Dynamics of Healthcare Exam Review

What contributed to the rising cost of healthcare

• Expensive medical technology and prescription drugs

• reimbursement systems that reward the volume of medical services instead of outcomes

• inadequate preventive services

• the aging population; and chronic disease.

How has the Affordable Care Act (ACA) increased access to care?

Gained access to healthcare through expansion (Medicaid).

• Medicaid →expanded health coverage to the poor

• Narrowed racial and ethnic disparities to have access to health insurance

• Medicare → for elderly who are 65 or older, or disabled with low income

• It’s available to more communities than it was before

What aspects of healthcare does the ACA cover?

• ACA covers preventive care and consumer protection?

• ACA covers the uninsured

What are the social determinants of health and how do they impact healthcare?

• The social determinants of health: They examine and address the adverse conditions a person is born,grow,work,live and age.

• They impact healthcare by allowing access 

What are the categories of healthcare services provided by the US healthcare system?

• Health promotion services

• Disease prevention services

• Diagnosis and treatment of illness

• Rehabilitation

• Chronic care

What are the Federally Qualified Healthcare Centers? Who do they serve?

The federal laws including public health, healthcare delivery and criminal justice systems

What are the agencies that come under the Department of Health and Human Services? What are the responsibilities of these agencies?

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

The U.S. Department of Health and Human Services 

• sets the guidelines for private government institution provide care with hospital and outpatient or ambulatory care services

• provide people what they need

• responsible for Medicare, Medicaid, public health, biomed research in USA and abroad

What are the aspects of the Patient Care Partnership?

High quality hospital care, safe/clean environment, patient involvement in care, protection/privacy, heal leaving hospital, help with billing claims

What are some ways the public healthcare system is funded?

Taxes/government funds, medicare, medicaid, CHIP (Children's health insurance program), TRIcare

Which populations are covered under Medicare?

65 years + and disabled

What coverage does Medicare provide?

• (Part A) Hospital Insurance 

• (Part B) Medical Insurance

• (Part C) Medicare advantage

• (Part D) Drugs

How do hospitals use diagnostic related groups (DRG) for billing?****

They use it to figure out how much to charge a patient based on patients with a similar diagnosis

Copayment

hare of the cost for healthcare services not covered by health insurance/ every time you go to the doctors office you have to pay each time/ out of pocket fee

Deductibles

what you pay at the beginning of the year.

HMOs (Health maintenance organizations)

health maintenance organizations: are prepaid health insurance that only covers care provided by providers and health care facilities inside the it

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

size of the aging population is growing

how will these demographic changes impact the healthcare system

these changes demand for healthcare, social services, and caregiving.

IADL - instrumental activities of daily living

tasks that require complex thinking and organizational skills. (e.g. Managing money, shopping, preparing meals, and taking prescribed medications)

ADL - activities of daily living

 basic skills needed to independently care for oneself (e.g. Eating, bathing, dressing, maintaining personal hygiene, and mobility. 

difference between IADL and ADL

The difference between them is that ADLs are basic living necessities, IADLs are the complex activities meant to help a patient/ one needs help and assistance with and the other needs you to do it on your own

How are long-term care facilities funded?

funded through a combination of public and private sources. Medicaid is the primary source of public funding for long-term care, particularly for low-income individuals / the federal government

what is the role in education of an occupational health and safety specialist?

preparing and delivering educational programs to teach employers and workers about workplace safety —> so that all have a safe learning environment

How does health literacy impact the overall health and safety specialist/healthcare system?

• It’s an important factor in disease prevention

• Associated with obesity, dietary choices, and exercise

• Impacts a person’s ability to communicate properly and take care of the patient

• Public’s knowledge of healthcare; people do not know where to get help from.

What are healthcare disparities?

Inequalities, and different coverages and health outcomes for different people (races).

What are Clinical Decision Support Systems (CDSS)?

Variety of technologies that provide healthcare practitioners with tools to improve the quality of care through diagnostic and treatment recommendation.

Advantages of EHR

Easy access to info on patients’ individual patient health record stored in a computer database; and it is convenient for both healthcare professionals and patients to send info.

Disadvantages of EHR

If there are technical difficulties, it won’t be possible to see the info; risk of violation of privacy laws.

What is health information technology (HIT)?

Array of tech to record, store, retrieve, protect, share and analyze health info.

COINSURANCE

the percentage of covered health costs you're responsible for paying after you've met your deductible.

Gatekeeper

 primary care physicians who serve as the initial point of contact for patients seeking healthcare services

What are various workplace settings of healthcare workers?

Hospitals, doc offices, nursing/residential facilities, home health services, outpatient, laboratory, ambulatory services.

where can someone obtain an education in healthcare?

Colleges, universities, online certifications

What are the components of common core knowledge?

