Chapter 2: Review Questions - Overview of Heath Care Today

2. List five challenges facing today's health care system.

Any five: • more than 50 million people uninsured in 2010 • a disparity in care provided to insured people as compared with the uninsured or underinsured, many of whom belong to racial and ethnic minorities • the staggering cost of advanced technology • increasing insurance costs and out-of-pocket costs that continue to soar • many doctors and health care facilities are refusing to treat Medicare patients or limiting the number they treat owing to slow and low pay • the Medicaid health insurance program for low-income people announced $112.8 million in cuts • medical errors are one of the nation's leading causes of death and injury

3. List four key elements of the Affordable Care Act.

Any four: • a new health insurance marketplace will be created in 2014 • the exchanges will guarantee that all people have a choice for high-quality, affordable health insurance even if a job loss, job switch, move, or illness occurs • a preexisting condition insurance plan will provide new coverage options to individuals who have been uninsured for at least 6 months • in 2014 patients will no longer be discriminated against based on a preexisting condition • insurance companies will be prohibited from imposing lifetime dollar limits on essential benefits • young adults will be allowed to stay on their parent's plan until they turn 26 years old • all new plans must cover certain preventive services such as mammograms and colonoscopies without charging a deductible, copay, or coinsurance • health plans must begin adopting rules for the secure, confidential, electronic exchange of health information (EMR) • the law establishes a hospital Value-Based Purchasing (VBP) program in original Medicare, which offers financial incentives to hospitals to improve the quality of care • hospital performance is required to be publicly reported, beginning with measures relating to heart attacks, heart failure, pneumonia, surgical care, health care–associated infections, and patients' perception of care • most individuals who can afford it will be required to obtain basic health insurance coverage or pay a fee to help offset the costs of caring for uninsured Americans

4. Explain why it is important to stay current with additional changes to the Affordable Care Act.

It is important to stay current with any additional changes made, as the changes may have an impact on health care providers as well as everyone receiving health care.

5. Explain how the implementation of a national EMR system would assist in a pandemic or national emergency.

A national electronic medical record system will allow the federal government to track the course and impact of a pandemic in real time and would provide local, state, and federal governments with the necessary data to direct therapies, medical personnel, and supplies during an emergency.

6. Identify the challenge a health care provider faces when implementing an EMR system that is addressed in HIPAA (1996).

There is a balancing act between ease of access for prompt medical care and the maintenance of confidentiality. Health care providers must make sure their EMR system is HIPAA compliant and that the EMR systems installed take care of all the privacy and information security issues.

7. Explain the difference between client server–based EMR and cloud- or Web-based EMR.

Client server–based EMR: the software is hosted on the hospital internal server, and the licenses are purchased outright. • Cloud- or Web-based EMR: the facility uses an Internet site to host data and programs instead of keeping them on an internal computer.

8. Identify the EMR system used throughout the U.S. Department of Veterans Affairs (VA).

VistA

9. Explain the use of HIPAA-compliant mobile phones and patient portals.

HIPAA-compliant mobile EMR: an EHR service that allows doctors to access critical patient records and office information from their iPhones. The iSALUS mobile EMR-EHR application lets physicians securely access real-time patient information such as progress notes, medical images, and contact and insurance information, plus office items such as schedules, rounds, task lists, dictations, patient charges, and office communications. • Patient portal applications: might allow patients to register and complete forms online, request prescription refills online, order eyeglasses and contacts, access medical records, pay bills, review lab results, and schedule necessary medical appointments.

10a. List three categories of telemedicine.

a. acquiring medical data such as medical images and biosignals (e.g., ECG tracings) and then transmitting this data to a doctor or medical specialist at a remote site • b. remote monitoring — enables medical professionals to monitor a patient remotely through use of various technologic devices • c. interactive real-time interactions between patient and provider — provided through telephone conversations, online communication, and home visits

10b. List three major advances aided by surgical robots.

a. computer assisted surgery — commonly used in orthopedic surgeries • b. telesurgical systems — enhance the surgery by providing three-dimensional visualization deep within hard-to-reach places such as the heart, as well as enhancing wrist dexterity and control of tiny instruments • c. shared control systems — monitor the surgeon, providing stability and support during the procedure; the human does the bulk of the work. Surgeons program the robots to recognize safe, close, boundary, and forbidden territories within the body. When the forbidden zone is reached, the robotic system locks up to prevent further injury. Shared-control systems might work best for brain surgeries; the surgeon provides the action, but the robot arm steadies the hand.

11a. Explain the main characteristics of INDEMNITY INSURANCE.

• provides individuals freedom and flexibility in choosing doctor and medical treatments • premiums are higher, and there are deductibles and other out-of-pocket expenses • most plans come with an annual coinsurance maximum; once it has been met, the insurance company will pay 100% of the medical costs for the rest of the calendar year • does not pay for preventative care • covers accidents and illnesses

11b. Explain the main characteristics of MANAGED CARE.

• has a lower deductible and smaller copayment than an indemnity plan • limited choices when it comes to doctors or hospitals • physicians must be authorized by the managed care provider • permission must be obtained from the primary doctor to see a specialized doctor • most often associated with health maintenance organizations (HMOs) that have management responsibility for providing comprehensive health care services on a prepayment basis (capitation) to voluntarily enrolled persons within a designated population

11c. Explain the main characteristics of WORKER'S COMPENSATION insurance.

