INTRODUCTION TO THE HEALTH CARE ENVIRONMENT
Study Questions
INTRODUCTION TO THE HEALTH CARE ENVIRONMENT
Study Questions
1a. American Medical Association (AMA)
The AMA's stated mission is to promote the art and science of medicine for the betterment of the public health, to advance the interests of physicians and their patients, to promote public health, to lobby for legislation favorable to physicians and patients, and to raise money for medical education.
1b. American College of Surgeons (ACS)
The American College of Surgeons is a scientific and educational association of surgeons that was founded in 1913 to improve the quality of care for the surgical patient by setting high standards for surgical education and practice.
1c. American Hospital Association (AHA)
AHA works with its members, state, regional, and metropolitan hospital associations and other organizations to shape and influence federal legislation and regulation to improve the ability of its members to deliver quality health care.
1d. American Nurses Association (ANA)
The American Nurses Association (ANA) is a professional organization to advance and protect the profession of nursing.
1e. Blue Cross / Blue Shield (BC/BS)
The Blue Cross Blue Shield Association (BCBSA) is a federation of 38 separate health insurance organizations and companies in the United States. Combined, they directly or indirectly provide health insurance to over 99 million Americans.
3a. ALOS
Average length of stay in Acute care facilities
(ALOS) = less than 30 days
• General ACF
• Specialty ACF
Define: 3b. acute care facility
Average length of stay (ALOS) = less than 30 days
• General ACF
• Specialty ACF
Define: 3c. ambulatory care facility
Ambulatory care facilities
• No overnight care provided
Long term care facilities
• ALOS = 30 days or more
• Independent Living Facilities
• Assisted Living Facilities
• Nursing Facilities
Define: e. behavioral health facility
Behavioral health facilities
• Diagnostic and therapeutic services for patients with a mental illness or psychiatric-related illness
Define: f. rehabilitation facility
Provide restorative and adjustive services
3g. home care agency
Provided in-home care
skilled and unskilled
3h. hospice agency
Provide paillative and supportive care for the terminally ill
3i. patient
patient who recives services from hospital
3j. client
a pateint who receives mental of health servcies
3k. resident
a patient who resides in a long term care facility
3l. payer
an organization or individual who provides the money to pay for health care services
3m. provider
any entity that provides health care sevices to patients, including health care organizations and health care professionals
3n. skilled nursing unit
Ongoing treatment (i.e., wound care, IV therapy)
ALOS =< 30 days
3o. satellite clinic
a facility owned by a hospital but operated at a distant site
3p. outpatient department
A patient who is receiving or has received health care services without being admitted as an inpatient or resident
3q. acute long term care facility
• Aggressive treatment in a limited setting
• ALOS = > 30 days
A long-term acute care facility is a hospital specializing in treating patients requiring extended hospitalization with an average length stay of at least 30+ days.
3r. inpatient
A patient who is receiving health care services, room, and board in a designated nursing unit
3s. outpatient
A patient who is receiving or has received health care services without being admitted as an inpatient or resident
3t. emergency patient
A patient admitted through the emergency department (ED) for the services provided by that department
3u. observation patient
• Applies to Medicare and Medicaid patients only
• A patient who is admitted for further evaluation to determine the nature of the illness and to identify the appropriate level of care
•Medicare: 48hours
•Medicaid: 23hrs.59min
3v. newborn patient
An infant born in that particular facility
3w. transfer patient
A patient transferred from one hospital service to another within the same facility
3x. private practice
professional who started their own business in their healthcare speciality
3y. primary care
It refers to the work of health care professionals who act as a first point of consultation for all patients within the health care system. Such a professional would usually be a primary care physician, such as a general practitioner or family physician, or a non-physician primary care provider, such as a physician assistant or nurse practitioner.
3z. secondary care
Secondary care is the health care services provided by medical specialists and other health professionals who generally do not have first contact with patients, for example, cardiologists, urologists and dermatologists.
3aa. contiuum of care
Continuity of health care (also called continuum of care)
is to what degree the care is coherent and linked, in turn depending on the quality of information flow, interpersonal skills, and coordination of care
3bb. continuing diagnostic unit
• Unit within or nearby hospital ED
• Provides further evaluation
3cc. critical access hospital
• Rural community hospitals
• Receive cost-based reimbursement
• Offer limited services (acute patient care)
3dd. community health center
community health center is a clinic staffed by a group of general practitioners and nurses.
3ee. observation unit
of the hospital in the unit, for observation of patient who needs assessment, evaluation, or monitoring because of a significant degree of instability or disability that does not require admission to the hospital as an inpatient.
3ff. episode of care
managed care healthcare services provided for a specific illness during a set time period
3gg. trauma center
A hospital equipped toprovide comprehensive emergency medical services to patients suffering traumatic injuries
3hh. tertiary care
Tertiary care is specialized consultative health care, usually for inpatients and on referral from a primary or secondary health professional, in a facility that has personnel and facilities for advanced medical investigation and treatment, such as a tertiary referral hospital.
6. Describe the three categories of non-government owned healthcare facilities.
Proprietary (for profit,private, investorowned)
• Governed by theentity(ies) which ownthem
• Stand-alone or multifacilitycorporations
Not-for-profit(voluntary)
• Religious-affiliated
• Community• Industry, unions, etc.• Universities
Nonprofit • 501(c)3 Charitable organization
7. Describe the three categories of government-owned healthcare facility ownership categories.
Federal -VA, Military finded by fed taxes
State - state psych hosp, funded by state
Local - hospitals, funded by county taxes
8. Admitting Process - Centralized
All patients are admitted through one central admitting department
• Advantages? - Patients are lobbied in one main location for hospital admit
• Disadvantages? - Patients may have t go to another location for specific care
8. Admitting Process - Decentralized
Patients report directly to the appropriate service area of the facility for admission
• Advantages? Streamline process for patients
• Disadvantages? staff needed to trained and updated
11. Define the role of each of the following in healthcare facility administration:
A. Chief Executive Officer :day to day operations, responsibilities as a communicator, decision maker, leader, manager and executor.
b. Chief Financial Officer :officer is also responsible for financial planning and record-keeping, as well as financial reporting to higher management.
c. Chief Operating Officer :is responsible for ensuring that business operations are efficient and effective and that the proper management of resources, distribution of goods and services to customers, and analysis of queue systems is conducted.
d. Chief Information Officer : responsible for the information technology and computer systems that support enterprise goals.
e. Chief Technology Officer: is an executive-level position in a company or other entity whose occupant is focused on scientific and technological issues within an organization.
13. Name the two basic types of health care facility functions or activities, and describe the HIM department’s role in each.
Care of patients and business services of hospital
HIM role in Both
16. State the general function of each department listed on the handout, “Health Care Facility Departments.”
