HPA 311 Exam #2
What is the eligibility criteria for Medicare A?
- Age 65 and over - Disabled people on Social Security - People with end-stage renal disease
Why is their limited use of retail clinics?
- Concentrated in large metropolitan areas -Limited scope of services -Lack of trust
What does Medicare B cover?
- Covers outpatient services - Preventive services - Home health visits - Services of attending physician - Diagnostic services - In skilled nursing facility will cover skilled services if Medicare A is exhausted
What is the eligibility criteria for Medicaid?****
- For the indigent - Eligibility determined by each state - 'Spend down' is required if a person exceeds established resource levels - Community spouse is protected against impoverishment
Where did the Nursing Home reform act fall short (what are the controversial issues that remain?)
- Improvements have reached a plateau - Inconsistent application - Do not focus on high-quality care - Quality of life is not measured - Punitive rather than a remedial tone - Staffing levels have reached a plateau
What are the restrictions for Medicare coverage in a SNF***
- Must follow 3-day hospital stay - Limited to 100 days per "benefit period" - Requires co-payment for days 21-10 - Covers only "skilled" care (Skilled nursing AND Physical and occupational therapy, speech therapy, and other therapies)
What challenges does long term care services present?***
- Not organized, hence not really a system -Most of the care is unpaid -Not financed by insurance or public programs -Delivered by family, friends, etc. -Mostly basic care -Enables people to live independently -Community-based services can fill in
What did The Nursing Home Reform Act (OBRA-87) act accomplish/mandate?
- Nursing homes are certified as a Medicare and/or Medicaid skilled nursing facility by the federal government (Centers for Medicare and Medicaid [CMS]). - "Conditions of Participation": Spells out the mandates that a nursing home is obliged to meet in order to remain Medicare/Medicaid certified and eligible for reimbursement - Regulations represent minimum level of quality -Assisted living and community-based services are currently left out
Who uses long term care services and supports?
- Older adults ( 60% to 65% of those using TLC) - Children and adolescents, young adults - physcially handicapped - mentally ill - those needing subacute/ high-tech care/ specialized care
In addition to meeting reasonable and necessary criteria to be admitted to an IRF, what are the other three requirements?
- Quality - Cost Effectiveness - Investment in Technology
Aura
- premonition to an event, an alert A sensation perceived by a patient that precedes a condition affecting the brain. An aura often occurs before a migraine or seizure. It may consist of flashing lights, a gleam of light, blurred vision, an odor, the feeling of a breeze, numbness, weakness, or difficulty in speaking..
Spinal tap (also called a Lumbar puncture (LP)
- test your spinal fluid - The procedure involves inserting a needle into the spine after numbing it and taking a sample of spinal fluid. -try to get sample of spinal fluid that's in brain, spinal, and spinal root. -Test most common symptom: imflamation, if one has menengitis
Who are informal caregivers?
-Not organized, hence not really a system -Most of the care is unpaid -Not financed by insurance or public programs -Delivered by family, friends, etc. -Mostly basic care -Enables people to live independently -Community-based services can fill in
Electrodiagnostic tests such as EMG
-electrodes inserted into the muscle or placed on skin overlying a muscle-electrical activity and muscle response are recorded
Spasm
-involuntary muscle spasms a sudden involuntary muscular contraction or convulsive movement.
Tremors
-rhythmic, quivering, purposeless skeletal muscle movements involuntary shaking movement that is repeated over and over
Activities of daily living (ADL)
-routine activities that people tend do every day without needing assistance. -BATTED ( Bathing, ambulatation, Toielting, Transfers,Eating, Dressing
What factors are contributing to the demand in dermatology (what are the three demand determinants)?
1) Access= Insurance- ACA mandated coverage of annual dermatological checkups 65 and older. Costs still impacted access as well as availability-average wait time 22 days 2) Demographics= • Aging population-older more susceptible. Higher income population-anti aging baby boomer. Self referral to dermatologist 3)Health Trends= • Promotion of healthy lifestyles • Public awareness campaigns Access, Demographics, Health Trends
What types of conditions to they treat?
