DHC Rutgers Final Study Document

Flashcards covering various topics from the provided lecture notes, focusing on healthcare, medical professions, and related concepts.

What is the ACA (Affordable Care Act)?

Three goals: 1) decrease # of uninsured 2) increase the quality and efficiency of hc 3) slow the rising $ of hc. Made in 2010 by Barack Obama, also known as "ObamaCare".

What are the mechanisms for obtaining healthcare insurance after the ACA?

Employer, SHOP (Small Business Health Options Program), direct enrollment, parents (coverage until 26), Marketplace or “Health Exchange”.

What is the Data Service Hub?

Connects the Marketplace to Medicaid and CHIP.

What is HealthCare.gov?

A one-stop shopping site for purchasing a non-group Health Insurance plan, determines eligibility for Medicaid and CHIP and can apply for SHOP

What is employer-shared-responsibility payment?

Fine if an employee was receiving Marketplace premium subsidy because the employer needs to provide HI so the employee shouldn’t be buying outside insurance.

What happened in 2010 related to implementing the ACA?

Under 26 yrs old are covered by parents; pre-existing conditions are not an exception; clinical preventive services are required; scholarship and loan repayment expanded for student training; FQHCs expanded.

What happened in 2011 related to implementing the ACA?

Limits on non-medical spending to 15% of the cost of HI premiums; establishment of CMS (Centers for Medicare and Medicaid); pharmaceutical fees levied on drug manufacturers.

What happened in 2012 related to implementing the ACA?

HRRPs (Hospital Readmission Reduction Program) = lower Medicare pay to hospitals that don’t meet standards for readmissions for THREE diagnoses: 1) Heart attack 2) Stroke 3) Pneumonia (nosocomial)

What happened in 2013 related to implementing the ACA?

EHRs required by private health insurers; Payment Reform = pilot programs that bundle services (ex: home care after surgery).

What happened in 2014 related to implementing the ACA?

Health Exchanges established; Medicaid expansion for people with incomes at 138% of the FPL; Essential health benefits required; shared responsibility for coverage.

What was the outcome of National Federation of Independent Business vs. Sebelius?

Individual states not required to expand Medicaid.

What modifications were made to the ACA funding?

Slashed funding for the navigator program by 80% in 34 states with FFMs; reduced funding for outreach and assistance programs.

What was the impact of the Tax Cuts & Jobs Act of 2017 on health insurance?

Eliminated individual mandate for everyone to have HI coverage and removed the tax penalty for people without private HI but not eligible for public.

What was the outcome of Burwell vs. King?

Individuals eligible for premium subsidies can purchase HI from either an SBM or FFM.

What is the ruling on contraceptives?

Employers w moral/religious opposition to contraceptives are exempt (Burwell vs. Hobby Lobby and Little Sisters of the Poor vs. Pennsylvania)

What are Social Determinants of Health (SDOH)?

The conditions in which people are born, grow, work, live, and age; examples: lack of access to stable housing, nutritious food, employment, education, personal safety, or reliable transportation.

What percentage of an individual's health is determined by socio-economic factors such as education, occupation, or income?

40% of an individual's health.

What are the different categories of healthcare services available in the US?

1) Health promotion services; 2) Disease prevention services; 3) Diagnosis and treatment of illnesses; 4) Rehabilitation; 5) Chronic care.

What are some of the agencies under the Department of HHS?

ACF, ACL, AHRQ, ATSDR, CDC, CMS, FDA, HRSA, IHS, SAMHSA.

What are the sources of federal revenue to cover the costs of the national budget?

Income tax (50%), Payroll tax (36%), Excise, estate, and other taxes (7%).

The Federal government reimburses State government up to how much for Medicare/Medicaid costs?

50-75% depending on the states per capita income.

What is Medicare?

Federal health program for people ages 65 and older, certain disabled people younger than 65, and any adult with permanent kidney failure (ESRD) or amyotrophic lateral sclerosis (ALS/Lou Gehrig’s Disease).

What are the Medicare Programs offered to those 65 Years of Age?

Hospital Insurance (Part A), Medical Insurance (Part B), Medicare Advantage (Part C), Prescription Drug Coverage (Part D).

What is Medicaid?

Federal-state cooperative HI plan for those who are not eligible for HI through an employer and cannot afford to buy HI thru Marketplace

What are the guarantees of Medicaid as an entitlement?

All Americans who meet Medicaid eligibility requirements are guaranteed coverage & states are guaranteed matching funds from the federal government to help pay for Medicaid coverage (50-75% matching rate, based on state’s per-capita income and changes every year).

