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PA HX > Exam 4 > Flashcards

Exam 4 Flashcards

1
Q

HIPAA

A

Health Insurance Portability and Accountability Act of 1996
-protection of sensitive patient health information

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2
Q

Medical record

A

collection of data recorded when a pt seeks medical treatment
1. required by licensing authorities to track/document
2. provide documentation of continuing health (birth-> death)
3. foundation for managing pt’s health
4. serve as legal documents
5. clinical data for education, research, data

meaningful use - safety, coordination of care, privacy, reduce disparity

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3
Q

Benefits to EMR

A

-better utilization
-organization
-better tracking
-shared records amongst providers (EHR)
-access to other providers’ notes

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4
Q

Mandated EMR

A

January 1, 2014 - part of American Recovery and Reinvestment Act
-maintains Medicaid and Medicare reimbursement

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5
Q

EMR

A

digital version of paper charts

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6
Q

EHR

A

built to share information with other healthcare providers

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7
Q

Consent for records, photos, videos

A

sign release for their own medical records due to doctrine of professional discretions
-cannot be released to third party without written permission by patient or guardian

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8
Q

Medical info about a pt often released due to:

A
  1. insurance claims
  2. transfer to another physician
  3. use in court of law
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9
Q

Federal Statute of Confidentiality of Alcohol and Drug Abuse Patient Records

A

protects patients with hx of substance abuse regarding release of into about treatment without written consent from pt

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10
Q

Health information technology (HIT)

A

electronic systems that healthcare professionals + pts use to store, share and analyze health information
-meaningful use:
1. adoption of EHR by providers
2. focuses on interoperability, health info exchange and pt portals
3. improve pt access to EHR

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11
Q

Social media in healthcare

A

widely used; need consent from pt to post anything

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12
Q

Telemedicine

A

remote delivery of healthcare services and clinical information using telecommunications and technology
-advanced form of care

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13
Q

Credentialing

A

systematic process of collecting and verifying qualifications for professionals
-purpose: to ensure that the individuals and companies are qualified to perform services offered
-PA student are also credentialed by PA programs
-PA-C credentialed by taking PANCE/applying for licensure
-required by work site
-maintained by Joint Commission on Accreditation of Hospitals + National Commission on Quality Assurance
-further step = privileging (administered by medical staff) that documents training/experience w/ specific procedures before granted privilege of performing activities (need proof)

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14
Q

PA Program Accreditation

A

official approval that program maintains standards that qualify that graduates can sit for PANCE exam
-voluntary process ensuring program requirements are met

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15
Q

ARC-PA

Accreditation Review Committee on Education for PA

A

body that completes that accreditation process
-works w/ other organizations to stay within guidelines
-standards recently revised in 2020
-began in 1970s w/ AMA -> own governing body in 1990s
-left AMA in 2000
-only accreditation body for PA/PA post grad programs

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16
Q

ARC-PA Mission

A

protects interests of students, public and PA profession by defining standards for PA education, evaluate programs and ensure compliance w/ standards

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17
Q

ARC-PA and Profession

A

-standards allow PAs to be academically and clinicaly prepared to practice medicine as members of patient-centered medical care teams
-collaborative team relationships is fundamental to PA profession and enhances delivery of care
-diagnostic, therpeutic, preventitive, and health maintenance services

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18
Q

ARC-PA Standards

A

establish minmum requirements for PA education in terms of resources, operations, curriculum, evaulation and assessment
-5th edition of standards released in 2020 + update to manual in Oct 2022

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19
Q

Clinical Role of PA’s

A

primary and specialty care in medical and surgical practice settings
-centered on pt care
-educational, research and administrative activities

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20
Q

Role of ARC-PA

A

-establish educational standards using broad based input
-define/administer process for competitive review of applicants
-define/administer process for accreditation decision making
-determine whether PA education programs are in compliance with standards
-work cooperatively w/ collab organziations
-define/admiinster appeal of accreditation decisions

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21
Q

Professional curriculum of PA education

A

medical, behavioral and social sciences
-ensures functionality in all fields upon completion of program

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22
Q

PA Program Standards

A

-administrative: instiutional responsibilities, resources and support
-curriculum: student based outcomes
-evaluation: self assessment for weakness/strengths

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23
Q

ARC-PA Commissioners

A

take part in decision making responsibilities of ARC-PA
-serve for 3 years and renewable upon ARC-PA recommendation
-nominated by members of AAPA and PAEA

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24
Q

Accreditation-Provisional

(step 1)

A

occurs when a program has provided all necessary steps to having their first cohort (6-12 months before enrollment of students)

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25
Q

Provisional Monitoring Visit

(step 2)

A

occurs as the first cohort is preparing to graduate

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26
Q

Final Provisional Visit

(step 3)

A

occurs 18-24 months after initial accreditation provisional is granted
-will receive accreditation-continued if all standards are met