Medical terminology, anatomy & physiology, infection control, safety, technical skills, language arts, math, history, and science

What are some characteristics of a healthcare professional?

active listening, problem solving, accountability, ethical behavior, steady composure when faced with adversity, look/dress the part, not getting emotionally attached

Licensing

the right to practice by a governmental agency to provide a service

Accreditation

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

Certification

 the action or process of providing someone with an official document attesting to a status or level of achievement.

Malpractice

professional misconduct

Negligence

failure to do something that a person with prudence would do

Why do healthcare professionals need continued education courses?

To maintain competence, keep up with rapidly evolving medical advancements, and meet licensing and certification requirements.

Who determines the requirements for CE courses?

The state licensing board or professional organization

What is the scope of practice for the different healthcare professions?

the boundaries of their professional role and responsibilities/specific activities, procedures, and interventions a healthcare professional is legally and ethically permitted to perform based on their education, training, and licensing

Which profession requires a bachelor's degree in order to practice healthcare

Registered Nurses, health educator specialists, school health educator, Orientation and mobility specialist, social and human service assistant, LPNs, PA, Registered Dietician Nutritionists, athletic trainer, exercise physiologist, psychologist, CEO (Chief executive Officer, Radiological technologists and technicians, etc. 

Are there any healthcare professionals that do not require licensure or certification in order to provide healthcare services?

Yes there are a number of healthcare professionals that do not require such as home health aide

Are there health care professions that are expected to decline?

podiatrist

What's the difference between PT and PTA

• PT requires a doctoral degree →3 years

• PTA - work under the the PT and help PT provide treatment, associates degree

What are community HC workers? What is their role and job function?

Support personnel who work with health educators to provide outreach and educate consumers on importance and availability such as cancer screening. Link between community and health educators, help enroll in WIC, medicare and medicaid,

What are the types of sonographers?

Abdominal, neurosonography, breast, vascular, cardio + pediatric, obstetric + gynecologic

What is the benefit of massage therapy?

To better someones mobility, increase range of motion, decrease spasm, eliminate pain/toxins, stimulate circulation, stress relief

What is the difference between psychiatric aides and psychiatric technicians?

Aides: cares for mentally and emotionally impaired, help with dressing, eating, bathing, grooming, playing games and watching TV

Technician: therapeutic care, care for mentally impaired, developmentally + emotionally disabled.

What is the educational requirement for vet techs?

Vet technicians require a two-year program, and vet technologists require a four-year program

What is the scope of practice and licensure requirements for vet techs?

both must pass a credentialing exam and must be registered, licensed, or certified depending on what state they work in. 

HMOs vs EPO

HMO: prepaid health ins that only covers care provided by providers and healthcare facilities inside the HMO (Health Maintenance organization)

EPO: similar to HMO but it doesn’t usually require the primary care provider to make referrals to specialist.

HMOs vs private insurance

HMO:  only covers care provided by providers and healthcare facilities inside the HMO

private insurance: coverage provided through an employer, or purchased directly by individuals and families to help cover medical care and related expenses.

How did the area of agency on aging come into existence?

Emerged from the OAA (Older Americans Act of 1965) to promote well being of elders and their needs and services.

telemedicine

Electronic info and communications tech to provide and support healthcare when distance separates participants

telehealth

Healthcare appointments delivered by the clinician through telecommunication technologies. Allows you to see the doctor without going to their office

What are teams that may be formed while a patient is receiving healthcare services? Who might be members of the teams?

Core Care Teams: physicians, nurses, therapists, social workers, pharmacists, dieticians, and community health workers. 

Coordinating Teams: case managers and administrative clerks.

Contingency Teams: cardiac arrest teams and disaster response teams.

 Ancillary Teams: cleaning and domestic staff.

Communication impairment

hinder communication and can cause problems in life.

Which professional will manage or treat communication impairment issues?

speech language pathologist

what is the role of a psychologist?

Psychologists study human behavior and mental processes to understand how people think, feel, and act. 

• use this knowledge to help individuals improve their mental health, cope with challenges, and achieve their goals. 

• engage in research, assessment, diagnosis, and treatments of various mental health conditions.

Areas of specialization in psychology?

Some specializations in this field include clinical psychology, counseling psychology, forensic psychology, industrial organizational psychology, neuropsychology, educational psychology, cognitive psychology, health psychology, etc.

Job function of the health care manager

• manage budgets, oversee daily operations, ensure compliance with regulations, and work to improve the quality of patient care. 

• Hiring, training, and evaluating staff.

What is the role of the Commission on Accreditation for Health Information Management Education (CAHIIM)?

strives to provide the public with effective and consistent quality monitoring of health informatics and health information management programs through maintenance of accreditation processes.

Components of malpractice case

4 legel companted must be proved including 

• (1) a professional duty owed to the patient; 

• (2) breach of such duty; 

• (3) injury caused by the breach

• (4) resulting damages.

What does each side have to prove in a malpractice case?

• The patient must prove that the healthcare provider had a breach of duty that caused injury and that the patient felt the damages of that breach.

• The healthcare provider must prove that the argument is not true and that there are other reasons for the injury besides negligence.