Allied Health

Allied Health

1. United States Health Care System

   • Purpose
     • Improve health for populations seeking care through Health Care professionals
   • 9 Settings Professionals Work
     • Ambulatory Care Centers (Community Centers)
       • Provide consultation, treatment, and medication using advanced medical technology. (Outpatient Care)
         • - Minor Surgeries/ Procedures - Therapies -Diagonostic Testing - Preventative Services
     • Acute Care Hospitals (Hospitals)
       • Provide care for individuals who have a disease that comes on quickly or that lasts for a short period of time.
         • - Technical equipment - Phamaceuticals - Medical Supplies - Medical staff and all neccessary personnel
         • - Diagnosis Illness - Care/ Treat acute conditions/ injuries
         • - Proprietary (for profit) - Nonprofit (charity based) - Government supported
     • Long- Term Care Agencies
       • Skilled nursing facilities
         • Provide care that requires skills of a licensed personnel, physical therapist or occupational therapy aide.
           • Regain skills such as feeding, dressing, and bathing themselves.
       • Assisted Living facilities
         • Bridge the gap between home care and nursing homes, provide a homelike enviornment
       • Hospice Care
         • Caring for the physical and emotional needs of terminal illnesses
           • Provides Care within patients home
     • Home Care
       • Supportive care within patients home
     • Doctor's Offices
       • Medical facilities in which medical doctor receives and treats patients
         • 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).
     • Specialty Hospitals
       • specialized care to specific patients, populations, or diseases
         • Pediatrics- (Children 1-18), Geriatrics (Adults 65+), Oncology (Cancer), Cardiology (Heart)
     • Health Maintenance Organizations (HMOs)
       • 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.
         • Medical biller & medical coder, Medical Assistant, Medical Transcriptionist, Pharmacy Technician, Optician
     • Rehabilitation Centers
       • Aide patients to return to their highest state of optimal health after illness or injury.
         • 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.
         • Occupational therapy aides- motion exercises, splinting to support an injury, and wound care.
           • Activities of Daily Living (ADL)
         • Speech pathology assistants- directly under licensed speech pahtologists.
     • Hospice Care (Palliative Care)
       • Critically ill- supportive treatment, alleviate their pain, and provide comfort when needed.
   • Health Maintenance Organizations (HMOs)
   • Group of people, agencies, and/or instutions that provide health care services to individuals
   • Private Sector Businesses

2. Health Insurance (Health Benefits/ Health Coverage)

   • Provides patients with a means to pay the costs associated with medical care and services.
   • Public Insurance
     • Affordable Care Act (ACA)- Act signed in 2010 to increase the quality of affordability of health insurance
       • 7 Major Changes
         • Up to age 26 able to stay on their parents health insurance
         • Preexisting Condition Insurance Plan (PCIP)- allows people with preexisting conditions to qualify
           • Children can't be denied
         • Reimburse health care providers to cover eary retirees until benefits of the ACA (01/14), 55-65
         • ACA addresses shortage of health care providers in rural areas
         • Insurance companies are required to explain the costs of insurance premiums
         • Medicaid eligibility numbers have increased for each state
         • Additional funding for building community health centers
       • How does the ACA protect health consumers?
         • Insurance companies held accountable. Not allowed to deny paying claims, create maximum annual payment limits, create lifetime payment limits
       • How does the ACA benefit senior citizens?
         • Free preventative care such as wellness checkups, Access to a community transition program- patient navigators assist seniors in accessing services within their communities
       • What is the Independent Payment Advisory Boards (IPAB)?
         • Reduce costs, eliminate waste, improve health care for seniors
       • Accountable Care Organization (ACOs)- Providers volunteering to give high quality care to their Medicare patients; Avoiding unnecessary duplication of services and preventing medical errors
       • 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.
       • 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.
     • Government Health Insurance
       • Medicaid- state-run government program that helps people with lower incomes pay for medical care
         • Children's Health Insurance Program (CHIP)
           • Families who don't have coverage
             • Pays only $50 annually as well as co-pays
         • Largest source of funding for health insurance for low income families
         • Funded by both federal and state govemments, managed at state level
         • Individual/ family salary below poverty level
       • Medicare- federal program for people 65+, younger with disabilities, people with end-stage renal disease (E SRD)
         • Previously worked and paid taxes to the government
         • Medicare Part A- inpatient hospital coverage, skilled nursing care, nursing home care, and hospice care
         • Medicare Part B- outpatient services, lab tests, visits to doctor, durable medical equipment (DME), ambulance and preventative services
         • Medicare Part C (Medicare Advantage Plan)- includes prescription drug coverage, ran by private companies, combines coverage provided with A & B
         • 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
         • 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
       • Tricare
         • Military
         • Department of Defense
       • Federal Employees Health Benefits (FE HB)
       • Indian Health Services (IHS)
       • Veteran's Health Care for military veterans
   • Private Insurance
     • Health Care Maintenance Organizations (HMOs)
       • Low or No Premiums, Lower Out of Pocket Costs, Lower Copayments, Smaller Network, Does not cover Out of Network
       • 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.
     • Preferred Provider Organizations (PPOs)
       • Out of Network Coverage, State or Nationwide, Provider Network, No Referrals to See Specialists, Easy to Use
       • Agreement between entities such as hospitals, doctors, surgery centers, and insurance agencies to provide health care at a reduced amount.
     • Point of Service- choose between an HMO or PPO each time they receive.
     • Provided by employers and other organizations
   • Costs of Insurance
     • Deductible- minimum amount payed out of pocket before a health isurer will pay any expenses to health care provider
     • Copayment (Copay)- predetermined amount defined by health insurer paid each time a health service is accessed.
     • Coinsurance- refers to splitting the cost between individuals and their insurance carrier

3. Cultural Differences

   • Communication Methods
     • Health Care Careers
       • Health Care Worker
       • Community Settings
       • Hospital Environment