HA 150- Final Review
What is the Hill-Burton Act? Name the pros and cons.
1946 post WWII, it was intended to expand hospital access to rural areas. The gov spent $ on building and modernizing hospitals. This lead to CON (certificate of need) programs Pros: Supposed to expand hospitals in rural areas Cons: no research was done on demand so too many hospitals were built and had to be closed
What is a hospitalist? Why was this specialty introduced? How does this specialty affect the triumvirate?
An MD or DO who works primarily in a hospital setting. It is a specialty like OBGYN, etc. they must get post graduate training They needed physicians who could strictly take care of patients so the quality is maintained and communication is created through hospital stay between staff, etc.
Explain why individuals with health insurance are likely to visit outpatient acute care facilities and those without insurance utilize hospital EDs? How does this affect cost? Name one solution to decreasing costs in this situation.
Because expensive to go to outpatient without insurance Cost increases Give more people access to insurance (ACA) and things are caught preventatively
What are some causes of DCW turnover? What are the consequences?
Causes: Lack of empowerment, poor supervision, and lack of respect. Consequences: lowered quality of care, cost increase, and the direct care workers who remain are affected
Would your health insurance premium cost more in a coal mining town or a city where most people bicycle to work? Use the term "risk pool".
Coal mining town because the risk pool is a smaller group of people... their premiums are higher because they are at a higher health risk
What is the difference between complementary therapies and alternative therapies? Given an example of each. Why are most of these treatments paid for out of pocket?
Comp. is in addition to allopathic, alt is non allopathic. Ex of comp is yoga or Massage "prescribed" for low back pain. Ex of alt. Is cancer patient used all allopathic So is now trying to acupuncture ONLY (nothing else). Most paid for out of pocket bc 28.
What is a DRG?
Diagnosis related group, it is how Medicare pays hospitals for patient care
Which type of health insurance is most common, employer-based private, Medicare, Medicaid, SCHIP, Tri-care or VA? Who is covered by each?
Employer-based is most common. Medicare covers 65+, is an entitlement, disabled on ssi, end stage renal disease. Medicaid covers low income, medically needy, and disabled. SCHIP is the state children's health insurance program. VA is the veterans association. Tri-care is active military.
What is the difference between and HMO, PPO and POS plan?
HMO is cheapest but most restrictive (if out of network won't be covered) PPO is most common and can go out of network if pay more POS is the closest to traditional indemnity and has expensive premiums, can chose between ppo and hmo each time care is needed
When would you elect a HSA over a FSA if given the option?
HSA because can be carried over through next year. FSA goes back to employer at end of year if not all used.
What are the top 3 determinants of health for college aged students.
Health behaviors, family history, enviornment
What is home health care? Hospice? Adult Day Services? Who are appropriate candidates? Who pays?
Home health care: medicare, skilled services with licensed nurses at home. intermittent care. Hospice: medicare, end of life care Adult day services: medicaid, typical 9-5 basically like babysitting
What is ICD-10? CPT? What is the relationship between the 2?
ICD-10 (International Classification of Diseases, 10th edition) this diagnoses CPT (Current Procedural Terminology) this is the treatment Work together to be like DRG... they are how private insurance pays hospitals for patient care
Would you choose a LCSW over a PsyD? Explain. Who would you access if you need psychiatric medication?
If you like one over the other, they all have same scope of care (phd, psyd, lcsw, and lfmt). Go to psychiatrist if you need medication
What is DRG Bundling? Why was the new legislation enacted?
In 2015 there was new legislation "DRG bundling" where hospital get to choose preferred provider for patient. They choose SNF 1 for her to go to. DRG bundling makes hospital, nursing home, attending physician all have to work together in this 90 day period to get her working better as fast as she can. Acute care to post acute care. Hospital nursing home and attending physician working together to get her as best and she can in 90 days. The amount of money they are getting paid for this episode of car is another ex of prospective payment and cost containment. Created bc double paying
What is the health care triumvirate? What are the relationships among the sides of the triangle? Give an example of each relationship relative to the health care system.
It is the relationship between cost, quality, and access. Example of each: If Q increases, C increases and A decreases. If C increases, Q increases and A decreases. If A increases, Q could decrease and cost decreases.
What is OBRA 87 and why is it considered one of the most important pieces of legislation in SNFs?
