HIM 111: Final exam: Chapters 1, 2, 4, 8, 6, 9, 10, 11 and 13

noneconomic damages

damages that are not monetary in nature; an issue targeted by tort reforms

DRG

diagnostic related group

treasurer

employee responsible for the management of a company's cash

Hill-Burton Act of 1946

funding for the improvement and expansion of hospital services

Health or medical informatics

is the science of computer application that supports clinical and research data in different areas of health care

Acuson P10

pocket sized ultrasound

Consolidated Omnibus Budget Reconciliation Act (COBRA)

provides health insurance protection if individuals were to change jobs

major medical policies

reimburse hospital services such as surgeries and any expenses related to any hospitalization

reinsurance

sets up a stop loss measure that limits the amount the company will pay for claims

Volunteer Management

the supervision of volunteers involved with an event

generic drug

usually named for its chemical structure and is not protected by a brand name or trademark

HealthVault

website that enables patients to develop electronic patient records free of charge

statutes

written laws enacted by legislatures

epidemic

A widespread outbreak of an infectious disease.

long-term care insurance

Provides payment for extended nursing care due to accidents, illness, or old age

united way

a civic organization that is active in identifying health risks and implementing community public health programs to target these risks

rental agreement

a contract on a monthly or annual basis does not give the resident access to healthcare services

Managed Care Organization (MCO)

a healthcare delivery system organized to manage cost, utilization and quality, managed care refers to the cost management of healthcare services by controlling who the consumer sees and how much the service costs

american health care association

a membership organization that represents nonprofit and for profit nursing and assisted living facilities, subacute care providers and facilities for developmentally disabled individuals

telebehavioral health

a method of service delivery that broadens the availability to, quality of, and access to care across all behavioral health program areas

Embedded Behavioral Health Model

a model that focuses on early intervention and treatment to promote soldier readiness

federal emergency management agency and substance abuse and mental health services administration

a model that helps victims of short term mental health issues as the result of types of disasters

comptroller

a person who is in charge of the financial accounts of a company or organization

Silver Sneakers

a physical activity program for senior citizens that encourages the elderly to participate in organized exercise at national fitness chains

assurance

a process of evaluating policies that meet program goals for provision of services to the public either directly or through regulation of other entities

Council of State and Territorial Epidemiologists (CSTE)

a professional organization of over 1000 public health epidemiologists who work in state and local health departments and provide technological assistance to the Association of state and territorial health officials and the cdc for research and policy issues

healthy people 2000

a report released in 1990, was created to implement a new national prevention strategy with three major goals: increase life expectancy, reduce health disparities and increase access to preventative services

annuity

a series of equal regular deposits

Deductibile

a specified amount of money that the insured must pay before an insurance company will pay a claim

fee-for-service

a system under which doctors and hospitals receive a payment for each service they provide

Fatality Management

a term defining forensic-based decisions influencing how the victims, their families, and the identification efforts are managed. main focus is on the overall ID efforts and influence of taphonomic factors on the process

salaries

a third method of payment

discounted fees

a type of fee for service, but are discounted based on a fee schedule; provider provides the service and then can bill the MCO based on the fee schedule

Coinsurance

a type of insurance in which the insured pays a share of the payment made against a claim.

universal healthcare program

access to all citizens

secondary prevention

activities that focus on early disease detection, which prevents the progression of the disease

lifestyle behaviors

all of the activities in which people engage

battery

an assault or an array of similar things intended for use together

social marketing

an innovative approach to public health educational practice

Accelerated Death Benefits

an insurance policy Rider allow an insurer personal with a terminal illness to use policy benefits prior to dying

duty to treat

any person deserves basic care

law

body of rules for the conduct of individuals and organizations

contractual rights to admission

can be considered a contract if a hospital has contracted to treat certain members of an organization, like a managed care organization.

social security amendments

changes to social security law which affected the way health care dollars were dispersed

public health function examples

child immunization programs, health screenings in schools, community health services, substance abuse programs, and sexually transmitted disease control

CAM

complementary and alternative medicine

Mental disorders are

conditions that alter thinking processes, moods, or behavior and result in dysfunction or stress. The condition can be psychological or biological in nature

deferred long term annuities

consist of a specified monthly income for a specified time period, These annuities are available to individuals up to age 85.

independent living

covers a broad range of settings for individuals who typically do not need regular healthcare services. The target market is 75 years or younger.

Medicare Prescription Drug Improvement and Modernization Act of 2003

created a major overhaul of medicare system

Medicare Deemed Status

- Allows the AAAHC to survey Medicare Advantage HMO and PPO plans

no-fault liability

- Developed to avoid costly legal fees because there is no process to assess blame

Life qualifying event

- Job change or geographic change

comprehensive health insurance policies

- Provide benefits that include outpatient and inpatient services, surgery, laboratory testing, medical equipment purchases, therapies, and other services such as mental health, rehabilitation, and prescription drugs

Point of Service Plan (POS)

- combination of HMO and PPO - based on HMO structure but allows people to go outside of the HMO to obtain services (only with certain conditions and circumstances)

HITECH Act of 2009

-Provided incentive payments to hospitals and healthcare providers to adopt health IT. -"Meaningful Use"- criteria required to be met that demonstrated meaningful use of electronic health records (EHR). EHR technology must be used to achieve certain objectives.

examples of primary prevention

-Smoking cessation programs -Immunization programs -Educational programs for pregnancy and employee safety

macroenvironmental conditions

-Socioeconomic, cultural, and environmental conditions that impact health, such as education, work environment, living and working conditions, healthcare services, food production, unemployment, water and sanitation, and housing

New Freedom Commission on Mental Health

2003 - Release of recommendations for mental health care in America. Called for a streamlined system. Advocated for Early diagnosis and treatment, New expectation for principles of recovery, Increased assistance in helping people find housing & work.