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27
Q

Accreditation-Probation

A

given to an established program that has failed to keep up the standards
-temp 2 year status

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28
Q

Accreditation-Continued

A

validation visits every 10 years +/-

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29
Q

Accreditation-Withheld

A

seeking accreditation-provisional but does not comply w/ standards

30
Q

Accreditation-Withdrawn

A

loss of accreditation
-may pose risk to graduates of the program by not being able to gain licensure depending on the state

31
Q

NCCPA

National Committee of Certification for PA’s

A

PA profession certification body that provides reliable indicator that those certified have demonstrated/possess/maintain knowledge and skill to practice safely/effectively
-over 20 years
-PA cert, re-cert and CME records (previously done by AAPA)

32
Q

NCCPA Cert Process

National Certifying Committee for PA

A

certifies all states and DC
-must attend accredited school
-must pass PANCE
-100 CME hours every 2 years
-PANRE every 10 years
-certified w/in 6 years of graduation
-up to 6 attempts on PANCE
-maintenance of certification is digital

33
Q

8 States w/ own PA regulatory body

A

Arizona, California, Texas, Iowa, Massachusetts, Rhode Island, Utah

34
Q

Temporary licensure

A

allows new grads to work prior to sitting for their PANCE exam
-much more restrictive than full license

35
Q

Patient centered EMR use

A

-let pt know your are going to log on
-computer can enhance provider-pt relationship
-maintain eye contact throughout computer use

36
Q

10 tips to enhance pt-cnetered EMR use

“HUMAN LEVEL”

A
  1. Honor golden minute: remain technoology free the first minute
  2. Use triangle of trust: allow u and pt to see screen
  3. Maximize pt interaction: encourage pt to interact w/ graphs + trending tools
  4. Acquaint yourself w/ chart: before entering pt room
  5. Nix the screen: disengage from compiuter when discussing sensitive pt issues
  6. Let the pt look on: see screen and follow actions
  7. Eye contact: maintain as much eye contact as possible
  8. Value the computer: discuss its benefits
  9. Explain what you’re doing: avoid long periods of silence
  10. Log off: to ensure medical info is secure
37
Q

Typical PA Program Length

A

27 months
-24 months before integration of master’s

38
Q

Typical PA student applicant

A

-2,000 PCE hours
-GPA = 3.56
-25 years old

39
Q

PAEA

Physician Assistant Education Association

A

-advocacy for PA education
-founded in 1972
-oversight for CASPA

40
Q

PANCE

A

360 multiple choice questions that assess medical and surgical knowledge
-6 attemps to pass within 6 years (3x in one year)
-need 350 score out of 800 to pass
-wait 90 days to retake if failed exam

41
Q

PANRE

A

recert after 10 years
-computer based exam
-240 multiple choice questions from NCCPA blueprint
-passing score of 379 out of 800

42
Q

PANRE-LA

A

administered over 12 quarters in years 7-9
-added in 2022 to start Jan 2023
-final score based on best 8 quarters
-25 questions each quarter w/ 5 minutes to answer each question
-can use printed/online references
-3 attempts to pass PANRE in year 10 if failed PANRE-LA
-still need CME requirements

43
Q

CME

A

100 hours every 2 years w/ NCCPA
-50 category 1 credits (medical conferences, training, journal reading w/ questions, grand rounds meeting)
-remaining 50 credits can be category 1 or 2
-NCCPA fee of $180 to log CME

44
Q

Issues related to PA practice

A

subcommittee of medical board formed ot deal w PA practice or state medical board that includes seats for PA representation

45
Q

PA licensing boards

A

states are trying to create PA licensing boards as a result of new PA practice acts that replace intial delegation amendments to medical practice acts
-composed of practicing PAs and physicians who employ/work with PAs
-typically advisory to governmental agency (ultimate authority)

46
Q

Delivering bad news

A

-communication
-knowledgeable about diagnosis, prognosis and treatment
-supportive space
-speak without medical jargon
-allow pt to process info (silence)
-evaluate your reaction to pt’s diagnosis

47
Q

Palliative care

A

hospice
-formal symptom assessment and treatment regarding disease processes shortening a pt’s life
-aid w/ decision making and goals of care
-practical/moral support for pt/caregivers
-collaborative models of care (team) for terminal illnesses

pts in U.S. spend < 1 week on hospice

48
Q

Healthcare Proxy

A

legally designated person to make decisions for a pt when they are unable to state their own wishes regarding medical treatment
-executes wishes via living will for resuscitation, antibiotics, feedings and other life sustaining treatment

49
Q

Living will

A

legal document stating pt’s wishes regarding treatment if unable to speak
-resuscitation instructions
-intubattion/mechanical vent instructions
-treatment guidelines
-future hospitalization and transfer
-artificially administered fluids and nutrition
-antibiotics
-etc