What is a DRG (Diagnosis-Related Grouping)?

A set of payment categories that are used to classify pts for the purpose of hospital reimbursement with a fixed fee regardless of the actual $ and that are based on the Dx, surgical procedure used, age of the pt, and expected length of stay

What does it mean to say that HMOs are capitated?

A fixed amount of money per patient per unit of time paid in advance to the physician for the delivery of health care services (where a payment is made to a PCP for every patient for whom they provide care)

What is a deductible?

The set amount of money you pay out of pocket for covered services per plan year before your insurance starts to share costs.

What is a copay?

A fixed fee applied to services covered by your insurance.

What is an HMO (Health Maintenance Organization)?

A type of MCO (Managed Care Organization); a form of prepaid HI that only covers care provided by providers inside the HMO network.

What is a PPO (Preferred Provider Organization)?

Preferred provider organizations; cover care provided both inside and outside the plan’s provider network, but the cost for out-of-network is typically higher.

What is an EPO (Exclusive Provider Organization)?

Exclusive provider organizations; offers a local network of healthcare providers, less expensive than PPO, care outside of the network is only covered in emergencies.

What demographic changes are expected to take place in the U.S.?

AGING POPULATION and the pop in racial and ethnic minority groups is expected to INCREASE.

What are ADLs (Activities of Daily Living)?

Basic skills required to independently care for oneself.

What are IADLs (Instrumental Activities of Daily Living)?

Activities that require more complex thinking and organizational skills.

What program is the primary payer and the safety net program for LTSS for many low-middle income families

Medicaid program.

What is the role of occupational health and safety specialists?

Analyze many types of work environments and work procedures; inspect workplaces for compliance to regulations on safety, health, and the environment; design programs to prevent disease or injury to workers and damage to the environment.

What do ergonomists do?

Consider the design of industrial, office, and other equipment to maximize worker’s comfort, safety, and productivity.

What do health physicists do?

Work in locations that use radiation and radioactive material; help protect people and the environment from hazardous radiation used in research and medical Tx.

What do industrial/occupational hygienists do?

ID workplace health hazards, such as lead, asbestos, noise, pesticides, and communicable diseases.

What is health literacy?

The ability of an individual to obtain, process, and understand health information and services needed to make appropriate health decisions.

What are health disparities?

Differences in health outcomes (infant mortality or longevity) because of differences in race, ethnicity, immigration status, income, education, or employment.

What is Health IT (Health Information Technology)?

The use of computers to store health data to support health information management across computerized systems and the secure exchange of health information among providers, consumers, and payers.

What are the PROs of EHRs (Electronic Health Records)?

Make it possible for multiple team members to schedule pt-team conference regardless of physical location; potential to improve pt safety by removing drug interactions and reduce $ by avoiding duplicate lab tests.

What are the CONS of EHRs (Electronic Health Records)?

Raises ethical concerns for pt privacy and security to prevent data breaches, cost effects entire structure of hc system, bc increased $ service is not available to all ppl (poor ppl may need it more but don't have access)

What is medical terminology?

Language used in medicine that allows hc profs to communicate w each other w precise accuracy abt medical issue assoc w pt.

What are Anatomy and Physiology?

Anatomy = structure of organisms; physiology = focuses on how organisms and their parts carry out normal physical functions that allow them to exist.

What are some technical skills?

Skills for direct patient contact, measuring and recording vital signs, first aid, CPR, AED, how to clear FBOA

What is infection control?

Preventing the spread of healthcare-associated infection.

What is definition of a health behavior?

An action taken to attain, maintain, or regain, good health and to prevent illness such as weight control, exercise, and good sleep habits.

What is licensing?

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

What is certification?

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

What is Accreditation?

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

What is malpractice?

Professional misconduct.

What is negligence?

Failing to do something that a reasonably prudent person would do in the same or similar situation, or doing something that they wouldn’t do

Why do healthcare professionals need Continuing Education courses?

Because the healthcare field evolves rapidly, need to learn the most recent information for their profession.

Who determines the requirements of CE courses?.

The state licensing board or professional associations.

What are the minimum education requirements of Doctors and Surgeons

MINIMUM: three years of college (either MD or DO)

What are some undergraduate courses that aspiring medical doctors take?

Biology, Chemistry, Physics, Math, English.

What is the MCAT (Medical College Admission Test)?

Medical examination used to enter a medical school.

What are the first two years of medical school generally like?

