Chapter 1 Health Care Delivery System

Chapter 1: Health Care Delivery System

Chapter Outline Key Terms Objectives Intro History of Medicine Health Care Delivery in the United States Continuum of Care Health Care Facility ownership Health Care Facility Organization Structure and Operation Licensure, Regulation and Accreditation

Objectives Define Key Terms Summarize the history medicine and the delivery of health care in the United States List programs and services offered as part of the continuum of care Differentiate between for-profit and not-for-profit health care facility ownership Interpret the authority and responsibility associated with a health care facility's organizational structure Define and provide examples of licensure, regulation, and accreditation Differentiate among health care providers and their disciplines

Chapter Review Homework True/False: Indicate whether each statement is true (T) or false (F). 1. Administrative simplification regulations that govern privacy, security, and electronic transactions standards for health care information were mandated by the Health Insurance Portability and Accountability Act. True 2. Anton van Leeuwenhoek established the germ theory of disease. False 3. Diagnosis-related groups required hospitals to be reimbursed a per diem amount. True 4. Hippocrates was the first physician to consider medicine a science and art separate from the practice of religion. True 5. Medicare, also known as Title 19, was established to provide comprehensive health care to people 65 years of age older, certain younger people with disabilities, and people with End-Stage Renal Disease. False 6. The American Medical Association was established in 1901 as a national organization of state and local associations. False 7. The AMA developed the Minimum Standard for hospitals to outline protocol for on-site inspections of hospitals. False 8. The Centers for Medicare and Medicaid Services (CMS) was previously known as the Health Care Financing Administration. True 9. The primary purpose of the Joint Commission is to provide voluntary accreditation. True 10. Tertiary care centers include services such as neurosurgery, radiation oncology, and pediatric surgery. True Multiple Choice: Select the more appropriate response. 11. Which is a characteristic of a governing board? a. It is also known as the medical staff. b. Its membership is represented by professionals from the community. c. It is responsible for administering care to patients. d. It reports directly to the medical staff and administration. 12. A patient is seen in the emergency department with glass in her eye. The attending emergency department physician feels it is necessary for the patient to be seen by a specialist. The specialist that most likely would see the patient would be from a. Anesthesiology b. Dermatology c. Ophthalmology d. Urology 13. The medical staff committee that reviews and medical staff application data is the a. Credentials committee b. Infection control committee c. Joint conference committee d. Tissue review committee 14. Which of the following is a function of the admitting department? a. Registers inpatient and outpatients. b. Provides patients with names of individuals who will sign an advance directive. c. Obtain patient signature for surgical consents. d. Document admission orders in the patient record. 15. Someone who is responsible for working with case managers of insurance companies to determine the appropriateness of admissions is employed in which hospital department. a. Admitting b. Community relations c. Nursing d. Utilization management 16. Health information management services include which of the following? a. Patient billing b. Coding and abstracting c. Patient registration d. Discharge planning 17. The assembly and analysis of discharged patient records is called a. Abstracting b. Document conversion c. Image processing d. Incomplete-record processing 18. The CPT coding book is published annually by the AMA to assign what type(s) of code? a. Diagnostic b. Diagnostic and procedure c. Procedures and durable medical equipment d. Procedures and services 19. A hospital committee that is responsible for analyzing trends of accidents and establishing priorities for dealing with high-risk areas is a. Disaster control b. Risk management c. Safety management d. Utilization review 20. United States health care delivery has been impacted by which of the following? a. Decreasing health care costs b. Absence of medical necessity requirements c. Review of appropriateness of admissions d. Lack of quality and effective treatments. Fill-in-the-Blank: Enter the appropriate term(s) to complete each statement below. 21. The private not-for-profit organization established to assess and report on the managed care plans is called ___Medicare_____. 22. Health care consumers are ___better___ educated and demand higher __quality__ health care. 23. The implementation of standards of sanitation, ventilation, hygiene, and nutrition occurred during ___Modern_____ medicine. 24. An oath that was adopted as an expression of early medical ethics is known as _Hippocratic Oath_. 25. In the middle Ages, the care of patients was based on charity and was often managed by __monks and nuns______. 26. French physicians Pierre and Marie Curie, in 1898, discovered that ___radium_____ provided a powerful weapon against cancer. 