability to pay.

What percentage of a CHC board must be patients?

At least 51%.

What additional services may CHCs provide?

Transportation, translation, education, and other enabling services.

What is an FQHC?

A Federally Qualified Health Center with special federal reimbursement and support.

How are CHCs and FQHCs related?

CHCs are a type of FQHC.

What is an urgent care center?

A walk-in clinic for prompt problems that are not serious enough for the ED.

Why were urgent care centers expected to lower costs?

They were supposed to divert non-emergency patients from expensive emergency departments.

What is an ambulatory surgery center (ASC)?

A freestanding facility performing surgery that does not require an overnight stay.

Do ASCs usually cost more or less per procedure than hospital operating rooms?

Less per procedure.

What concern exists when physicians own ASCs?

Financial incentives may influence referrals and utilization.

What is a retail clinic?

A clinic inside a pharmacy or other retail setting for simple conditions and preventive care.

Who usually staffs retail clinics?

Nurse practitioners or physician assistants.

What was the promise of retail clinics?

Expand access and provide convenient lower-cost care.

Why did outpatient "disruption" not fully happen?

Hospitals and insurers increasingly acquired UCCs and ASCs rather than being displaced by them.

What is induced demand?

Convenient access causes people to use care they might not otherwise have used.

Why can urgent care increase total spending?

It may add new visits instead of replacing more expensive care.

Why did retail clinics have limited impact on underserved populations?

Many were in affluent areas and had low Medicaid acceptance.

What is fragmentation of outpatient care?

Patients receive care from multiple disconnected sites with limited coordination.

Does having more healthcare access points guarantee coordinated care?

No.

What is post-acute care (PAC)?

Services helping patients recover or manage ongoing needs after a hospital stay.

Name four major PAC settings.

LTCH, IRF, SNF, and HHA.

What is the PAC intensity order from highest to lowest?

LTCH → IRF → SNF → HHA.

What is an LTCH?

A Long-Term Care Hospital providing extended hospital-level care for complex patients.

What kind of patient needs an LTCH?

A medically complex patient who still needs hospital-level care for weeks.

What is the typical Medicare LTCH length-of-stay threshold?

Average stay greater than 25 days.

Ventilator plus complex wound after acute hospitalization: where does the patient go?

LTCH.

What is an IRF?

An Inpatient Rehabilitation Facility providing intensive multidisciplinary rehabilitation.

How much therapy can an IRF patient often tolerate?

About 3 or more hours per day.

What kind of patient is appropriate for an IRF?

A medically stable patient capable of intensive rehabilitation.

What is a SNF?

A Skilled Nursing Facility providing skilled nursing and less-intensive rehabilitation.