Patient Protection and Affordable Care Act (PPACA)

2010 federal legislation designed for comprehensive health reform, with an intent to expand coverage, control health care costs, and improve the health care delivery system

Patient Protection and Affordable Care Act

2010 legislation aimed at reducing the number of uninsured individuals and decreasing health care costs

Institute of Medicine (IOM)

A branch of the National Academy of Sciences whose goal is to advance and distribute scientific knowledge with the mission of improving human health (IOM 2013)

public health preparedness

A continuous cycle of planning, organizing, training, equipping, exercising, evaluating, and taking corrective action in an effort to ensure effective coordination during incident response.

Implied Contract

A contract formed in whole or in part from the conduct of the parties.

Express Contract

A contract in which the terms of the agreement are fully and explicitly stated in words, oral or written.

Managed behavioral healthcare organization (MBHO)

A corporate entity to which a health plan may outsource the management of mental health services for its subscribers. This entity assumes the financial risks and benefits of managing treatment budgets and authorization for access to mental health services.

Medicaid

A federal and state assistance program that pays for health care services for people who cannot afford them.

Independent Practice Association (IPA)

A group of physicians who are in private practice to see MCO members at a prepaid rate per visit. The physicians may sign contracts with many HMOs.

Children's Health Insurance Program (CHIP)

A joint federal-state program that provides health-care insurance for low-income children.

Civil Law

A law that governs relationships between individuals and defines their legal rights.

medical surge

A management methodology for responding to large-scale medical incidents.

psychiatrist

A medical doctor who has specialized in the diagnosis and treatment of psychological disorders

per diem rate

A method of paying for healthcare in which the hospital is paid a flat fee per day, regardless of the service delivered on any given day

prospective reimbursement

A method of payment in which certain preestablished criteria are used to determine in advance the amount of reimbursement.

Compensatory Damages

A money award equivalent to the actual value of injuries or damages sustained by the aggrieved party.

bundled rate

A payment for a group of related health care services, often over a specific period.

graying of the population

A population that has more middle-aged and older people than young people.

National Committee for Quality Assurance (NCQA)

A private not-for-profit accreditation organization whose mission is to evaluate and report on the quality of managed care organizations in the United States

Cost Plus Reimbursement

A reimbursement given to rural hospitals as per the classification of MRHFP, which makes these hospitals eligible for grants to increase access to consumers.

retrospective utilization review

A review of utilization after services have been delivered.

psychologist

A scientist who studies the mind and behavior of humans and animals

health

A state of complete physical, mental, and social well-being

Incident Command System (ICS)

A system implemented to manage disasters and mass-casualty incidents in which section chiefs, including finance, logistics, operations, and planning, report to the incident commander.

gatekeeper

A team member who keeps abreast of current developments and provides the team with relevant information.

Active shooter incident

A term used by law enforcement to describe a situation in which a mass shooting is in progress when police and law enforcement agents arrive at the scene.

Group Insurance

A type of health insurance in which all those insured have the same coverage and pay a set premium

Green House Project

A unique type of nursing home that focuses on creating a residence that not only provides services but is also a home to the residents, not an institution where they receive care.

intentional tort

A wrongful act knowingly committed.

internal auditor

An employee of the business who ensures the company's employees are following company policies, that the company meets all legal requirements, and that operations are running efficiently.

informed consent

An ethical principle requiring that research participants be told enough to enable them to choose whether they wish to participate.

Information Technology (IT)

Any computer-based tool that people use to work with information and support the information and information-processing needs of an organization

voluntary health insurance

Any type of insurance that you chose to buy into through your employer or purchased privately

affirmative action plans

Attempt to ensure that percentage of minorities within the organization are a similar proportion to the labor market availability

home care

Care provided in a person's home to assist him or her with activities of daily living.

general duty

Concept that everyone owes a duty to exercise due care so as not to subject others to unreasonable risks of harm.

Community preparedness

Cooperation within communities to get ready for tectonic events. This can take a variety of forms.

Monopolies

Corporations that gain complete control of the production of a single good or service.

Olmstead Decision

Court mandated that people with disabilities must be moved out of institutions and into less restrictive settings and that the waiting list for services must be reduced

Punitive Damages

Damages that punish defendant, seeking to deter such conduct in the future

primary prevention

Efforts to prevent an injury or illness from ever occurring.

