TEST 2 - UNIT C - PP - HEALTHCARE DELIVERY Flashcards
(54 cards)
Regulatory agencies in health care enforce
standards and practice requirements that play a major role in the quality and costs of care delivered.
The Joint Commission (TJC)
•An independent, nonprofit organization that accredits health care organizations in more than nine different types of health care settings.
The Joint Commission (TJC) MONITORS
•Monitors state legislative and regulatory changes and updates its standards accordingly.
The Joint Commission (TJC) publishes
•Publishes the National Patient Safety Goals annually.
The Joint Commission (TJC) partners w/
•Partners with other organizations to develop safe practices, identify the root cause of errors, and create a system to mitigate future risk.
Sentinel Event
A sentinel event is one that results in a client death or permanent or severe temporary harm.
Sentinel Events are reported to
These events are reported to TJC and are tracked to help health care organizations improve client safety and quality of care.
The National Committee for Quality Assurance (NCQA)
Widely recognized accreditation program that measures quality of care based on patient satisfaction scores and its Healthcare Effectiveness Data and Information Set (HEDIS®) tool.
The HEDIS® tool measures
90 different points across several areas of care.
These scores, or standards of care, are then compiled with a client satisfaction score to rate each organization.
Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) uses a braod
•Uses a broad range of standardized questions to measure and compare client satisfaction between health care facilities.
Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) adminsitered
•Administered randomly to clients between 48 hours and six weeks after discharge.
Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) scores are publicly reported to
•Scores are publicly reported and ensure accountability and transparency of client satisfaction data.
The Press Ganey
•Popular survey tool to measure health care delivery and client satisfaction in acute care agencies.
The Press Ganey has metrics on
•Has metrics on access to care, wait times, client interactions with the health care team, and the visit itself.
The Press Ganey is delivered how
•Emailed to every client at the conclusion of their visit.
Health-care costs are paid for in one of five ways:
Public health insurance (e.g., Medicare and Medicaid)
Private health insurance (e.g., Aetna, Blue Cross, United Healthcare, Prudential)
Insurance for special populations (e.g., CHAMPVA, TRICARE, Indian Health Service [IHS], Workers’ Compensation, and disability insurance)
Charitable organizations (e.g., Shriners and the Kaiser family)
Self-pay (those who are uninsured)
•Public health insurance
(e.g., Medicare and Medicaid)
•Private health insurance
(e.g., Aetna, Blue Cross, United Healthcare, Prudential)
•Insurance for special populations
(e.g., CHAMPVA, TRICARE, Indian Health Service [IHS], Workers’ Compensation, and disability insurance)
•Charitable organizations
(e.g., Shriners and the Kaiser family)
•Self-pay
(those who are uninsured)
•Medicare
Over 65
Or those younger than 65 years who have end-stage renal disease and certain other debilitating illnesses.
Part A,B, D
Diagnosis-related groups (D R G s)
•Medicaid
Based on Income in relation to poverty level
Benefits differ by state
Children’s Health Insurance Program-
for children who may not meet Medicaid requirements but need health coverage
