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CPH 664 > Introduction & Hospitals 101 > Flashcards

Introduction & Hospitals 101 Flashcards

1
Q

What are the key players in the healthcare industry?

A
  1. Providers
  2. Patients
  3. Pharmaceutical/Biotech Companies
  4. Employers
  5. Payors
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2
Q

What role does a patient serve?

A

see doctors (providers) and pay for medical services

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3
Q

What is considered a provider?

A

Does not only include doctors, also includes APPs, nurses, and
facilities

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4
Q

List ways in which providers drive demand in a hospital.

A
  1. Referrals, recommendations, prescriptions (specialist, tests,
    treatments)
  2. Patient education and counseling (specific services)
  3. Practice patterns and new technologies (innovations)
  4. Physician- induced demand (financial incentives)
  5. Preventive care, chronic disease management
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5
Q

Physician are the drivers for the service but…

A

they do not pay for the service

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6
Q

List other demand drivers.

A
  1. Population demographics
  2. Chronic diseases
  3. Public health trends
  4. Healthcare awareness
  5. Insurance coverage
  6. Economic factors
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7
Q

List supply drivers

A
  1. Healthcare workforce
  2. Medical facilities and equipment
  3. Pharmaceuticals and medical supplies
  4. Regulatory Environment
  5. Technological Advancements
  6. Healthcare Funding
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8
Q

Payors role in healthcare

A

pay for services that the consumer (aka patient) receive

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9
Q

What are the 2 types of payors in healthcare?

A
  1. private insurance
  2. government funded insurance
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10
Q

How or by who does the pharma/biotech company get paid?

A
  1. by the provider
  2. by the payor
  3. by the patient (in the case of self insured)
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11
Q

What is the reason employers began offering health benefits?

A

to fill job openings when federally imposed wage controls prohibited employers from raising wages to attract workers during WWII

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12
Q

By 1958

A

57% of Americans had insurance

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13
Q

Tension between providers and pharma/biotech companies

A

get providers to recommend or prescribe medications/products
through sales efforts

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14
Q

Tension between pharma/biotech companies and payors

A

they negotiate with payors to add new drugs/products to approved
list of treatments (note: if drug/product is not covered by insurance, it’s unlikely to be prescribed)

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15
Q

Tension between payors and providers

A

negotiate lower fees with providers

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16
Q

Tension between payors and employers

A

search for the lowest premiums

17
Q

Tension between payors and patients

A

payors avoid insuring high risk patients

18
Q

Tension between employers and patients

A

employers minimize healthcare benefits

19
Q

Providers make… and have…

A

…more money when they provide more healthcare services
…legal obligation to provide the best care possible

20
Q

Relationship between patients and providers

A

insured patients will follow the providers recommendation since it
is the insurance company that pays

21
Q

Identify the two big problems in healthcare.

A
  1. high costs
  2. too many uninsured patients
22
Q

Identify goals of affordable care act

A
  1. make affordable health insurance to more people through tax
    credits for household between 100% and 400% of the federal
    poverty level
  2. Expand the Medicaid program to cover all adults with income
    below 138% of the federal poverty level
  3. Support innovative medical delivery methods designed to lower
    cost of healthcare generally
23
Q

Those who do not qualify for Medicaid…

A

can purchase subsidized health insurance through the Health
Insurance Marketplace (exchange)

24
Q

Identify types of providers

A
  1. Facility Providers
  2. Professional Providers
25
What are facility providers?
hospitals, skilled nursing facilities, assisted living facilities, home health agencies, ambulatory surgery centers
26
What are professional providers
physicians, pharmacists, nurses, advanced practice providers (APPs), and allied health professionals (physical therapists, social workers, etc)
27
What are the types of physician rendering services
1. Primary Care 2. Specialists
28
Primary care physicians are trained as...
family practice, general practice, general internal medicine, and pediatrics
29
Primary care physicians treat...
common conditions or injuries, and often provider preventive healthcare screenings
30
Primary care physicians role
coordinator of a patient's care, assessing a patient's condition (an treating if simple) or referring a patient to a specialist physician
31
Specialist focus their work based on...
in-depth training in different diseases, body systems or types of healthcare service
32
Examples of specialist physicians
anesthesiology, radiology, pathology, cardiology, obstetrics/gynecology, ophthalmology, orthopedics, psychiatry, general surgery, oncology, neurology, or hospital medicine
33
What is a hospital based physician?
the specialties of radiology, anesthesiology, pathology, surgery, obstetrics and gynecology, etc. - along with emergency room physicians and hospitalists are commonly referred to as
34
True or False: "hospitalist" and "hospital-based" are the same thing
False; while hospitalists are hospital-based physicians, "Hospitalist" and "Hospital-based" are not synonyms
35
What is hospital medicine?
a medical specialty dedicated to the delivery of comprehensive medical care to hospitalized patients
36
Each provider rendering care to a patient...
bills for services related to the patient (example: PCP, PT, Radiologist, Surgeon, Pathologist, Hospital, etc)
37
List the types of hospital personnel a patient might interact with.
1. Scheduling 2. Registration 3. Financial Counselors 4. Physician, Resident Fellow 5. Advances Practice Practitioner (APP) 6. Nurses and Nurse Aids 7. Lab techs or Phlebotomists 8. Radiology techs 9. Patient Transport 10. Cafeteria Staff and Dieticians 11. Housekeeping 12. Respiratory Therapists 13. Physical and Speech Therapists
38
Map of Patient Journey

CPH 664 (1 decks)

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