Legislation (act) that creates a set of national minimum set of standards of care and rights for people living in certified nursing facilities.
What factors should you consider when choosing a hospital?
Location (to family and friends) Insurance / physician privileges Volume (for any condition you have, go to hospital that has tons of experience with it) Quality ratings
What is managed care? What is a gatekeeper?
Managed care: plans that contract w healthcare providers/ facilities to provide care at reduced costs (per member per month) Gatekeeper: HMO has the PCP guide the care (to get specialty)
What are the differences between Medicare and Medicaid?
Medicare- an entitlement, 65+, disabled on social security disibility income, end stage renal disease Medicaid- disabled, low income, medically needy (temporary) The CMS (center for medicare and medicaid services) is responsible for oversight of both programs (watch dog)
Why is having 1% of the NIH budget dedicated to CAM research a challenge for CAM practitioners and consumers? Relate this to health insurance coverage and the "Catch 22" phenomenon discussed in class.
National institute of health, under this national institute of drug abuse (nida) etc but Now national centers for complementary and _____ (cam). All of these do research, but The 1% can't do much research (little research). Ins will cover the other research ones Done who can then create a drug and then fda approval. Vice versa w cam, wont cover bc No research (not much), no drug, then no fda approval. Catch 22 is not willing to put money Into research but takes research to cover it, won't ever get anywhere
Do hospitals make a profit on patient care? Name some ways hospitals are increasing their profits?
No, they lose $ on patient care Diversification- gift shop, cafeteria, pharmacies, courses, etc.
What is "spend down"?
Nursing homes (SNF's) bc medicaid is main payer... example below Irma (87 yrs w medicare) has stroke and needs PT and ST... goes to hospital first (medicare pt a)... discharged to lower level of care (post acute care... nursing home) medicare part a will pay nursing homes 100 days at 100% and dwindle down after the first 20 days This means medicare is paying less and less for this persons stay and she or her family must pay the rest out of pocket eventually considered low income and then medicaid picks up rest of bill and NH is reimbursed by NH
What is a premium? Deductible? Co-pay? Co-insurance?
Premium: amount you pay monthly for insurance Deductible: amount you pay out of pocket before insurance kicks in Co-pay: $ amt. you pay when you seek services Co-insurance: % you pay when you seek services
What is the relationship between prevention and cost of health care? Why don't insurance companies invest much in prevention if it lowers costs?
Prevention lowers cost of care in the end. Because prevention isn't the focus of modern western medicine, so the research is not done (think CAM).
What is retrospective payment? What is prospective payment? Do most health care organizations get paid retrospectively or prospectively?
Retro- fee for service, clinician does work bills insurance and insurance pays them Pro- paying per person per month (Managed care) Most paid prospectively
What is a skilled nursing facility? Assisted living? Who are appropriate candidates for each? Who pays?
SNF is a nursing facility where skilled care is being completed (good candidate is those that need help with ADL's) . Assisted living is an alt. to a retirement community for those who need a little help with their IADL's. SNF is paid by medicaid, Assisted living by resident or their family.
What is a direct care worker? What is their demographic? Why should we care about this demographic in terms of long-term care for the elderly?
Someone who works directly with patients (ex. CNA). They are mostly female, color, 25-44 years old. This demographic is staying the same, while the number of elderly is increasing so not enough DCW to take care of old.
What is a RUG?
Stand for Resource Utilization group. It is the prospective payment system used my medicare to reimburse skilled nursing facilities. An RNAC (registered nurse assessment coordinator) fills out a MDS (minimum data set). The more detailed an RNAC fills out the MDS, the getter grasp you get on how sick a patient is and the more money you get!
If the U.S. needs more nurses, why is it so difficult to get into nursing school?
There aren't enough nurses teaching because they are so busy working
"You can't medicate your way out of a bad lifestyle." What does this mean in relation to where the U.S. ranks on health outcomes compared to other developed countries.
US uses medication and "quick fixes" instead of fixing the true problem and education to stop the disease etc. from occurring in the first place. US ranks poorly because of our extremely unhealthy lifestyles
With regard to stress, what does "maintain perspective" mean?
remember you aren't in physical danger and to relax
How is stress related to chronic illness?
stress can lead to chronic diseases
Name 3 ways you, personally, can reduce the level of perceived stress in your life.
time management, start living a healthier life style (sleeping, eating, exercising), and participate in yoga or activities that relax me