Federal Trade Commission Act (1914)

Established a federal body to help enforce antitrust laws; run by commissioners assisted by economists and lawyers

patient centered outcomes research institute

Established as part of ACA to set priorities and fund comparative effectiveness research

Prevention and Public Health Fund

Established by the ACA, this fund is intended to eliminate the prior shortcomings of unpredictable federal budget appropriations for public health and prevention programs

Patient Bill of Rights

Established in 1973, a list of rights that are designed to protect both the patient and HCP

Fraud Enforcement and Recovery Act of 2009

Expands the potential liability for false claims by applying FCA to a broader range of transactions, reducing the proof required to establish illegal activities, and expanding the pool of potential whistleblowers that may bring retaliation claims

Pseudo-dementia

False dementia

Lily Ledbetter Fair Pay Act of 2009

Federal law that resets the time to file a charge in unequal pay cases every time a discriminatory paycheck is received.

Sherman Antitrust Act (1890)

First federal action against monopolies, it was signed into law by Harrison and was extensively used by Theodore Roosevelt for trust-busting. However, it was initially misused against labor unions

National Response Framework (NRF)

Framework that guides how the nation conducts all-hazards incident response

entitlement programs

Government benefits that certain qualified individuals are entitled to by law, regardless of need.

Cures Acceleration Network

Grants center to encourage research in the cure and treatment of diseases

Professional Associations

Groups of individuals who share a common profession and are often organized for common political purposes related to that profession.

mass shootings

Illegal killing of three or more people at a single time

Center for Mental Health Services (CMHS)

In partnership with state health departments, leads national efforts to assess mental health delivery services.

health insurance

Insurance that covers medical illness or injury.

Telemedicine

Involves the use of video, audio, and computer systems to provide medical and/or health care services.

carve outs

Medical services not included within the capitation rate as benefits of a managed care contract and may be contracted for separately.

Medical Savings Account (MSA)

Medicare health savings account program

Consumer Operated and Oriented Plans (CO-OPs)

Member-run health organizations in all 50 states and must be consumer focused with profits targeted to lowering premiums and improving benefits.

American Medical Association (AMA)

National organization of medical doctors of all specialties

defensive medicine

Ordering more tests and procedures than are necessary in order to protect oneself from a lawsuit.

Electronic Medical Record (EMR)

Patient medical record from a single medical practice, hospital, or pharmacy

elders

People who are older and often wise, respected leaders in a group

MCO issues

Physicians who contract with several MCOs are concerned with providing quality care to their patients because MCOs focus on cost, As a result of the MCOs' focus on cost, a physician's ability to practice without close monitoring of their healthcare choices can be limited, Surveys indicate that the more managed care networks the physician contracts with, the less satisfied they are with managed care.

Lemuel Shattuck

Prepared a report that set forth the importance of establishing state and local boards of health

women's health and cancer rights act (WHCRA)

Prevents discrimination against women who have cancer

social insurance

Programs in which eligibility is based on prior contributions to government, usually in the form of payroll taxes.

Personal Protective Equipment (PPE)

Protective equipment that blocks exposure to a pathogen or a hazardous material.

boycotts

Protests in which people refuse to buy from or work for a person, nation, or business.

Social Security Act of 1935

Provided old-age pension and a program of unemployment insurance and federal welfare program, Has resulted along with Medicare, a drastic reduction in poverty among elderly in the US

Social Security Act

Provided some financial security for the elderly, disabled, children, and the unemployed

national defense authorization act

Provides additional FMLA leave for military families, expanding FMLA to include employees caring for an injured service member as well as those who have a family member called to active duty.

Medicare Part A (aka Hospital Insurance or HI)

Provides hospital insurance automatically @ age 65 (if FICA qualified) @ no fee but may have deductible & co-pay.

Experience Rating

Rating system that bases insurance rates on claims history

usual, customary, and reasonable (UCR)

Refers to the charges of a physician

Essential Health Benefits (EHB)

Required benefits that must be offered by metal plans as well as some other insurance plans

emergency medical treatment and active labor act (EMTALA)

Requires Medicare participants receive emergency care for a life-threatening condition from a hospital or medical entity that provides dedicated emergency services. Facilities can be fined thousands of dollars for not adhering to the EMTALA

Poison Prevention Packaging Act of 1970

Requires use of child-resistant containers for prescription and nonprescription drugs

Rotary International

Responsible for efforts to eradicate polio through vaccine programs throughout the world

Chief Technology Officer (CTO)

Responsible for ensuring the throughput, speed, accuracy, availability, and reliability of IT

federal emergency management agency

Responsible for managing catastrophic events

Designated Health Services

Services defined by the Federal Physician Self-Referral Statute (Stark Law), which prohibits physicians from ordering certain services for patients from entities with which the physician or an immediate family member has a financial relationship

Quarternary Prevention

Set of health activities to mitigate or avoid consequences of unnecessary/excessive intervention of the health system

Intellectual Disabilities

Significant limitations both in intellectual functioning and adaptive behavior, including the social and practical skills of daily living.

Exclusive Provider Organization (EPO)

Similar to a PPO but reimburses members only when affiliated providers are used

Health Savings Account (HSA)

Tax-sheltered savings account similar to an IRA but created primarily to pay for medical expenses.

