Allied Health

Allied Health

United States Health Care System
1. Purpose
  1. Improve health for populations seeking care through Health Care professionals
2. 9 Settings Professionals Work
  1. Ambulatory Care Centers (Community Centers)
    1. Provide consultation, treatment, and medication using advanced medical technology. (Outpatient Care)
      1. - Minor Surgeries/ Procedures - Therapies -Diagonostic Testing - Preventative Services
  2. Acute Care Hospitals (Hospitals)
    1. Provide care for individuals who have a disease that comes on quickly or that lasts for a short period of time.
      1. - Technical equipment - Phamaceuticals - Medical Supplies - Medical staff and all neccessary personnel
      2. - Diagnosis Illness - Care/ Treat acute conditions/ injuries
      3. - Proprietary (for profit) - Nonprofit (charity based) - Government supported
  3. Long- Term Care Agencies
    1. Skilled nursing facilities
      1. Provide care that requires skills of a licensed personnel, physical therapist or occupational therapy aide.
        Regain skills such as feeding, dressing, and bathing themselves.
    2. Assisted Living facilities
      1. Bridge the gap between home care and nursing homes, provide a homelike enviornment
    3. Hospice Care
      1. Caring for the physical and emotional needs of terminal illnesses
        Provides Care within patients home
  4. Home Care
    1. Supportive care within patients home
  5. Doctor's Offices
    1. Medical facilities in which medical doctor receives and treats patients
      1. Physicians- Medical Doctors (MD), Doctors of Osteopathy (Therapy)
        Chiropractors- Back/ Musculoskeletal (Limited to prescribing and diagnosing
        Nurse- Master's of doctoral in nursing (prescribe under guidance of physician
        Physician's assistants (PAs)- BA & 2 years of PA School (prescribe under guidance of physician
        Medical Administrative Assistants (MAAs)
        Medical Assistant (MAs)- clinical duties under a physician, nurse practitioner, or PA (Vital signs, sterilize, assist in procedures, take electrocardiograms (E KG).
  6. Specialty Hospitals
    1. specialized care to specific patients, populations, or diseases
      1. Pediatrics- (Children 1-18), Geriatrics (Adults 65+), Oncology (Cancer), Cardiology (Heart)
  7. Health Maintenance Organizations (HMOs)
    1. Provide health care options at reduced costs, arrange for the provision of health care through a prepaid plan that provides through networks of doctors and hospitals.
      1. Medical biller & medical coder, Medical Assistant, Medical Transcriptionist, Pharmacy Technician, Optician
  8. Rehabilitation Centers
    1. Aide patients to return to their highest state of optimal health after illness or injury.
      1. Physical therapist aides- work with physical therapists to provide care with ambulation (moving from place to place), bend mobility and transfer, exercises to promote physical strength, pain relief techniques.
      2. Occupational therapy aides- motion exercises, splinting to support an injury, and wound care.
        Activities of Daily Living (ADL)
      3. Speech pathology assistants- directly under licensed speech pahtologists.
  9. Hospice Care (Palliative Care)
    1. Critically ill- supportive treatment, alleviate their pain, and provide comfort when needed.
3. Health Maintenance Organizations (HMOs)
4. Group of people, agencies, and/or instutions that provide health care services to individuals
5. Private Sector Businesses
Health Insurance (Health Benefits/ Health Coverage)
1. Provides patients with a means to pay the costs associated with medical care and services.
2. Public Insurance
  1. Affordable Care Act (ACA)- Act signed in 2010 to increase the quality of affordability of health insurance
    1. 7 Major Changes
      1. Up to age 26 able to stay on their parents health insurance
      2. Preexisting Condition Insurance Plan (PCIP)- allows people with preexisting conditions to qualify
        Children can't be denied
      3. Reimburse health care providers to cover eary retirees until benefits of the ACA (01/14), 55-65
      4. ACA addresses shortage of health care providers in rural areas
      5. Insurance companies are required to explain the costs of insurance premiums
      6. Medicaid eligibility numbers have increased for each state
      7. Additional funding for building community health centers
    2. How does the ACA protect health consumers?
      1. Insurance companies held accountable. Not allowed to deny paying claims, create maximum annual payment limits, create lifetime payment limits
    3. How does the ACA benefit senior citizens?
