Health Systems Flashcards
(83 cards)
What requirements does a PT need for a temporary license?
- Applied for NPTE or are awaiting the results of the NPTE
- Licensed in another state
- meets conditions under the board’s discretion
- expiration of a temporary license
A licensed physical therapist shall maintain professional liability insurance in the minimum amount of $_______ per occurrence or claims as made as a condition of practicing as a physical therapist.
$1,000,000
What are examples of preventative care?
- wellness programs
- immunizations
- health screenings
- education
Who makes up a primary care team?
- PCP
- pulmonologist
- psychiatrists
- practical nurses
- PT
- social workers
Definition/examples: Specialized medical management, lab tests, rehab services, daycare, sports medicine, hospice, etc
specialty care
Type of setting: Public health departments, Wellness and health education settings, imaging and surgical care clinic
ambulatory care
Type of setting: Acute care, post or subacute care, skilled nursing homes
inpatient
What is the fastest growing segment of the health care delivery system?
home care
What year was the first hospital prepayment plan founded?
1929
Standards of performance in healthcare were developed by who?
American Hospital Association
- BCBS was one of the first
Who paid their premiums up until WWII with BCBS?
the patient – health care premium payments were offered by employers as an alternative to wages after WWII
What healthcare titles of the social security act improved the accessibility of healthcare to the elderly and poor?
Title XVIII (18) and Title XIX (19)
What is the most significant piece of health care legislation ever passed by Congress health care for the elderly?
Medicare (1965)
definition: Established in 1965 by title XIX of the Social Security Act, the state administered to the poor, elderly, and disabled to what healthcare plan?
Medicaid
Medicaid expenses are shared between who?
State and Federal government
(true/false) Medicaid benefits vary among states
true
Medicaid was amended in ____ to include people with certain disabilities and chronic renal disease.
1972
The reasonable cost payment method of Medicare, Medicaid, and others were financially rewarding for health care providers making the cost of health care (increase, decrease).
increase (The increase is passed along to the employers or to the taxpayers in the case of Medicare)
definition: Comprehensive health care service coverage of hospital and physician services for a FIXED fee that must be provided by a plan provider.
Health Maintenance Organization (HMO)
Who acts as the primary gatekeeper of HMO?
PCPs
definition: Network of health care providers who have contracted with a managed health insurance plan to provide services to plan members.
- Members have discounted rates and comply with pre-authorization and utilization review requirements
- there is a gatekeeper for specialist access
Preferred Provider Organization (PPO)
definition: Network of providers who have contracted with a managed health insurance plan to provide services to plan members BUT an Additional fee is paid for use of providers outside the network or for specialists
- Typical to see copay for primary care physician office in network and increased difference for out of network primary care physician office visits and specialists
Point of Service organization
definition: Uses the patient’s primary diagnosis to categorize them into diagnosis related group
Case payment rate is preset
Prospective Payment System (PPS)
definition: Practices and processes employed to influence use of healthcare services by a patient
- Care management: Clinical management of healthcare resources
Utilization Management