Patient Abandonment

Terminating the relationship with the patient without giving reasonable notice or providing a competent replacement, resulting in a lack of necessary medical care

Per capita or per person basis

That amounts to almost $10,300 for every man, woman, and child in the U.S

Environmental Protection Agency (EPA)

The US federal agency with a mission to protect human health and the environment.

Reinsurance Program

The combination of reinsurance agreements that a primary insurer purchases to meet its reinsurance needs.

Population Health Management

The concept that the health of all individuals is improved when the health of the entire population is improved

National Center for Health Statistics (NCHS)

The federal agency responsible for collecting and disseminating information on health services utilization and the health status of the population in the United States

Bureau of Labor Statistics (BLS)

The government agency responsible for tracking income, expenses and labor statistics in the United States.

Health Maintenance Organization (HMO)

The oldest type of managed care. Members must see their primary care provider first in order to see a specialist.

balance billing

The practice of billing patients for any balance left after deductibles, coinsurance, and insurance payments have been made.

Social Media Marketing (SMM)

The practice of using social media sites to sell products and services.

prepayment

The satisfaction of a debt or installment payment before its official due date

Congregate care facilities

The target population in these facilities is 55 years or older, There is no assistance with daily activities, and a state license is not required, They fall somewhere between independent living and assisted-living facilities.

Electrotherapy

The use of electrical devices for therapeutic benefits.

Edwin Chadwick

This was a public health official who wrote reports on the poor living conditions of the cities and believed that poverty was caused by illnesses

mass care

To provide immediate shelter, feeding, basic first aid, distribution of needed items, and related services to persons affected by an emergency incident

American Hospital Association (AHA)

Trade association of hospitals, healthcare facilities, and medical administrators

Genetic Information Nondiscrimination Act (GINA)

U.S act that prohibits discrimination against individuals on the basis of their genetic information in both employment and health insurance.

Security Rule

Under HIPAA, regulations related to the security of electronic protected health information that, along with regulations, related to electronic transactions and code sets, privacy, and enforcement, compose the Administrative Simplification provisions.

telehealth

Use of technology to deliver health-related services and information, including telemedicine

American Psychological Association (APA)

World's largest association of psychologists with around 152,000 members including scientists, educators, clinicians, consultants and students

Tax Equity and Fiscal Responsibility Act of 1982 (TEFRA)

a US federal law created in order to reduce the budget gap by generating revenue through closure of tax loopholes and introduction of tougher enforcement of tax rules, as opposed to changing marginal income tax rates

Managed Long Term Services and Supports (MLTSS)

a cms medicaid program, as a strategy for expanding home and community based services to ensure quality and increase efficiency

Mobilizing for Action through Planning and Partnerships (MAPP)

a community driven strategic planning process for improving community health

continuing care retirement community

a complex of residences that includes independent living, assisted living and nursing home care, so seniors can stay in the same general location as their housing needs change over time, beginning when they are still healthy and active

Electronic Health Record (EHR)

a computerized lifelong health care record for an individual that incorporates data from providers who treat the individual

contractual relationship to care for a designated population

a contract to care for a designated population is indicative of a health maintenance organization or managed care contract, a physician is contractually required to care for those member patients of a managed care organization, they may sign contracts to provide care for hospitals, schools, or long term care facilities that have designated populations

posttraumatic stress disorder (PTSD)

a disorder characterized by chronic physiological arousal, recurrent unwanted thoughts or images of the trauma, and avoidance of things that call the traumatic event to mind

brand-name drug

a drug with a registered name or trademark

Food and Drug Administration (FDA)

a federal agency charged with enforcing regulations against selling and distributing adulterated, misbranded, or hazardous food and drug products

Federal Trade Commission (FTC)

a federal agency established in 1914 to investigate and stop unfair business practices

Agency for Healthcare Research and Quality (AHRQ)

a federal agency established to improve the quality, safety, efficiency, and effectiveness of health care for Americans

Centers for Medicare and Medicaid Services (CMS)

a federal agency within the U.S. Department of Health and Human Services that is responsible for Medicare and Medicaid, among many other responsibilities.

artificial intelligence (AI)

a field of computerized methods and technologies created to imitate human decision making

Copayment

a fixed fee paid by the patient at the time of an office visit

Preferred Provider Organization (PPO)

a group of doctors and hospitals that agree to provide health care at rates approved by the insurer

de facto mental health service system

a growing sector of nonprofit groups and organizations for the mentally ill that provide education and support

Chief Financial Officer (CFO)

a high-level corporate executive who manages a firm's finances and reports directly to the company's chief executive officer or president

insane asylum

a hospital for mentally incompetent or unbalanced person

Sapien heart valve

a life-saving alternative to open-heart surgery for patients who need a new valve but are at high risk for surgery

Organization for Economic Cooperation and Development (OECD)

a membership organization that provides comparable statistics of economic and social data worldwide and monitors trends of economic development

Independence at Home

a model under the Affordable Care Act that funds physicians and nurse practitioners to deliver primary care services in the home to older adults with high-cost multiple chronic illnesses