1. Injuries (sprains/strains/fractures/lacerations) 2. Musculoskeletal (joint/extremity pain) 3. Respiratory (URI/s throat/asthma/bronch) 4. Ill-Defined (abd pain/cough/fatigue/dysuria) 5. Nervous System (migraine/otitis/eye pain) 6. Skin (cellulitis/abscess/poison ivy/rash) 7. Genitourinary System (UTIs/hematuria) 8. Inf/Parasitic Diseases (cholitis/strep throat) 9. Digestive (constipation/gastritis/ulcer) 10.Circulatory (bleeding/DVT/hypertension
What are the two types of skin cancer?
1. Non-Melanomas -(most common skin cancers) (BASAL cell AND and SQUAMOUS CELLS) 2. Melanomas (Begins in the melanocytes, epidermis meets the dermis. spread to other parts of body)
How does patient acuity level impact placement within the continuum?
Acuity and complexity increase from one end of the continuum to the other (Continuum of LTC: The full range of LTC services)
What are the advantages of this virtual model?
Advantages For patients: • Convenient • Economical price • Can give more honest and comprehensive answers • No need to leave home For physicians: • Convenient - patients' answers are more organized • Reduced overhead • No parking problem • No weather and scheduling issue
Neuralgia
BURNING nerve pain
What does the central nervous system consist of?
Brain and Spinal Cord
Mohs surgery
• layers of cancer-containing skin are progressively removed and examined until only cancer-free tissue remains • Most Mohs procedures are done on non-melanoma skin cancers on the head and neck, where the need to spare healthy tissue is paramount • Increasing demand
What does the peripheral nervous system consist of?
•Cranial nerves and spinal nerves
What are the main drivers of alternative models to the traditional primary care office?
•Demand for primary care continues to escalate as more baby boomers begin enrolling in Medicare •Over 30 million more Americans covered under health insurance as result of PPACA •Access is even more strained due to growing shortage of PCP in rural, urban and suburban communities •EDs have become surrogates for family physicians as the number of non-emergent patients swells, maxing out ED capacity •Changing patient expectations-Growing consumer demand for convenience, reliability, affordability
Benefits of Concierge Medicine
•Easy access to physician and office personnel •Limited wait times •Extended office visits •24/7 phone and email access to physician •Rapid referrals •Coordination of care with specialists •Acute and emergent visits available same or next day •Emphasis on Wellness and Preventative Care
Who do retail clinics serve?
•Healthier/wealthier more likely to use retail clinics •Convenience is single most important factor •Despite success, estimates suggest on 3% population is seeking care at retail settings
What are retail clinics?
•Limited scope healthcare delivery sites located in retail settings and staffed by mid-level providers •At economical price •Registered nurse practitioners or physician assistants (no physician) •Offer convenient and fast care
What are virtual doctors?
•Medical consultation & treatment through website •Scopes •Simple consultations •Simple diagnosis & treatment •Prescriptions for non-complicated conditions •Referring patient to a specialist if necessary •Fee can be paid by a debit or a credit card •Economical prices: $25-50
Concerns of Concierge Medicine
•Not a substitute for health insurance •No matter how steep retainer fee is does not cover out of office visit specialists such as ER, hospitalization, major surgery, diagnostics, etc. •Fee is not reimbursed by either private health insurance or Medicare
Who are the providers for urgent care?
•Pricing schedule and coverage varies by provider •Covered by most insurance plans, most cases must pay the co-insurance or deductible •For some services, pre-authorization nee
What are urgent care clinics?
•Rapid access outlets for walk-in patient •Between Emergency Department (ED) and the physicians' office •Minor injury but not enough to necessitate a trip to an ED •Do not want to wait for a scheduled appointment with primary care physician •Quick, Convenient, and Affordable •No appointment needed •Operating extended hours than primary care physicians' office •Little or no waiting •Reasonable price
What are the operational challenges?
•Resistance of PCPS •Concerns over poor financial performance •Peoples perceptions of retail clinics •Staffing issues •Perceived "newness" of business model
What are the operational challenges of urgent care?
•Resistance of PCPS •Concerns over poor financial performance •Staffing issues •Perceived "newness" of business model
Who does urgent care serve?
•Staffed primarily with physicians trained in family practice, emergency medicine or occupational medicine •See most of the same conditions seen in family practice or in the "fast care" section of the ED
What are disadvantages of this virtual model?
