Term
| History of Health Care financing |
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Definition
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Term
| Medicare was introduced in what year |
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Definition
1965
paid for everything, led to dr abusing system which led to DRGS |
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Term
DRG
Diagnosis Related Grouping introduced in what year? |
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Definition
| 1983, as an attempt to reduce health care costs |
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Term
| How is payment determined for DRGs? |
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Definition
| reimbursement given for diagnosis based on research for average costs |
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Term
| Managed Care Organization |
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Definition
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Term
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Definition
| Health Maintenance Organization |
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Term
Preferred Provider Organization
Patient Pays Less |
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Definition
PPO
Utilizes peer review
Monitors overuse
retrospective payment |
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Term
| Problems with access to health care |
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Definition
| Lack of insurance, helped by Medicaid program |
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Term
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Definition
| Antidumping laws, illegal to transfer a pt based on financing |
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Term
| What are 3 types of health care financing? |
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Definition
MSA- Medical savings account
Private Insurance
Public Insurance (medicare and Medicaid) |
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Term
| How does payment mode effect patient care? |
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Definition
| Private pay would be more selective of procedures based on cost, but payment method should not effect pt care |
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Term
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Definition
| first step into health care system, tests, x rays and possible specialist referrals |
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Term
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Definition
| intensive care, ER, Med/Surg, OB |
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Term
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Definition
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Term
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Definition
usually long term
Ex. Home IV therapy |
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Term
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Definition
| assures medical necessity of tests, xrays, medications etc |
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Term
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Definition
| initial decision of UR challenged, taken to the next step |
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Term
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Definition
est 1951
sets standards of care |
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Term
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Definition
Should meet the needs of patient
Nurse patient ration |
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Term
| Patient classification system |
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Definition
nurse determines acuity level on each patient
higher the acuity more staff needed
staffing needs change every four hours |
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Term
| Happy nurses make better employees!! |
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Definition
Creative scheduling
Competitive wages
adequate staffing increases pt satisfaction as well |
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Term
| Total Patient Care Advantages |
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Definition
Holistic
Unfragmented
Good RN to RN shift reports
Nurse maintains high autonomy
Lines of responsibility and accountability are clear |
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Term
| Total Patient Care Disadvantages |
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Definition
Costly due to number of RNs required
RN availability due to shortages |
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Term
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Definition
evolved during WWII due to shortage
LPN and CNA provide care
Staff members complete tasks for group of patients |
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Term
| Advantages of Functional Nursing |
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Definition
Economic and effective
Minimum amt of RNs needed
Tasks are completed quickly
Little confusion about job responsibilities |
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Term
| Disadvantage of functional nursing |
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Definition
Care may be fragmented
too many workers per patient
patient may be confused about who does what
caregivers unchallenged by repetitive functions |
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Term
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Definition
reduce fragmented care, utilizes team leader to coordinate team activities
Leads to good patient care |
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Term
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Definition
High quality, comprehensive care given
Whole team involved in problem solving |
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Term
| Team Nursing Disadvantages |
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Definition
Continuity of care suffers if team assignments vary
Team leader may not have the leadership skills required to direct the team
Insufficient time for care planning and communication leads to unclear goals |
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Term
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Definition
Modified team approach
Team assigned to each module |
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Term
| Advantage of modular nursing |
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Definition
continuity of care provided when assigned to same module
RN more involved in planning care
Geographical closeness
More efficient communication saves times |
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Term
| Disadvantage of modular nursing |
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Definition
Costs can increase to stock each module
Long corridors not conducive module nursing |
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Term
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Definition
RN Case Manager coordinates patient care throughout hospitalization
Assess
Plan
Implement
Evaluate
Interaction |
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Term
Case manager's assessment
What is going on in patient's community |
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Definition
Diagnosis
Support system
Financial resources |
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Term
Case manager planning
Involve anyone involved in providing care |
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Definition
Analysis of data
Client centered
Input from family members and potential caregivers |
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Term
| Case manager implementation |
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Definition
Plan of care into action
Keep family and patient informed |
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Term
| Evaluation by case manager |
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Definition
Monitor established outcomes and monitor progress
Chart audits |
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Term
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Definition
| good communication between caregivers |
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Term
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Definition
Based on EBP
Recipe card for treatment of predicable diagnosis
Road map for care
any variance is investigated- direct effect of reimbursement |
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