50
Q

MOLST

Medical Orders for Life Sustaining Treatment

A

form used for pts who want to avoid or receive any or all life sustaining treatment; only authorized form in NYS documenting both nonhospital DNR/DNI orders
-pt who reside in long term care facility and/or may die within. a year
-used in a variety of healthcare settings
-legal checklists required concerning life-sustaining tretament
-no checklist used = alternative method assuring strict adherance to legal requirements
-witnesses to consent
-renewed/discontinued after 90 days

bright pink paper

51
Q

Deciding on MOLST

A

conservations w pt, family and qualified health professional
-provider defines goals for care, reviews treatment options and ensures shared/informed medical decision making
-provider MUST consult w/ all of the above personnel about diagnosis, prognosis, goals, treatment preferences, gain consent and sign orders derived from discussion

52
Q

MOLST Sections

A

-Page 1 (section A+B): resuscitation; pt/proxy/witnesses sign
-Section C: signatures of physician
-Section D: advanced directives
-Section E: treatment guidelines, ventilation, future hospitalization/transfer, fluids, nutrition, antibiotics
-“Other” section: dialysis, transfusion

53
Q

Pain Management

A

obtain good hx and physical exam
-pain: nociceptive, neuropathic, mixed-pain, psychosocially based pain

54
Q

Pain mgmt in elderly

A

-underreporting of pain
-multiple co-morbidities
-side effects of meds to treat pain
-changes in metabolism of meds due to age

55
Q

Treating mild pain

A

NSAIDS, cognitive behacorial training, complementary modalities

56
Q

Treating moderate pain

A

low dose/low potency opioids, +/- NSAID, complementary modalities

57
Q

Treating Severe Pain

A

potent opioids, PCA, neural blockage, spinal anesthesia, complementary modalities

58
Q

PA Education facts

A
  1. 300 accredited programs as of Nov 2022
  2. terminal degree = masters
  3. average program length = 27 months
  4. “minds on hands on” - short training
  5. didactice + clinical phases
  6. clincial experience during didactic
  7. service in 1/3 programs to expose population health issues and cultural diversity
59
Q

PA student debt upon graduation

PAEA Survey

A

-21.9% 100k-125k
-20.8% 75k-100k
-14.5% 50k-75k

60
Q

OTP

Optimal Team Practice

A

May 2017 by AAPA
-direct reimbursement for all PA services
-PA representation on state medical boards or separate PA regulatory boards
-elimination of the requirement for written practice agreement to supervisory physician
-PA scope of practice determined at the practice level (even though AAPA does not advocate for independent practice)

61
Q

Collab Organizations of ARC-PA

A

-AAPA
-PAEA
-NCCPA

62
Q

Informed Consent Law

A

Code of Medical Ethics Opinion 2.1.1
-pts have right to receive information and ask questions about treatments to make well educated decisions
-communication between pt and provider

63
Q

To obtain informed consent, provider must

A

-assess patient’s ability to understand
-pt’s independent and voluntary decision
-discuss diagnosis, purpose, risks/benefits, options, outcomes of refusal
-documentation

64
Q

Medical billing and coding

A

process of converting pt charts and clinical data to medical claims (submitted for reimbursement)
-data entered through EMR
-applying procedure codes
-ICD-10

65
Q

Coding requirements for outpatient documentation and coding

A

January 1, 2021- outpatient E/M CPT 99202-99215 office visits have new guidelines to follow for assigning CPT code

66
Q

2022 changes to coding requirements

A

-elimination of hx/PE as elements for code selection
-providers choose to base documentation on medical decision making (MDM) or total time spent on encounter [office setting]
-MDM or time (not both)

67
Q

MDM vs. time E/M 2022 changes

A
  1. time: prep for visit, documentation, face to face time
  2. MDM: 4 levels (straightforward, low, moderate, high), number and complexity of problems/data (tests, orders, review), risk of complications
68
Q

MDM vs. time E/M 2022 changes

A
  1. time: prep for visit, documentation, face to face time
  2. MDM: 4 levels (straightforward, low, moderate, high), number and complexity of problems/data (tests, orders, review), risk of complications
69
Q

ICD-10

A

-3-7 characters in length
-68,000 codes
-first digit = letter
-digits 2+3 = number
-digits 4-7 = aplha or numeric
-flexible for adding new codes
-very specific
-up to 12 codes on claim form

70
Q

Golden rules of coding

A

-bill for what you actually do
-do not up code
-do not commit fraud (medicare/medicaid investigation)
-review / understand before clinical year

71
Q

CMS (center for medicare/medicaid services)

A

federal Medicare/Medicaid agency that oversees HIPAA administration
-creates safety guidelines for facilities
-penalizes facilities falling below standards by lowering reimbursement
-monitors 30 day risk for unplanned readmissions
-decubitus ulcers

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