      1. Free preventative care such as wellness checkups, Access to a community transition program- patient navigators assist seniors in accessing services within their communities
    4. What is the Independent Payment Advisory Boards (IPAB)?
      1. Reduce costs, eliminate waste, improve health care for seniors
    5. Accountable Care Organization (ACOs)- Providers volunteering to give high quality care to their Medicare patients; Avoiding unnecessary duplication of services and preventing medical errors
    6. IPABs & ACOs monitor health care reimbursement. Process follows: 1) Medical Billers and coders submit claims for Medicare patients. 2) Boards make projections about the amount spent on reimbursement for supplies and services for Medicare patients.
    7. Methods to increase access to health care through Medicaid: - Doctors receive higher reimbursement rates, more individuals are also eligible to receive Medicaid coverage. - Individual states receiving incentives to expand Medicaid coverage - Individuals receive tax incentives enrolling in health care plans. - Health Insurance Marketplace allow individuals and businesses to apply for affordable health insurance.
  2. Government Health Insurance
    1. Medicaid- state-run government program that helps people with lower incomes pay for medical care
      1. Children's Health Insurance Program (CHIP)
        Families who don't have coverage
        Pays only $50 annually as well as co-pays
      2. Largest source of funding for health insurance for low income families
      3. Funded by both federal and state govemments, managed at state level
      4. Individual/ family salary below poverty level
    2. Medicare- federal program for people 65+, younger with disabilities, people with end-stage renal disease (E SRD)
      1. Previously worked and paid taxes to the government
      2. Medicare Part A- inpatient hospital coverage, skilled nursing care, nursing home care, and hospice care
      3. Medicare Part B- outpatient services, lab tests, visits to doctor, durable medical equipment (DME), ambulance and preventative services
      4. Medicare Part C (Medicare Advantage Plan)- includes prescription drug coverage, ran by private companies, combines coverage provided with A & B
      5. Medicare Part D (Medicare Prescription Drug Benefit)- subsidizes the costs of prescription drugs and premiums
        Can be purchases in 1) separately as only Medicare D 2) in addition to Medicare Part C
      6. Diagnosis- related Groups (DRGs)
        Use a formula to calculate reimbursement for providers in acute care settings
        Principal Diagnosis- Primary condition that led to the patient being admitted to the hospital
        Secondary Diagnoses- complications that may affect the patients course of treatment or prolong stay
        Factors Used to Calculate DRGs
        Severity of Illness
        Risk of Mortality
        Prognosis
        Treatment Difficulty
        Need for Intervention
        Resource Intensity
    3. Tricare
      1. Military
      2. Department of Defense
    4. Federal Employees Health Benefits (FE HB)
    5. Indian Health Services (IHS)
    6. Veteran's Health Care for military veterans
3. Private Insurance
  1. Health Care Maintenance Organizations (HMOs)
    1. Low or No Premiums, Lower Out of Pocket Costs, Lower Copayments, Smaller Network, Does not cover Out of Network
    2. Provides or arranges managed care for health insurance, self funded health care benefit plans, individuals, and other entities. Acts as a liaison with health care providers on a prepaid basis.
  2. Preferred Provider Organizations (PPOs)
    1. Out of Network Coverage, State or Nationwide, Provider Network, No Referrals to See Specialists, Easy to Use
    2. Agreement between entities such as hospitals, doctors, surgery centers, and insurance agencies to provide health care at a reduced amount.
  3. Point of Service- choose between an HMO or PPO each time they receive.
  4. Provided by employers and other organizations
4. Costs of Insurance
  1. Deductible- minimum amount payed out of pocket before a health isurer will pay any expenses to health care provider
  2. Copayment (Copay)- predetermined amount defined by health insurer paid each time a health service is accessed.
  3. Coinsurance- refers to splitting the cost between individuals and their insurance carrier
Cultural Differences
1. Communication Methods
  1. Health Care Careers
    1. Health Care Worker
    2. Community Settings
    3. Hospital Environment

Next up

Description

Resource summary

Similar

	Created by Casey Jones about 6 years ago