works to improve quality to the nursing home and extended care facility industry
managed care
provide cost-effective, quality care for groups of clients
case management
range of models for combining healthcare services for individuals or groups
clinical pathways
tracks the client's progress, planning care, and provides client teaching and discharge planning
client-focused care
brings all services and care providers to the clients
case method
one nurse is responsible for a group of clients during an 8 or 12-hour shift
fuctional method
focuses on the jobs to be completed
team nursing
nursing team led by a professional nurse; members use diverse skills and education to deliver client care
primary nursing
one nurse is responsible for total care of a number of clients 24 hours a day, 7 days a week
Medicare
provided a national and state health insurance program for older adults (Social Security Act)
Medicaid
(federal public assistance program)insurance for people who require financial assistance. paid by general taxes
Supplemental Security Income (SSI)
benefits for people with disabilties who are not eligible for social security
prospective payment system (PPS)
limit how much is paid to hospital by medicare.
diagnostic-related groups (drgs)
classifies clinical conditions used for reimbursement by medication to health facilities.
health maintenance organization (hmo)
provides basic health care. fee is set without knowledge of the patients amount or kind of service.
preferred provider organization (PPO)
group of physicians and perhaps a healthcare agency (often hospitals) that provide an insurance company or employer with health services at a discounted rate
preferred provider arrangements (PPAs)
similar to a PPO but can be contracted with individual healthcare providers, rather than an organization of healthcare providers
independent practice associations (IPAs)
similar to an HMO or PPO except that an IPA's clients pay a fixed prospective payment to the IPA, and the IPA pays the provider
Integrated delivery System (IDS)
incorporates acute care services, home health care, extended and skilled care facilities, and outpatient services to provide care throughout the life span