Inpatient Prospective Payment System (IPPS)

a payment system for inpatient hospital stays

Medicare Advantage

a program by which eligible Medicare beneficiaries may choose to receive their health care through a qualified managed care plan, which in turn receives capitation payments from Medicare for each enrollee

service benefit program

a program that provides benefits without guaranteeing the contract of the indemnity party

Managed behavioral healthcare organization accreditation program

a program that provides consumers, employers, and others with information about the quality of the nation's managed behavioral healthcare organizations

Alzheimer's disease

a progressive and irreversible brain disorder characterized by gradual deterioration of memory, reasoning, language, and, finally, physical functioning

healthy people report 2010

a report that contains a health promotion and disease prevention focus to identify preventable threats to public health, major goals were to increase quality of life and life expectancy and to reduce health disparities

Employee Wellness Program (EWP)

a set of communications, activities, and facilities designed to change health-related behaviors in ways that reduce health risks

premenstrual dysphoric disorder (PMDD)

a severe form of PMS that markedly interferes with social relations, work, or education

assisted living facilities

a supportive living arrangement for people who need assistance with ADLs or IADLs but who are not so impaired physically or cognitively that they need 24-hour care

National Clearinghouse for Long-Term Care Information

a website developed by the US department of health and human services to provide information and resources to help a consumer plan for future long term care needs

tertiary prevention

activities that focus on rehabilitation and monitoring of diseased individuals

Hazard Communication Standard (HCS)

an OSHA regulation aimed at promoting awareness of hazardous substances and understanding of safe handling practices

mental health parity and addiction equity act of 2008

an act that amends the mental health parity act of 1996 to include substance abuse treatment plans as part of group health plans

Employee Retirement Income Security Act (ERISA)

an act that regulate pension and benefit plans for employees, including medical and disability benefits

Worker Adjustment and Retraining Notification Act (WARN)

an act that states employers with 100 employees or more must give their employees 60 days notice of layoffs and business closings

price fixing

an agreement between two or more firms on the price they will charge for a product

cafeteria plan

an employee benefit program that allocates a certain amount of money to each employee that can be spent on benefits.

Price information exchange

an illegal action as per the Sherman Act of 1890 where exchange of price information between healthcare providers can also be illegal

moral treatment

approach to mental illness calling for dignity, kindness, and respect for those with mental illness

Exploring Accreditation Project (EAP)

assesses the accreditation of public health agencies

Core Public Health Functions

assessment, policy development, assurance

medical severity diagnosis related group

assigned to each patient case based on diagnosis and other info

public welfare insurance

based on financial need (medicaid)

the excess readmission ratio act (ERR)

based on the treatment of six patient conditions

disease specific policies

benefits cover only the specific diseases covered

constitutional factors

biologically determined traits

public law

cases involving the action of public agencies or officials

minority stress

chronic health effects of homophobia, such as high blood pressure and depression

Program of All-Inclusive Care for the Elderly (PACE)

comprehensive healthcare delivery system funded by medicare and medicaid

Electronic Patient Record (EPR)

computer-based clinical data for an individual that are kept by a single health care organization (i.e. hospital, acute care facility, regional health authority)

Criminal Law

concerned with actions that are illegally based on court decisions

assessment, policy development, assurance

core functions of public health

iron triangle of healthcare

cost, quality, access

national center for posttraumatic stress disorder

created within the VA, addresses the needs of military related PTSD

private law

deals with disputes between private citizens

concurrent utilization review

decisions regarding appropriateness are made during the course of health care utilization

torts

derived from the French word for wrong, are a category of wrongful acts, in civil law, which may not have a preexisting contract.

rules and regulations

describe exactly how specific activities are to be carried out

Family and Medical Leave Act (FMLA)

designed to assist families manage family issues by permitting families to take leave without pay

National Managed Care Contract (NMCC)

designed to comply with the managed care laws of all 50 states and the district of Columbia, as well as with federal requirements

residential care facilities

designed to provide basic physical and emotional care to individuals who can no longer care for themselves

retrospective reimbursement

determines the amount of reimbursement after the delivery of services and provides little financial risk to providers

expert systems

developed to imitate experts' knowledge in decision making

tricare

developed to respond to the growing needs of retired members

Policy Development

developing policies that support the health of the population, including the use of the scientific knowledge base in making decisions about policy.

health disparities

differences in the incidence, prevalence, mortality, and burden of diseases and other health conditions among specific population groups

psychotropic medications

drugs that mainly affect the brain and reduce many symptoms of mental dysfunctioning

ePrescribing

electronically transmitting prescriptions from care provider to pharmacy

Uniformed Services Employment and Reemployment Rights Act (USERRA)

entitles individuals who leave the military service to return to their job

Community Recovery

equilibrium community will recover from events which make any constituent species have low density

Health Plan Employer Data and Information Set (HEDIS)

established by the NCQA in 1989. It is used by nearly 100% of all health plans to measure service and quality of care. The reported data are available to MCOs and physicians

American act caregiver program

established state grants to fund family and informal care givers who provide home care.