Disadvantages •Not all insurances cover •Not comprehensive
General dermatology
Dx and Tx of localized and systemic disorders involving the skin, hair, nails • Examples: acne, dandruff, athlete's foot, moles, psoriasis and skin cancer. • Educate: annual dermatologic screenings, sun protection, skin cancer awareness or skin
All IRF patients must be medically stable and tolerate a minimum of:
3 hours of therapy a day
What is the ABCD rule?
A (Asymmetry) one portion of the mole does not match the other • B (Border) edges are irregular, notched, or blurred • C (Color) different shades of black or brown, patchy colors • D (Diameter) spot is 6 millimeters across, or growing larger
What is the difference between assisted living and personal care facility and a Skilled nursing facility (SNF)?
Assisted Living: - Food, shelter, assistance, 24 hour-non-medical custodial care - Assistance or supervision with activities of daily living - "Age in Place" - Private living, own kitchen, BR Personal Care: - Food, shelter, assistance, 24 hour-non-medical custodial care - Assistance or supervision with activities of daily living - Relocate as acuity increases -Up to 3 residents in room Skilled Nursing Facilities (SNF): - Approximately 16,000 nursing homes in US - Provide 24 hour skilled nursing and rehabilitation - Highly regulated
The ABCD rule to spot skin cancer includes
Asymmetry, Border, Color, Diameter
What are the two main components of the nervous system?
Central Nervous System (CNS) and Peripheral Nervous System
Computed Tomography (CT)
High-speed x-rays reassembled into composite image using iodine-based contrast and radiation - Computer converts the data into cross-sectional images or "slices"
*** ( (you do not need to know all of the individual conditions, just a general treatment focus as compared to SNFs)
IRF= Inpatient Rehabilitation Hospital Qualifying conditions= 1. Stroke 2. Brain injury 3. Amputation 4. Spinal cord 5. Fracture of the femur 6. Neurological disorder 7. Multiple trauma 8. Congenital deformity 9. Burns 10. Polyarthritis (includes "joint replacement")
Cosmetic Dermatology
Improve the aesthetics of the skin by performing surgery. • Many cosmetic dermatologists are trained during their residency on the use of fillers and laser surgery, and most limit their cosmetic practice to minimally invasive procedures • Demand expected to rise, increase disposable income, anti-aging treatments
What are diagnostic procedures/Treatments
Incisional & Excisional= Incisional removes only wedge of tissue • Excisional removes entire tumor/growth Punch Biopsy= cuts through all layers of skin • Tissue sample is cut off at the base Needle aspiration= Syringe to remove small sample of cells
What is the difference between intramural and extramural services? Know a few of each.
Intramural Services - Home Health care - Meals on Wheels - Homemaker, chores, and errands, etc VS. Extramural Services - Adult day programs - Senior centers - Respite care
Nerve pain often described as "burning pain":
Neuralgia
The Long term care continuum
Low Acuity --------------------High Acuity Independent living,-- Assisted living/personal care, --nursing homes, ---subacute/ post acute
The largest payer of LTC services?
Medicaid
Treatment: Surgical
Mohs Micrographic surgery-remove tissue layer by layer until no cancerous cells are present in microscopic examination • Simple excision-tumor is cut with some normal skin around it • Curettage: tumor cut with a curette-electrode used to tx area with electric current • Laser surgery laser bean to make bloodless cuts in tissue or remove a surface lesion • Dermabrasion-removal of top layer of skin using a rotating wheel
Describe the difference in the non par vs the hybrid model.
Non-Par Status 1. Some practices are designed to opt out of all private insurances and Medicare. 2. There is usually an annual contract between patient and physician. 3. No payment or fee will be accepted from insurers or third party payers. 4. Patients can submit for reimbursement from their private insurers (not Medicare) for non participating physician services. Hybrid Models 1. Practices can charge a fee to patients for services and simultaneously charge private insurers and Medicare for services rendered. 2. Practices can provide services ala carte such as labs and radiology services and charge monthly fees for membership
What are the other factors that impact patient's placement within the long term care continuum? (Total of four factors)
Patient's placement is determined by: - Extent of disability - Client preferences - Availability of Services - Ability to pay
What are the signs and symptoms of scabies?