Labs and classrooms, courses like: A&P, Biochemistry, Pharmacology, Psychology, Medical Ethics, Medicinal Laws, plus skills to take medical histories, examine patients, and diagnose illness.

What are the last two years of medical school generally like?

Patient Experience under Physicians in rotations like Internal Medicine, Family Practice, Obstetrics, Gynecology, Pediatrics, Psychiatry, and Surgery.

What kind of internship does a medical student have to partake in after they complete medical school?

3 to 8 year Internship with popular specialties are Family medicine/general practice, General pediatrics, General internal medicine, OB/GYN, Anesthesiology, Psychiatry and General Surgery.

What examination is required for medical licensure (MD and DO)?

MDs = USMLE (U.S. Medical Licensing Examination); DOs = COMLEX-USA (Comprehensive Osteopathic Medical Licensing Examinatio

What are the minimum education requirements of a Podiatrist

DPM degree, licensure, and 3-year residency.

What is the minimum education required to be a Physician Assistant

Two years of college, licensure, educational program

What licensure/certification exam is required to be a Physicians Assistant

PANCE - Physician Assistant National Certifying Examination, administered by the NCCPA - National Commission on Certification of Physician Assistants; requires 100 hours of continuing education every 2 year & recertifying examination every 10 years

What paths are there to becoming a Registered Nurse (RN)

3 paths - BSN, Associate’s degree in nursing (ADN), Diploma

What is the required Licensure exam to be a RN

NCLEX-RN exam Required after one have graduated from an approved nursing program

What is the educational pathway to becoming an Advanced Practice Registered Nurse (APRN)?

Master’s, licensed RN in state & must take a national certification exam

What is the path way to becoming a Licensed Practical Nurse (LPN)

Most practical nurse training programs last 1 yr with a state-approved non-degree training program in practical nursing needed for licensure; HS diploma required for entry.

What are the requirements of the LPN Licensure exam?

Exam which covers four major client needs categories: safe & effective care environment, health promotion & maintenance, psychosocial integrity and physiological integrity.

What degrees do Dentists need?

Doctor of Dental Surgery; Doctor of Dental Medicine with MINIMUM requirements of a Licensure plus DDS, DMD

What do Dental Hygienists need?

Need licensure, accredited dental hygiene school

Education Requirements for a Dental Assistant

Varies by states; typically a dental-assisting program but there is also no formal education needed.

Min education requirements for a Dental Laboratory Technician

Varries; high school diploma

Education requirement for Dietitians and Nutritionists

Master's degree

Education requirements for Dietitians Technicians

Associate's degree

Minimum Education Requirements for Dietary Manager

Certification

Minimum education requirements for a Pharmacist

PharmD- Doctor of Pharmacy

What Exam must you take to be licensed as a Pharmacist

The NAPLEX - North American Pharmacist Licensure Examination which tests pharmacy skills and knowledge

Education Requirements for Pharmacy Technicians and Aides

Only requires a high school diploma

Education Requirements for Optometrists

OD and licensure

Education requirements for Optician

Certification; graduation from accredited 2 year program

Education and Certifications for Disorders of Communicate

Speech-Language Pathologists and Audiologists require Licenses; Speech-Language Pathology Assistants and Audiology Assistants need at minimum Associate's

MINIMUM Education Requirements to be a Ophthalmic Laboratory Technicians

At least graduation from high school

Minimum Education Requirements to be a Speech-Language Pathologists

Masters degree

Eligibility for a Practical Exam

The test must that they passed for eligibility for a license in SLP

Educational requirements to be a physical therapist

post baccalaureate degree from accredited PT program

What type of master's do one need to be an Orthotists and Prosthetists

Master’s in orthotics & prosthetics

Minimum Education Requirements to be an occupational therapists

Typically a master’s degree and certified

Requirements to be athletic trainers

Require 3-year program, can lead to bachelor's and associate's programs

MINIMUM Education Requirements to be a Chiropractors

Doctor of Chiropractic licensure

Education for Psychologists

Requires Master’s or doctorate

Minimum Education Requirements to be a Substance Abuse/Behavioural Disorder/Mental Health Counselors

Varies from HS diploma to master

What fieldwork is required to achieve a Bachelo's(BSW) degree

400 hours of field work

License requirements for Social workers Social Workers

Typically requires a license

Education for Genetic counselors

Masters; highly favorable for a PhD and certification

Minimum Education level for a Health education specialist

Minimum Bachelors

Requirements to be a Health Services Manager

Typically masters but can be bachelors with on the job training