Center for Medicare and Medicaid Innovation

established to research different payment and delivery systems

almshouses/poorhouses

established to serve the indigent by providing shelter while treating illness

practice profiling

examines specific provider patterns of practice

National Center for Complementary and Alternative Medicine (NCCAM)

explores the types of practices in the context of rigorous science, train complementary and alternative researchers and disseminate information

skilled nursing facilities

facilities that provide full-time nursing care for people who have chronic illnesses or are recovering from a temporary medical condition

Negligence

failure to take proper care in doing something

U.S. Food and Drug Administration (FDA)

federal agency that regulates claims on product labels

Centers for Disease Control and Prevention (CDC)

federal government agency responsible for improving the overall health and safety of the people of the United States

American Taxpayer Relief Act of 2012

federal law that clarified estate tax provisions

Older Americans Act of 1965

federal legislation to improve the lives of elders

Indemnity Plan

fee-for-service health insurance plan

geropsychology

field of psychology dedicated to the mental health of elderly people

Community First Choice

focuses on community health services to Medicaid enrollees with disabilities

Biosurveillance

focuses on early detection of unusual disease patterns that may be due to human intervention

Clayton Act of 1914

forbids certain actions that are likely to lessen competition, although no actual harm has yet occurred

Mental Health Parity Act

forbids health plans from placing lifetime or annual limits on mental health coverage that are less generous than those placed on medical or surgical benefits

benefits improvement and protection act of 2000

formally called the Medicare, Medicaid, and CHIP Benefits Improvement and Protection Act, modified Medicare payment rates for many services, Added coverage for preventive and therapeutic services, Increased federal funding to state programs.

village movement

formed a nonprofit organization, Beacon Hill Village, which formed a network to provide services to older homeowners that allowed them to remain in their homes longer and maintain their independence

public health accreditation board

formed as a nonprofit organization dedicated to improving and protecting the health of the public by advancing the quality and performance of tribal, state, local, and territorial public health departments

patient point

formerly known as healthy advice network, it provides education to patients electronically while they are in the waiting room or an exam room

Self Funded or Self Insurance

health insurance programs that are implemented and controlled by the company itself

examples of secondary prevention

health screenings ( high blood pressure screenings), colonoscopies, mammograms

staff model

hires providers to work at a physical location

Epidemiology Triangle

host, agent, environment

prospective utilization review

implemented before the service is actually performed by having the procedure authorized by the MCO based on clinical guidelines

medical malpractice

improper or negligent treatment of a patient by a provider which results in injury, damage or loss

extensive contracts

include housing, residential services, amenities, and unlimited access to health care at budgeted monthly rates.

modified contract

includes housing, residential services, and amenities but only limited healthcare access

Primary care case managers

individual providers (or groups of providers) agree to act as an individual's primary care provider and receive a small monthly payment for helping to coordinate referrals and other medical services

individual private health insurance

individually purchased private health insurance (nongroup plans) = coverage for so Americans

Material Safety Data Sheet (MSDS)

information sheets that must be provided by the manufacturer for all hazardous products

national association of local boards of health (INALBOH)

informs, guides, an d is the national voice for boards of health

life insurance

insurance paid to named beneficiaries when the insured person dies

Limited Benefit Plans

insurance products with reduced benefits intended to supplement comprehensive health insurance plans, not to be an alternative to them, not typically required to provide the same level of coverage, so they cover fewer types of medical expenses than a comprehensive policy, have higher co-insurance percentages, co-payments and deductibles than comprehensive plans

population health

interdisciplinary method that provides resources to address designated health disparities in populations

Stakeholders

interested entities that participated in the industry

common law

interpreted past legal decisions regarding a case

Flexner Report (1910)

introduced the european model of science based edu., hospital based clinical rotations, and a 4 year edu. model

U.S. Commission on Mental Health

investigated the quality of mental hospitals and allocated funding for outpatient facilities

phobias

irrational fears of specific objects or situations

Occupational Safety and Health Act

is a federal law that establishes and promotes workplace safety standards for businesses.

Blue Cross/Blue Shield

is the oldest and largest system of privately sponsored insurance.

American Public Health Association

issued a set of guidelines for the basic function of the local health department

cost shifting

issues created by reducing medicare and reimbursments

Committee on Operating Rules for Information Exchange (CORE)

it has set up standards and operating rules for streamlining processes between providers and healthcare plans, this system allows for real time access to patient information pre and post care

Lilly Ledbetter Fair Pay Act of 2009

law that closed the loophole that limited suits on discriminatory pay

antitrust laws

laws that prevent monopolies and promote competition and fairness

medical loss ratio

minimum amount of dollars a healthcare plan spends on providing care rather than administration

group model

negotiates with a group of physicians exclusively to perform services

National Alliance on Mental Illness (NAMI) and mental health America

nonprofit organizations that provide education and support for the mentally ill

alternative medicine

nontraditional medicine that is used solely for treatment

complementary medicine

nontraditional treatment used along with conventional medicine

MelaFind optical scanner

not for definitive diagnosis but rather to provide additional information a doctor can use in determining whether or not to order a biopsy

involuntary commitment

occurs when people are being forced to receive treatment or are committed to a facility against their wishes

voluntary commitment

occurs when people commit themselves willingly to receive care

Physician-Hospital Organization (PHO)

organization that includes hospitals and physicians contracting with one or more Health Maintenance Organizations, insurance plans, or directly with employers to provide health care services

