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Chapter 1 Health Care Delivery System
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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/