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Health Care Delivery Systems > Midterm > Flashcards

Midterm Flashcards

(68 cards)

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1
Q

What is the Social Security Act ?

A

system of payments in which younger, working people support older, retired people
- enacted by Pres. Roosevelt

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2
Q

What is the Emergency Medical Treatment and Active Labor Act (EMTALA) ?

A

federal statute intended to prevent Medicare-participating hospitals with dedicated emergency departments from refusing to treat people based on their insurance status or ability to pay
- for everyone

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3
Q

What is the Consolidated Omnibus Budget Reconciliation Act (COBRA) ?

A

coverage of group health benefits to employees and their families in the case of certain events which would cause coverage to be terminated

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4
Q

What is the Patient Self-Determination Act (PSDA) ?

A

legislation that requires healthcare facilities to provide information about advance health care directives to adult patients during admission to the facility

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5
Q

What is the Patient Protection and Affordable Care Act ?

A

provisions to expand coverage, control health care costs, and improve health care delivery systems

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6
Q

What does HIPAA stand for ?

A

Health Insurance Portability and Accountability Act

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7
Q

What is the goal of the Joint Commission ?

A

improve patient outcomes through improved performance

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8
Q

How is part A of medicare funded ?

A

social security tax and federal taxes

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9
Q

How is part B of medicare funded ?

A

75% by the federal government and 25% by subscribers

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10
Q

What population is medicare for ?

A

elderly, disabled and renal dialysis patients

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11
Q

What is included in Medicare part A ?

A
  • funded primarily through employee payroll deductions and employer contributions
  • coinsurance for hospital and skilled nursing facility stays
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12
Q

What is included in Medicare part B ?

A
  • funded primarily from federal general funds
  • supplementary medical insurance
  • optional: however most eligible patients opt to pay the premiums
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13
Q

What is covered in Medicare part A ?

A
  • inpatient hospital care
  • limited skill nursing facility care
  • hospice care
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14
Q

What is covered in Medicare part B ?

A
  • primary care provider services
  • outpatient tests
  • certain medical supplies and equipment
  • home health care
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15
Q

What is covered in Medicare part C ?

A

medicare advantage managed care plans

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16
Q

What is covered in Medicare part D ?

A

limited prescription coverage

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17
Q

Who is the primary population for Medicaid ?

A

the financially indigent
- women and children are the majority
- administered by the states under broad federal guidelines
- about 17% of the population

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18
Q

What is TRICARE ?

A

health care insurer for the Department of Defense (DOD)/ Veteran’s administration (VA)

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19
Q

What is surveyed on HCAHPS ?

A
  • communication with Nurses & Doctors
  • staff responsiveness
  • pain management
  • communication about medicines
  • discharge information
  • hospital cleanliness and quietness
  • one global item: overall rating of hospital
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20
Q

What does HCAHPS stand for ?

A

hospital consumer assessment of healthcare providers and systems

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21
Q

What is health care economics ?

A

study of supply and demand of resources and its effect on the allocation of health care resources in an economic system

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22
Q

What is pay for performance mean in healthcare economics ?

A

reimbursement to clinicians and hospitals for the provision of appropriate and high-quality care
- designed to enhance the communication and coordination of care among patients, providers and clinicians

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23
Q

What are the main attributes with health care economics ?

A
  • markets
  • price and cost
  • supply and demand
  • efficiency and equity
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24
Q

What is legislation ?

A

process of introducing, adopting, changing or repealing law

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25
What is regulation ?
process of putting laws into action through the establishment of rules
26
What is litigation ?
process of seeking help through the courts to address a perceived wrong
27
What is civil law ?
one individual sues another monetarily to compensate for a perceived loss - malpractice is included here
28
What is malpractice ?
the failure of a person with professional training to act in a reasonable and prudent manner - 1 type of negligence (original is the other)
29
What is Stare Decisis ?
to let the decision stand - aka the use of precedents
30
What is Respondeat Superior ?
the master is responsible for the acts of his servants
31
What is Res Ipsa Loquitur ?
the thing speaks for itself - harm is obviously the result of negligence
32
What is the Nurse Practice Law ?
legal instrument that defines what the functions of nursing shall be and sets standards for licensure - each state has its own
33
What are the 3 types of consents ?
- informed - implied - express
34
What is informed consent ?
obtained only after the patient receives full disclosure of all pertinent information regarding the surgery or procedure and only if the patient understands the potential benefits and risks associated with doing so
35
What are advanced directives (ADs) ?
written instructions regarding desired end-of-life care
36
What is good samaritan immunity ?
RN is not liable for injury that occurs as a result of emergency treat provided that: - care is provided at the scene - care is not grossly negligent
37
Is no conflict a good thing ?
some level of conflict is needed and desirable to get things done
38
What is competing conflict ?
one party pursues what it wants, regardless of the cost to others
39
What is cooperating/accommodating conflict ?
one party sacrifices his or her beliefs and wants to allow the other party to win
40
What is smoothing conflict ?
an individual attempts to reduce the emotional component of the conflict
41
What is the responsibilities of the nursing board ?
- protect the public - issue and renew licenses - continuing educational requirements - investigation and resolution of complains - disciplinary procedures for misconduct - scope of practice
42
What is the main difference between Advance Practice Nurses and RN's ?
- can prescribe medications - diagnose and treat - perform tests or procedures
43
What is beneficence ?
actions one takes should be done in a effort to promote good - doing good
44
What is paternalism ?
one individual assumes the right to make decisions for another
45
What is justice ?
seeking fairness and equality
46
Wha is veracity ?
obligation to tell the truth
47
What is fidelity ?
need to keep promises
48
What is utility ?
good of the many outweighs the wants/needs of the individual
49
What does the MORAL model stand for ?
- M: massage the dilemma - O: outline options - R: review criteria and resolve - A: affirm position and act - L: look back: evaluate the decision making
50
What are the stages of conflict ?
- latent conflict - perceived conflict - felt conflict - manifest conflict (overt conflict) - conflict aftermath
51
What are the different conflict resolution strategies ?
- compromising - competing - cooperating/accommodating - smoothing - avoiding - collaborating
52
What oversees both Medicare and Medicaid ?
CMS (centers for Medicare and Medicaid)
53
Who is the largest purchaser of managed care in the country ?
centers for medicare and medicaid services
54
What is latent conflict ?
underlying conditions in organizations and individual relationships that have the potential for conflict
55
What is perceived conflict ?
one or more parties perceive that their situation is characterized by incompatibility and interdependence
56
What is felt conflict ?
parties begin to personalize perceived conflict by focusing on the conflict issue and planning conflict management strategies
57
What is manifest conflict ?
parties involved are aware of conflict and action is taken
58
What is conflict aftermath ?
completion of the conflict process
59
What is bullying ?
use of threats or physical force to intimidate and control another person
60
What is mobbing ?
underlying conditions in organizations and individual relationships that have the potential for conflict
61
What is incivility ?
rude, intimidating, and undesirable behavior directed at another
62
What can restorative care also mean ?
rehab care - discharged to rehab center/home care
63
What is nonmaleficence ?
do no harm
64
What is moral distress ?
when individual knows the right thing to do but organizational constraints make it difficult to take the right course of action
65
What are the ANA code of ethics for ?
RN promotes, advocates for, and strives to protect the health, safety, and rights of the patients
66
What is intential torts ?
assault, battery, false imprisonment
67
What is libel ?
written defamation
68
What are lobbies ?
group that attempts to influence legislation

Health Care Delivery Systems (2 decks)

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