DOH test

Dynamics in Healthcare Exam Review

1. Affordable Care Act: 

• What is it?

Healthcare reform legislation signed into law by President Barack Obama in March 2010 with a goal of increasing access to health insurance while controlling healthcare costs. 

• What has contributed to the rising cost of healthcare?

It’s caused by the use of expensive medical technology and prescription drugs, reimbursement systems that reward the volume of medical services instead of outcomes, inadequate preventive services, the aging of the population, the increased prevalence of chronic diseases, and high administrative costs.

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

Medicaid expanded health coverage to nearly all adults with incomes at or below 138% poverty in states that adopted the expansion.  Additionally, tax credits are available for those with incomes up to 400% of poverty who purchased coverage through the health insurance marketplace.  

• What aspects of healthcare does the ACA cover?

It covers preventative care, maternity and newborn care, mental health and substance abuse disorder services, prescription drugs, pediatric services, and hospitalization. 

• How has it affected small businesses?

Small businesses can purchase healthcare plans on the SHOP.

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

They are the conditions in which people are born, work, live, and age.  It’s important in preventing diseases and treating them.  30% of health outcomes are determined by health behaviors. 

3. What are the categories of healthcare services provided by the US healthcare system? (This was a 5 in 1 question)

Health promotion services: help clients reduce the risk of illness, maintain optimal function, and follow healthy lifestyles

Disease prevention services: help reduce the risk of injury or illness in the workplace or for the general public

Diagnosis and treatment of illness: identifying and treating injury or disease

Rehabilitation: restoration of a person to normal or near-normal function after a physical or mental illness

Chronic care: ongoing care for a chronic health condition 

4. Who is the largest employer of healthcare workers?

Hospitals are the largest employer of healthcare workers. 

5. What facility provides primarily out-patient services?

Ambulatory healthcare services like offices of practitioners or group practices provide out-patient services.

6. What are Federally Qualified Healthcare Centers? Who do they serve?

Funded by Medicare and Medicaid, they are the largest safety net of primary and preventative care.  They serve medically underserved populations like veterans or the homeless. 

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

CMS: administer Medicare and Medicaid

CDC: promote health and prevent outbreak of disease

HRSA: improve access to healthcare in underserved communities

IHS: provides healthcare services to Native Americans and Alaska Natives

Dynamics in Healthcare Exam Review

8. What is a Patient Care Partnership?  What are the different aspects of the Patient Care Partnership?

It replaced the Patient’s Bill of Rights in 2003.  It included six expectations for hospital care: high quality hospital care, clean and safe environment, patient involvement in their own care, protection of patient privacy, help with leaving the hospital, and help with billing claims.

9. What are some ways the public healthcare system is funded?

It’s funded through federal, state, and local governments, private health insurance, and philanthropy and non-patient revenues.
10. Which populations are covered under Medicare? What coverage does Medicare provide?
Medicare is for those 65 and older, certain disabled people, and any adult with permanent kidney failure.  It covers hospitalization, doctor visits, prescription drugs, short-term stays in a skilled nursing facility, home health care, hospice, preventative services like immunizations and cancer screenings.
11. How do hospitals use diagnostic related groups (DRG) for billing? 

Hospitals are paid a set amount for each patient in any of the established disease categories and diagnostic related groups. 

12. What are copays and how do they impact costs to the healthcare system? 

They are fixed amounts that patients must pay out of pocket for specific healthcare services, such as doctors visits and prescriptions, while insurance covers the rest.  They reduce overall costs to the healthcare system by encouraging people to care more wisely or go to the doctor less because of the fee. 

13. What are deductibles and how do they impact costs to the healthcare system?
They are the amount that a person must pay out of pocket each year before their insurance begins to cover services.  They shift some cost to the patient, reducing the overuse of services.
14. What are health maintenance organizations (HMO)?

They are a capitation system that only covers the cost of health services to providers and facilities within a network and requires specialty referrals from a primary care provider. 

15. What is an HMO vs an EPO vs HMO vs private insurance?
An HMO and an EPO are similar, but HMOs require specialty referrals from a primary care provider.  PPOs use fee-for-service to pay for services, but payment is less for providers and facilities out of the network, while HMOs only cover the cost of services within the network.
16. What are some of the demographic changes expected to take place in the US? How will these changes impact the healthcare system?
The size of the older population will continue to significantly rise.  This leads to the existence of more chronic diseases, increasing the size of the healthcare system.

17. What are instrumental activities of daily living (IADL) and activities of daily living (ADL)?  What is the difference between the 2 groups? How do they affect the aging of the population?

IADLs: activities that require more complex thinking and organizational skills

ADLs: basic skills required to independently take care of oneself

IADLs are more complex than ADLs.  The aging population is prone to losing their IADLs or ADLS due to chronic disease and a loss of ability, making them require long-term care services. 

18. How are long-term care facilities funded? How was it previously funded?
They are funded by government services like Medicaid.  Previously, they were managed by states.

Dynamics in Healthcare Exam Review

20. What is health literacy? How does it impact overall health and the healthcare system?
 

Health literacy is the degree to which individuals have the capacity to obtain, process, and understand basic health information and services needed to make appropriate health decisions.  People with low health literacy experience more frequent medical errors, illness and disability, and loss of wages.

21. What are healthcare disparities? Give examples.

Healthcare disparities are differences in health outcomes because of differences in race, ethnicity, immigration status, income, education, or employment.  An example is that African American babies have a way higher infant mortality rate compared to white infants.

22. What is health information technology (HIT)?

It’s an array of technologies to record, store, retrieve, protect, share, and analyze health information. 