Provider-sponsored organization (PSO)

organizations that are owned or controlled by healthcare providers

Civil Rights Act of 1964

outlawed discrimination based on race, color, religion, sex, or national origin

False Claims Act (FCA)

passed by the federal government during the Civil War to regulate fraud associated with military contractors selling supplies and equipment to the Union Army.

risk plans

pay a premium per member that is based on the member's county of residence

Job Lock means that _______.

people are tied to job that they can't leave because a new employer may not provide insurance

activities of daily living (ADLs)

personal daily care tasks, including bathing, skin, nail, and hair care, walking, eating and drinking, mouth care, dressing, transferring, and toileting

catastrophic health insurance

policies cover unusual illnesses with a high deductible and have lifetime reimbursement caps

Statutory Consent

presumes a reasonable person would give consent to the lifesaving procedure

newborns and mothers' health protection act (NMHPA)

prevents health insurance companies from discharging a mother and a child too early from the hospital

Third-party payer

private or government organization that insures or pays for health care on behalf of beneficiaries

utilization review

process of evaluating the appropriateness of services provided

Medicare Part D

produced the largest additions and changes to medicare

Dementias

progressive brain impairments that interfere with memory and normal intellectual functioning

physician self-referral law

prohibits physicians from referring Medicare patients to clinical laboratory services in which the physicians or their family members had a financial ownership/ investment interest and/or compensation arrangement

tort reform

proposed changes in the civil justice system that aim to reduce the ability of victims to bring tort litigation or to reduce damages they can receive

American Recovery and Reinvestment Act of 2009

protects health coverage for the unemployed by providing a 65% subsidy for COBRA coverage to make the premiums more affordable

Patient Self-Determination Act of 1990

protects patient rights including the right to agree to or refuse medical treatment

Flexible Spending Account (FSA)

provide employees with the option of setting aside pretax income to pay for out of pocket medical expenses

Medigap (or Medicare Supplementary Insurance, MSI)

provide supplemental insurance coverage for medicare patients

Deficit Reduction Act of 2005

provided federal funding to states to expand community based long term care

Capitated Rates

providers receive a set rate for serving enrolled patients regardless of how much care the provider gives

National Mental Health Act

provides funding for research, prevention and treatment of mental illness

public health security and bioterrorism preparedness and response act

provides grants to hospitals and public health organizations to prepare for bioterrorism

public health security and bioterrorism preparedness and response act of 2002

provides grants to hospitals and public health organizations to prepare for bioterrorism

Health Insurance Portability and Accountability Act (HIPAA)

provides stricter confidentiality regarding the health information of individuals

medicare cost plans

reimburse the MCOS on a preset monthly basis per enrollee based on a forecasted budget. The cost plans allowed members to pursue care outside the network

american association of homes and services for the aging

represents nonprofit adult day services, home healthcare services, community services, senior housing, assisted living facilities, continuing care retirement communities, and nursing homes

pharmaceutical research and manufacturers of america

represents the pharmaceutical industry

Americans with Disabilities Act

required state medicaid programs to cover medicare premiums for lower income individuals

Hart-Scott-Rodino Antitrust Improvement Act

requirement of notification prior to a merger to FTC, DOJ in order to give government time to decide of they will oppose the merger on antitrust grounds. Rule applies to mergers of $70 million or more.

Family and Medical Leave Act of 1993

requires employers to provide up to 12 weeks of unpaid leave for family and medical emergencies

Immigration Reform and Control Act of 1988

requires employers with on or more employees to verify that all job applicant are US citizens or authorized to work in the US

Chief Information Officer (CIO)

responsible for overseeing all uses of MIS and ensuring that MIS strategically aligns with business goals and objectives

Accreditation Association for Ambulatory Health Care (AAAHC)

reviews and accredits managed care organizations

network model

similar to the group model but these providers may see other patients who are not members of the HMO

claims processing

sorting claims upon submission to collect and verify information about the patient and provider

Workers Compensation

state programs that provide benefits to workers who suffer work-related injuries or illnesses, or to their survivors

Medicare Part B

supplemental health plan to cover physician services

community service

support services that include adult day care centers, meal programs, senior centers and transportation

Electronic Clinical Decision Support Systems (CDSSs)

systems that are designed to integrate medical information, patient information and a decision making tool to generate information to assist with cases

health information systems

systems that store, transmit, collect and retrieve these data

consumer-driven health plan (CDHP)

tax plans with high deductible coverage

medical material management and distribution

the ability to acquire, maintain, transport, distribute and track medical material during an incident and to recover and account for unused medical material, as necessary

information sharing

the ability to conduct multijurisdictional, multidisciplinary exchange of health related information and situational awareness data among the federal, state, local territorial and tribal levels of government and the private sector

public health laboratory testing

the ability to conduct rapid and conventional objection, characterization, confirmatory testing, data reporting, investigate support, and laboratory networking to address actual or potential exposure to all hazards

public health surveillance and epidemiological investigation

the ability to create, maintain, support, and strengthen routine surveillance and detection systems and epidemiological investigation processes, as well as expand these systems and processes in response to incidents of public health significance

