Week 5 (chap 11)
2 streams of money in healthcare financing
1.) collection money for healthcare (going in) 2.) reimbursement of healthcare providers for care (going out)
A nurse has very strong client education skills. In which health care setting would the nurse make best use of these skills?
primary care center
Inpatient vs. Outpatient
*inpatient*: Admitted to the hospital overnight *Outpatient*: seen and sent home the same day
IHI Triple Aim
-population health -experience of care -per capita cost
rate setting
Government could set targets or caps for spending on health care services
IHI
Institute for Healthcare Improvement
PPACA =
Patient Protection and Affordable Care Act goal to decrease amount of uninsured
outpatients
Patients who do not require hospitalization but are under a physician's care
prospective payment plans
Pay by diagnosis: If care costs less, the agency absorbs the costs/ if care costs more, the agency covers the costs
HMOs (health maintenance org)
Prepaid care plans to receive all medical services through a group of affiliated providers
medicare vs medicaid
Provided health care to elderly vs. Provided health care to poor people
managed care
Provider receives a predetermined capitated payment for each patient.
medical neighborhood
a patient-centered medical home and the constellation of other clinicians providing health care services to patients within it
PPOs (preferred provider organizations)
a prepaid group practice to provide service at lower fee in return for prompt payment & guaranteed patient volume
hospice
a type of end-of-life care for persons who are terminally ill
Which government policy addresses penalizing hospitals for readmissions of clients with certain diagnoses within 30 days after discharge?
affordable care act
comparative effectiveness analysis
assess and weigh the benefits and costs of new technologies make decisions about whether a medical benefit is worth the cost and whether it should be covered by a public or private insurance program
Based on the Patient Protection and Affordable Care Act (ACA), nurses are to assume an important new role in health care. Which is an example of this new role?
collaborate with agencies to provide for client's home health needs
What is the goal of this health insurance coverage concept?
comparison of available health care plans
single-payer system
one entity (ex government) collects all healthcare fees & pays out costs
multipayer system
care is paid for by both private insurance companies and the government
respite care
care provided for caregivers of homebound ill, disabled, or elderly patients
extended-care services
caregivers that provide medical and nonmedical care for people with chronic illnesses who are unable to care for themselves independently
DRGs (diagnosis-related groups)
classification of patients by major medical diagnosis for the purpose of standardizing health care costs
care coordination
deliberate organization of patient care activities between two or more participants (including the patient)
health insurance marketplace
designed to help people more easily find health insurance that fits their budget and needs
The growth in home health care is largely attributed to which factor?
early discharge of patients from hospital settings
high reliability organizations
operate in a complex, high-hazard domain for an extended period without serious accidents or catastrophic failures
Capitation
gives providers a fixed amount per enrollee of health plan
healthy people 2030
goals will be focused on reducing health problems based on current trends client's health is affected by social, economic, and political factors
ACO (accountable care organization)
group of health care entities organized to deliver most efficient healthcare for specific pop
ambulatory care
health care settings located in areas that are convenient for people to walk into and receive care
ANA (american nursing association) main goal =
health promotion
palliative care
hospice care goal of giving patients with life-threatening illnesses the best quality of life they can have through the aggressive management of symptoms
The diagnostic-related group is a part of which health care system?
medicare
Third-party payer
members pay monthly premiums in combination with employer payments
primary vs secondary vs tertiary healthcare
primary: common health problems secondary: problems require more specialized tertiary: management of rare disorders
entitlement reform
proposed legislation making changes in entitlement benefits such as Medicare and Medicaid paid by the government to citizens, with the goal of improving the nation's budget
medicare bases fee for payment on what
prospective payment plan based on predetermined fixed costs
medicare
provide health courage to all social security recipients
Bundled Payments
provider receives a fixed sum of money to provide a range of services
community health centers
regionalized services for vulnerable geographic populations with an emphasis on primary care and education
aging in place
remaining in the same home and community in later life, adjusting but not leaving when health fades
Value-based purchasing
requires Medicare and Medicaid Services to redistribute a portion of the payments to hospitals based on performance on quality measures
extended care
services that meet the health needs of clients who no longer require acute hospital care but require rehabilitation/nursing care
benefits to hospital at home program
shorter lengths of stay
parish nursing
specialty nursing practice emphasizes holistic care
fee-for-service
system in which a bill is generated and a fee is paid every time a provider does something for a patient
Which statement regarding health care reform trends is most accurate?
systems are in place to pay for performance and penalize hospitals for excessive readmissions
CHIP (Children's Health Insurance Program)
targets uninsured children whose families don't qualify for Medicaid
quality in healthcare
the degree to which health services for individuals and populations increase the likelihood of desired health outcomes
medicaid
to make health care available to those who do not qualify for medicare
pay for performance
using financial incentives to reward providers for achieving a range of payer objectives
hospital at home program
when patients are treated in own homes by appropriate health care professionals