23. What are Clinical Decision Support Systems (CDSS)? What type of job is this?

It’s the variety of technologies that provide healthcare professionals with tools to improve the quality of care through diagnostic and treatment recommendations.  It’s a Health IT job. 

24. What are  electronic health record (EHR)?What are the advantages and disadvantages of EHR?

It’s an individual patient health record stored in a computer database for easy access by physicians and other healthcare workers regardless of the setting.  An advantage is that the information can be shared with different healthcare providers across different healthcare organizations (interoperability).  However, medical offices, treatment centers, and hospitals must maintain a master patient index and electronic systems that are developed for different purposes need to interact with one another.

25. What is the definition of telemedicine?

It’s the use of electronic communications and information technologies to provide or support clinical care at a distance. 

26. What is the definition of telehealth?

It’s healthcare appointments delivered by the clinician through telecommunication technologies.  Also, communicating appointment reminders, visit summaries, and laboratory and diagnostic results through an electronic record.

27. What is HIPAA? What should be considered confidential? Describe ethics in relation to confidentiality.  Could you pick out a HIPAA case? (ie-discussing a case publicly in an elevator)

HIPAA regulations give patients access to their protected health information and protect the privacy of their information by limiting access to it by other parties.  Any information that can identify a patient, like their name, address, or diagnoses is considered confidential.  Ethically, healthcare providers have a duty to protect patient privacy. 

28. What are the various workplace settings of healthcare workers? 

The five major industries are hospitals, offices of health practitioners, nursing and residential facilities, home health services, and outpatient, laboratory, and other ambulatory services.

29. Where can someone obtain an education in healthcare?

Someone can obtain an education in healthcare from community colleges, universities, vocational schools, online programs, and hospitals that offer accredited training.

30. What are the components of common core knowledge?

Medical terminology: language used in medicine that allows healthcare professionals to communicate with each other

Anatomy and physiology: courses that provide a comprehensive understanding of how the human body works and allows professionals to describe diseases and disorders of each body system

Technical skills: procedures for measuring and recording vital signs, first aid, CPR, AED, FBAO

Safety and Infection control: applying procedures and protocols to reduce the potential for bodily injury; prevent the spread of disease from patient to patient or patient to provider

Medical Math: applying mathematical computations to healthcare procedures

Healthy behavior: actions taken to attain, maintain, or regain good health and prevent illness

Communication: sharing of information between two people

Dynamics in Healthcare Exam Review

31. What are some of the characteristics of a healthcare professional?

A healthcare professional must have professionalism, the conduct, character, skill, and judgment of a trained person.  They must be ethical and follow their code of ethics (like the Hippocratic Oath).  They must also maintain confidentiality of patient information. 

32. What is the definition of the following: licensing, accreditation, certification, malpractice, negligence? (This was a 3 question drop down question.)

Licensing: a right conferred by a governmental body to practice an occupation or provide a service

Accreditation: the process by which an external entity review an organization or program of study to determine of the organization or program meets certain predetermined standards

Certification: the action or process of providing an individual with an official document attesting to his or her status or level of achievement 

Malpractice: professional misconduct

Negligence: most common type of malpractice that refers to someone failing to do something that a reasonably prudent person would do in the same or a similar situation or, alternatively, doing something that a reasonably prudent person would not do in the same or a similar situation

What is the definition of licensing of a healthcare professional? 

Licensing is a right conferred by a governmental body to practice an occupation or provide a service. 

What is the definition of certification of a healthcare professional?

Certification is the action or process of providing an individual with an official document attesting to his or her status or level of achievement. 

What are the components of a malpractice case? What does each side have to prove in a malpractice case? 

The components of a malpractice case are duty of care, breach of duty of care, causation (harm), and damages.  A patient has to prove all four of these in a malpractice case. 

33. Why do healthcare professionals need continuing education (CE) courses?  Who determines the requirements for CE courses?

They need continuing education courses because the healthcare field evolves rapidly and frequently, so they need to learn the most recent information.  State licensing boards and professional associations determine the requirements for CE courses.

34. What is the Area Agencies on Aging? (Its a 1973 Act.)  How did the Area Agencies on Aging come to exist? What was established because of this?

The Area Agencies on Aging is a part of the Aging Network, which is a system of federal, state, and local entities committed to supporting older Americans in living independently in their homes and communities.  They were established as a part of the 1973 Older Americans Act and Title VI.   They offer nutrition, health and wellness, elder rights, caregiver support, and supportive services including transportation. Senior centers were established because of this and were where 60% of services are delivered.

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

Two teams are formed, either functional or patient-centered. A functional team is formed to take care of a specific problem, like a mental health team or a coronary care team.  Patient-centered teams include patients and their families who are involved in making healthcare decisions together with their doctor and other healthcare professionals.  These teams are mostly made up of healthcare providers, backup medical care like pathologists and technologists, and those who concentrate on the delivery, costs, quality, and availability of services like public health agents and hospital administrators.

36. What is a communication impairment? Which professional would manage or treat communication impairment issues?

It’s a condition that affects a person’s ability to understand, express, or process language, speech, or voice.  A speech-language pathologist would manage or treat communication impairment issues.

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

The CAHIIM accredits approved programs in health information management.

38. What is FQHC?

A Federally Qualified Health Center (FQHC) provides preventive, medical, dental, and mental health services to low-income, minority, and homeless individuals in both urban and rural underserved areas. 

39. Define functional team.

A functional team is formed to take care of a specific problem.  Examples would be a mental health team or a coronary care team.