Emergency public information and warning system

the ability to develop, coordinate and disseminate information, alerts, warnings and notifications to the public and incident management responders

emergency operations coordination

the ability to direct and support an event or incident with public health or medical implications by establishing a standardized, scalable system of oversight, organization and supervision consistent with jurisdictional standards and practices and with the NIMS

Responder Safety and Health

the ability to protect public health agency staff responding to an incident and the ability to support the health and safety needs of hospital and medical facility personnel, if requested

Medical Countermeasure Dispensing

the ability to provide medical countermeasures in support of treatment or prophylaxis to the identified population in accordance with public health guidelines, recommendations or both

Nonpharmaceutical Interventions

the ability to recommend to the applicable agency and implement, if applicable, strategies for disease, injury and exposure control

sexual harassment

the abuse of one's position of authority to force unwanted sexual demands on someone

personal care accounts

the account is funded by the employer but owned by the employees and remains with the company if the employee leaves

instrumental activities of daily living (IADLs)

the activities of daily living needed for independent living

tying

the anticompetitive practice of requiring buyers to purchase one product in order to get another

life expectancy rates

the average age which people are expected to live from birth

health literacy

the degree to which individuals have the capacity to obtain, process, and understand basic health information and services needed to make appropriate health decisions

social and community networks

the external influences on the health of an individual characterized by interactions between groups of people and/or organizations and institutions

Healthy People 2020

the fourth set of health goals and objectives for the U.S. that defines the nation's health agenda and guides its health policy

National Incident Management System (NIMS)

the management system used by federal, state, and local governments to manage emergencies in the United States.

Per Member Per Month (PMPM) payment

the member fee that is given to the provider regardless of how often the members use the service and the types of services used

surveillance

the monitoring of patterns of disease and the investigation of disease outbreaks to develop public health intervention strategies to combat disease

Health Reimbursement arrangements (HRA)

the most common type of CDHPS

national institute of mental health

the nation's leading mental health research agency, housed in the National Institutes of Health

infant morality rates

the percentage of babies that do not survive past their fifth birthday

Public Health

the practice of protecting and improving the health of people in a community

health promotion

the process of enabling people to increase control over, and to improve, their health

charitable care or bad debt

the provider does not expect a payment after the person's inability to pay has been determined or the efforts to secure the payment have failed

capitation policy or per member per month policy

the provider is paid a fixed monthly amount per employee which is often called a PMPM payment

health education

the providing of accurate health information to help people make healthy choices

Determinants of health

the range of personal, social, economic, and environmental factors that influence health status

determinants of health

the range of personal, social, economic, and environmental factors that influence health status

Public Health Functions

the responsibility of local health departments to protect and promote health, and prevent disease and injury

public health

the science and practice of health protection and maintenance at a community level

environmental health

the study of how environmental factors affect human health and quality of life

epidemiology

the study of the distribution of mental or physical disorders in a population

Ergonomics

the study of working conditions that affect the physical condition of employees

Gross Domestic Product (GDP)

the total finished products or services that are produced in a country within a year

bioterrorism

the use of biological and chemical weapons in terrorist attacks

meaningful use

the use of certified electronic health record technology to achieve health and efficiency goals, with a financial incentive from Medicare and Medicaid

eHealth

the use of electronic means to transfer health information and resources

Health Information Technology

the use of various forms of technology to improve the quality of health services to individuals and communities

out-of-pocket payment

total amount that a consumer spends directly for healthcare

managed care plans

type of health program that combines administrative costs and service costs for cost control

Silent PPOs

unauthorized third parties outside the contract between the MCO and the physician that gain access to the MCO discount rates

ACA 2010

universal health coverage under government mandates; does not address the problem of access.

informatics

use information and technology to communicate, manage knowledge, mitigate error, and support decision making

standard of care

used to be strictly based on a locality rule, has now become a state or national standard, which has also resulted in increased claims

health equity

when all people have the opportunity to attain their full health potential and no one is disadvantaged from achieving this potential because of their social position or other socially determined circumstance

market division

when one or more health organizations decide which type of services will be offered at each organization

Medicare Part C (Medicare Advantage)

•Replaces and covers expenses found in Part A and B •Medicare private fee-for-service plans (PFFS) •Medicare managed care plans (HMOs and PPOs) •Medicare specialty plans

Nursing Home Reform Act

Passed into law as part of the 1987 OBRA; specified services that nursing homes must provide and standards for these services, in addition to the residents' bill of rights.

Marketing Mix

Product, Price, Place, Promotion

Medicare and Medicaid

Health benefits for the elderly and poor

Home healthcare services

Offer medical care in the home, are provided primarily to the elderly, chronically ill, and mentally impaired

Summary of Benefits and Coverage (SBC)

Offers consumers the opportunity to easily compare health insurance plans.

Dr. John Snow

(1813-1858) English physician who used hand-drawn data layering on maps of London to identify and treat a cholera epidemic