The Acute Medical Care System Chapter 10

Question 1

There are 2 sets of criteria for Medicaid eligibility including categorical eligibility and medically needy eligibility. One area of categorical eligibility includes income. Income for eligibility for Medicaid is compared this, to determine eligibility:

Answer 1

The Federal Poverty Level (FPL)

Question 2

All states are required to cover those who fit the criteria in one or more category. The following populations are eligible for coverage under Medicaid EXCEPT:

Answer 2

Those with Social Security Income at the Federal Poverty Level

Question 3

____________ is a government insurance plan for active military personal and their families. This insurance plan consists of 3 options. The follow described which option: A health maintenance program organization model of care that utilizes primary care case management. It uses military hospitals and clinics as the primary provider of care.

Answer 3

TRICARE Standard

Question 4

The Indian Health Service (I.H.S.) is an agency of the federal government that provides healthcare to millions of American Indians and Alaska Natives. The I.H.S. has two mechanisms for delivery, delivery by the IHS and health care developed and administered by the tribes (aka ____________________).

Answer 4

Tribal Self-Determination

Question 5

What significant piece of legislation expanded Medicaid eligibility in 2010?

Answer 5

The Patient Protection and Affordable Care Act (PPACA) aka the ACA

Question 6

This service operates the largest health care system in the US. OTs and PTs are important members of the team. A minimum of 2 years of service and an honorable discharge from the military is required to utilize this system.

Answer 6

Veteran Affairs

Question 7

Historical Development of Hospitals

Answer 7

First hospitals were charitable organizations who sought to provide care to those they served rather than cure/rehabilitation

• Care for/shelter = poor, elderly, orphaned, homeless, contagious, or dangerously insane.
• Often dirty and overcrowded

Question 8

Hospital Structure Board of directors =

Answer 8

retains fiduciary responsibility to manage and govern the hospitals

Question 9

Medical division

Answer 9

Often headed by a physician known as chief of medical staff

Divided into division by specialty

Question 10

Patient focused care has resulted in reorganization of hospital system

Answer 10

Organizes provider around perceived patient need rather than discipline
Avoid problems of poor communication and redundancy of services
Therapist may be organized into a product-line team, around common pattern types
May use a matrix system = therapist responsible to team leader for activities/performance and manger for non-clinical.

Question 11

Hospital Characteristics: Size

Answer 11

Large hospitals represent large tertiary care centers for general populations and indigent populations/persons in need.

Question 12

Owned and operated by for profit corporations

Answer 12

investor-owned or for-profit hospitals

Question 13

Owned and managed by federals, state, or local government

Answer 13

public hospitals

Question 14

Public hospitals was the primary source of care for the poor and indigent before Medicaid

Answer 14

City/county hospitals, military hospitals, VA hospitals, and US public health services hospitals.
An important safety net for the poor and those not covered by private organizations

Question 15

Hybrid ownership structures

Answer 15

Some hospitals have multiple owners.

Question 16

Hospitals Characteristics

General Vs Specialty

Answer 16

General hospital/ general medicine

Specialty hospitals Specific disease or defined population

Question 17

Acute Care vs Long-Term Care

Acute care

Answer 17

Serve inpatient with an average length of stay of no more than 30 days
Acute short-care hospitals

Question 18

Hospital Characteristic: Ownership, Nonprofit organizations

Answer 18

Nonprofit hospitals

Managed by community boards or religious organizations

Question 19

Long-term care hospitals

Answer 19

Include facilities such as nursing homes, psychiatric hospitals and rehabilitation hospitals, home health agencies
Care over a long period of time continues or intermittent throughout an individual’s life.

Question 20

Teaching Hospitals

Answer 20

Sophisticated technology and cutting edge research
Deliver a large percentage of health care services and a disproportionate share of charity and indigent care
Only 6% are members of the Council of Teaching Hospitals and health system (COTH)
COTH standards
- Member hospitals must sponsor 4 approved medical residency programs
- 2 of 4 programs must be either medicine, surgery, pediatric, family practice, OBGYN, or psychiatry
Educate the notation’s physicians and conduct medical research while providing quality care to patients.

Question 21

Safety- net Hospitals

Answer 21

Typically both academic medical centers and public hospitals

Question 22

Other Types of Hospitals

Multihospital Systems and Networks

Answer 22

AHA American hospital association defines alliance as a formal organizations that work for the benefit of their members to provide services and products as well as a promotion of activities and ventures.

Question 23

Level of Acute Care; Primary Care

Answer 23

First level of care in the United States healthcare system
Main entry point
Illnesses in general, episodic, common, and non-chronic in nature

Question 24

Integrated Delivery Models, Horizontal Integration

Answer 24

When two or more firms producing similar services trying to become a singer organization

Question 25

Integrated Delivery Models, Vertical integration

Answer 25

Hospitals and physicians trying to provide a continuum of care within a single organization Physician – hospitals relationship are sometimes called physician hospital organizations

Question 26

Physician Hospital Relationship

Answer 26

Definition equals as a structural mechanism that facilitates the integration of the physicians into the management and governance of the hospital and activities of the clinical Dash medical staff

Question 27

PPACA of 2010 encourages the

Answer 27

development of risk taking physician hospital organization called accountable care organization’s in an integrated outpatient team the patient centered medical home

Question 28

ACO are integrated

Answer 28

health delivery systems that manage populations of patients across all level of care

Question 29

PCMH are coordinated ambulatory

Answer 29

care system comprised of patient teams led by a physician that work together to manage populations.

Question 30

Article: OT Practice in Acute Physical Hospital Settings Themes;

Answer 30

1. Comparing the practice of novice and experienced OTs in acute care Novice note the importance of quality supervision as essential but often feel they do not get it. 2. OTs and the discharge planning process 3. Role of occupation in acute care setting 4. Personal skills needed and organization factors affecting acute care practice Relationship with multidisciplinary colleagues are both valuable and a source of frustration,