27. Benjamin Franklin founded ___Pennsylvania Hospital_____, the first United States Hospital. 28. Services that included preventive and acute care and are provided by a general practitioner are known as __Primary care______ services. 29. A hospital that is privately and whose excess income is distributed to shareholders and owners is a __for-profit______ hospital. 30. Health care information can be released on with patient’s _written request__ or by a _physician__. Short Answer: Briefly respond to each question. 31. Define the term multidisciplinary as it relates to hospital committees, and list at least three hospital committees. Multidisciplinary Definition: Combining or involving several academic disciplines or professional specializations in an approach to a topic or problem (Google, 2015). In hospitals, usually outside agencies and organizations are contacted to provide certain services, but some hospitals are multidisciplinary, where medical staff and hospital departments can easily provide certain services instead of hiring an outside organization. 32. Describe the uses of diagnosis and procedure indexes. 33. Compare the terms electronic signature and digital signature. A digital signature is a type of electronic signature that uses public key cryptography to authenticate a document or message. An electronic signature refers to the various methods of to authenticate an electronic document like a typed signature at the end of an email, or a scanned copy of a handwritten signature attached to a document, or a pin to identify the sender to the recipient. 34. Describe three contract services that a health information department would use. The following are some contract services that HI departments would use: a) Master Patient Index (MPI) Duplication Review: software that companies use to identify, correct and eliminate duplicate MPI records. b) Medical Transcription: local and national medical transcription services that provide internet-based and pickup/delivery of medical transcription to health care facilities. c) Release of Information Processing: use of an outside copy service to process release of information requests. 35. Distinguish between the terms regulation and accreditation. A regulation is an interpretation of the law that is written by the responsible regulatory agency and accreditation is a voluntary process that a health care facility or organization undergoes to demonstrate that it has met the standards beyond those required by law. 36. List the types of organizations that The Joint Commission accredits. a) General, psychiatric, children’s and rehabilitation hospitals b) Critical access hospitals c) Medical equipment services, hospice services and other home care organizations d) Nursing homes and other long term care facilities e) Behavioral health care organizations, addiction services f) Rehabilitation centers, group practices, office-based surgeries and other ambulatory care providers g) Independent or freestanding laboratories (HOSPA, 2015) 37. Explain the relationship between abstracting and the generation of diagnosis and procedure indexes. Abstracting, generation of diagnosis and procedure indexes are part of the Healthcare facility organization and structure. Abstracting is part of the coding process, abstracting is performed to enter codes and other pertinent information with the use of computer software. The diagnosis and procedures done to the patient all fall under this coding system. 38. Compare primary care, secondary care and tertiary/quaternary care services. Include an example of each service. Primary care services include preventive and acute care. For example. Annual physical examinations. Secondary care services are provided by medical specialists or hospital staff members to a patient whose primary care was provided by a general practitioner who first diagnosed or treated the patient. Example: A patient seen by the primary practitioner for an eye injury. They refer the patient to an eye specialist. Tertiary care services are provided by specialized hospitals equipped with diagnostic and treatment facilities not generally available at hospitals. Example: Cardiothoracic and vascular surgery. Quaternary care is an extension of tertiary care and includes advanced levels of medicine that are not widely used and very expensive: Example: Experimental medication 39. Differentiate between a proprietary and a voluntary hospital. Proprietary hospitals are for-profit and owned by corporations. Voluntary Hospitals are not-for-profit and are usually operated by religious or other volunteer groups 40. Summarize the purposes of record circulation. Record circulation occurs when an inpatient is readmitted, when there are scheduled or unscheduled outpatient visits, for authorized quality-management studies or for education and research purposes. References Google. (2015, August 20). Google web search. Retrieved from Google: https://www.google.com/webhp?sourceid=chrome-instant&ion=1&espv=2&ie=UTF-8#q=define%20multidisciplin... HOSPA. (2015, August 20). The Joint Commission of Accreditation of Health Care Organizations (JCAHO). Retrieved from Hospital Alliance Association: http://hospaa.org/the-joint-commission-on-accreditation-of-health-care-organizations-jcaho-2/