• the employer pays a premium to an insurance carrier for worker's compensation coverage • the policy pays the medical bills and a significant portion of the lost wages when an on-the-job accident or illness results in injury or disability • the injured worker must fill out a claim form and send it to the insurance carrier • the injured worker receives no bill, pays no deductible, and is covered 100% for medical expenses related to that injury or illness

12. Identify the federal and state program that provides health care for the indigent.

Medicaid is a federal and state program that provides medical assistance for the indigent.

13a. Define the coverage of MEDICARE PART A.

Hospital insurance — helps cover inpatient care in hospitals and helps cover skilled nursing facility, hospice, and home health care

13b. Define the coverage of MEDICARE PART B.

Medical insurance — helps cover doctors' services, hospital outpatient care, and home health care, and helps cover some preventive services to help maintain health and to keep certain illnesses from getting worse

13c. Define the coverage of MEDICARE PART D.

Prescription drug coverage — a prescription drug option run by Medicare-approved private insurance companies that helps cover the cost of prescription drugs until a preset amount of money has been reached; then the Medicare beneficiary is in a temporary donut hole

14. Identify at least three health care delivery systems that provide long-term or custodial care for patients unable to care for themselves.

• nursing homes or health care centers • extended care facilities (ECFs) • physical medicine and rehabilitation facilities • hospice

15. Explain the basic concept of freestanding, in-home, or hospital-based hospice care.

Hospice provides palliative and supportive care for terminally ill patients and their families. Emphasis is placed on control of symptoms and preparation for and support before and after death.

16. List five functions a hospital may perform.

a. the care and treatment of the sick • b. education of physicians and other health care personnel • c. research • d. prevention of disease • e. local health center

17. List three ways in which hospitals may be classified.

a. type of service offered • b. ownership of the hospital • c. the type of accreditation the hospital has been given

18a. Explain what Magnet status signifies.

Magnet status is an award given by the ANCC to hospitals that satisfy a set of criteria designed to measure the strength and quality of their nursing.

18b. Identify at least six benefits a hospital would obtain by achieving Magnet status.

• enhanced nursing care • increased staff morale • appeal to high-quality physicians • reinforced positive collaborative relationships • creation of a "Magnet culture" • improved patient quality outcomes • enhanced nursing recruitment • retention • competitive advantage

19. Identify two agencies that set hospital operational guidelines.

a. American Hospital Association (AHA) • b. The Joint Commission (TJC)

20. Name the citizens' group that is at the head of the hospital's organizational structure, and describe its responsibilities.

Governing board — responsibilities include establishing policy, providing adequate financing, and overseeing personnel standards.

21. Identify the individual in direct charge of a hospital, and explain his or her responsibilities.

a. Chief executive officer (CEO) • b. responsibilities include planning for the implementation of policies set forth by the governing board. (The chief operating officer (COO) is responsible for the day-to-day operations of the hospital and reports directly to the CEO. The chief financial officer (CFO) is responsible for the fiscal aspects of the hospital administration and reports directly to the CEO.)

22a. Main function of the BUSINESS OFFICE

managing patient accounts

22b. Main function of ADMITTING

admission of patients

22c. Main function of PATHOLOGY or CLINICAL LABORATORY

diagnostic procedures on specimens from the body

22d. Main function of DIAGNOSTIC IMAGING

x-ray, nuclear medicine, and ultrasound studies

22e. Main function of RADIATION ONCOLOGY

treatment of cancer growths

22f. Main function of PHARMACY

distribution of medications

22g. Main function of PHYSICAL MEDICINE

rehabilitation of patients

22h. Main function of CARDIOPULMONARY or RESPIRATORY

treatment related to respiratory function

22i. Main function of NUTRITIONAL CARE

preparation of food and meals

22j. Main function of ENDOSCOPY

diagnostic procedures performed with the use of endoscopes

22k. Main function of GASTROENTEROLOGY (GI lab)

diagnostic studies related to the digestive system

22l. Main function of CARDIOVASCULAR DIAGNOSTICS

tests related to heart and blood vessels

22m. Main function of NEUROLOGY

studies of the nervous system

22n. Main function of HEALTH INFORMATION MANAGEMENT SYSTEM

managing patient charts or electronic medical records

22o. Main function of CENTRAL SUPPLY

storage and distribution of supplies and equipment used for patient care

22p. Main function of SOCIAL SERVICES

assistance to patients and families

22q. Main function of ENVIRONMENTAL SERVICES

housekeeping duties

22r. Main function of SECURITY

protection of the hospital, patients, visitors, and employees

22s. Main function of IT SERVICES

installation and repair of electronics including computers, printers, and software

22t. Main function of MECHANICAL

keeps equipment in working order

22u. Main function of HUMAN RESOURCES

recruitment, employee payroll, exit interviews

23. List three resources used to access employment opportunities.

Any three: • surf the Web for local job openings • check newspaper classifieds • school job placement, career counselors, instructors • health care hotlines • employment agencies • library resources • health care facility websites and bulletin boards • networking with professionals in the field • networking with NAHUC members