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