Pink-to-red bumps: pimple like • Intense itching, especially at night • Sores caused by scratching • Tell-tale signs: THE BURROW: small, thread-like, scaly line (3-10 mm long), sometimes with a tiny black speck (the burrowing mite) at one end.
What model is staffed with physicians trained in family practice, emergency medicine or occupation
Urgent Care
Who are the retail clinics providers?
Pricing schedule and coverage varies by provider •Private Insurance (97%) •Medicare (93%) •Medicaid (approximately 60%)
Treatment: Radiation and Chemotherapy
Radiation • Uses high energy x-rays or other types of radiation to kill cancer cells or keep them from growing Chemotherapy • Uses drugs to stop the growth of cancer cells either by killing the cells or by stopping them from dividing
What is the primary payor source for SNFs?
Reimbursement sources: - MediCAID= 66% - Medicare= 13% - private pay and other sources- the remainder
How is scabies diagnosed and treated?
Scabicides = kill scabies mites • Treatment should be given to both the infested person and to household members and sexual contacts • Decontaminated bedding, clothing, towels by washing in hot water and drying in a hot dryer, by dry-cleaning, or by sealing in a plastic bag for at least 72 hours
What is community based care?
Services are obtained from various health care agencies -Economical and least restrictive settings -Supplement informal caregiving when needed -Temporary respite to family members -Delay or prevent institutionalization
What is a UDS? What is it used for?
Uniform Data System = documenting the severity of patient disability and outcomes of medical rehabilitation. allows participating hospitals to compare their outcomes to the region and nation.
Seizure
a neuromuscular reaction to abnormal electrical activity within the brain. •The causes include fever or epilepsy, a recurring seizure disorder. •Seizures are also called convulsions.
What types of conditions do retail clinics treat?
acute conditions and preventative care measures
Loss of memory caused by brain damage or trauma:
amnesia
Non-melanomas include:
both basal and squamous cell carcinomas
Dermatopathologists
• Pathology/study of the skin (Pathology is the study and recognition of disease) • research that goes toward creating dermatological cures and treatments
Magnetic Resonance Imaging (MRI)
combination of large magnets, radiofrequencies, and a computer to produce detailed images of organs and structures within the body. - NO RADIATION
What is the single most reason people use retail clinics?
convenience
This sector of dermatology improves aesthetics of the skin by performing surgery:
cosmetic dermatology
Dysphagia
difficulty swallowing
Gait, abnormal
disorder in the manner of walking
Vertigo
dizziness, abnormal session of movement when there is none
Myleogram
dye injected into the spinal canal to make the structure clearly visible on X-rays.
Syncope
fainting, loss of consciousnes
What are the causes of pressure injuries?
• Pressure against the skin that limits blood flow to the skin and nearby tissues. • Other factors related to limited mobility can make the skin vulnerable to damage and contribute to the development of pressure sores. susstained pressure, friction, shear
Aphasia
impairment of ability to communicate
What is scabies?
infestation with microscopic mite Sarcoptes scabei (parasite infestations)
What is dermatology/dermatologist?
• Specialty = Dermatology: study of the skin, hair and nails • Specialist = Dermatologist-one who specializes in the medical, surgical, and cosmetic care of skin, hair and nails, (integumentary system
Amnesia
loss of memory caused by brain damage or trauma
Gait assessment rating scale (GARS)
measures different functions of how they ambulate, how they walk
Brain scan
nuclear medicine procedure used IV injection of radioisotopes to identify intracranial masses, lesions, tumors, etc.
What is concierge medicine?
relationship between a patient and a primary care physician in which the patient pays an annual fee or retainer. In exchange for the retainer, the physician provides enhanced care. (aka: Direct care, Boutique medicine, Retainer-based medicine, Innovative medical practice design)
What is an example of an extramural community based care?
senior centers (b/c outside of the community)
Specialty/specialists
specialty= neurology specialist=neurologist
Which is a sign of scabies
the burrow
Rhythmic, quivering, purposeless skeletal muscle movements:
tremors
What are pressure injuries? What other names are they called?
• Decubitus ulcer/ pressure sore/ bedsore/ pressure ulcer
