Chapter 2: Overview of the healthcare today

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Accepting assignment

Providers of medical services agreeing that the receipt of payment from Medicare for a professional service will constitute full payment for that service

Accreditation

Recognition that a health care organization has met an official standard

Acute care

Level of health care, generally provided in hospitals or emergency departments,for sudden, serious illnesses or trauma

Attending physician

Term applied to a physician who admits and is responsible for a hospital patient

Capitation

Payment method whereby the provider of care receives a set dollar amount per patient,regardless of services rendered

Case manager

Health care professional and expert in managed care who assists patients in assessing health and social service systems to ensure that all required services are obtained;coordinates care with doctor and insurance companies

Catastrophic coverage

Coverage at Medicare beneficiary has after reaching a certain amount of "out of pocket" monies paid for their medications during the temporary coverage gap. The beneficiary will pay a coinsurance amount.

Chief executive officer

Individual in direct charge of a hospital who is responsible to the governing board

Chiropractic medicine

Complimentary and alternative health care profession with the purpose of diagnosing and treating mechanical disorders of the spine and musculoskeletal system with the intention of affecting the nervous system and improving health

Chronic care

Care for illnesses of long duration, such as diabetes or emphysema

Community health

Concerned with the members of a community with emphasis on orienting and early detection of disease

Coverage gap

Sometimes called a "donut hole"; a temporary coverage gap in Medicare that occurs after the beneficiary has accumulated a certain amount of money in total prescription drug expenses.

Custodial care

Unskilled care given for the primary purpose of meeting personal needs, such as bathing and dressing

Diagnosis-related groups

Classsification system used to determine payments from Medicare by assigning a standard flat rate to major diagnostic categories. This flat rate is paid to hospitals regardless of the full cost of the services provided

Governing board

Group of community citizens at the head of the hospital organizational structure

Health maintenance organization

Organization that has management responsibility for providing comprehensive health care services on a prepayment basis to voluntarily enrolled persons within a designated population

Home health

Equipment and services provided to patient in-home to ensure comfort and care

Homeopathic medicine

Alternative medical system. A belief that "like cures like", meaning that small, highly dwiluted quantities of medicinal substances are given at higher or more concentrated doses would actually cause those symptoms.

Hospice

Supportive care for terminally I'll patients and their families

Hospitalist

Full-time, acute care specialist who focuses exclusively on hospitalized patients

Inpatient

Patient who has been admitted to a health care facility for at least 24 hours for treatment and care

Integrated delivery networks

Health care organizations merged into systems that can provide all needed health care services under one corporate umbrella

International statistical classification of diseases and related health problems

Detailed description of known diseases and injuries. Each disease(or group of related diseases) is described with its diagnosis and is given a unique code, up to six characters long. Published by the world health organization

Magnet status

Award given by the American nurses credentialing center to the hospitals that satisfy a set of criteria designed to measure their strength and quality of nursing

Managed care

The useof panned and systematic approach to providing health care, with the goal of offering quality care at the lowest possible cost

Medicaid

Federal and state program that provides medical assistance to the indigent

Medical savings accounts (MSAs)

Tax exempt bank accounts that are owned by an individual and managed by a financial institution.

Medicare

Government insurance; enacted in 1965 for individuals older than the age of 65 and any person with a disability who has recieved who has recieved social security benefits for 2 years (some disabilites are covered immediately)

Medicare supplement

Private insurance plan available to medicare-eligible persons to cover the costs of medical care not covered by medicare.

Merger

The combining of individual physician practices and small, stand-alone hospitals into larger networks

Naturopathc Medicine

Alternative medical system that proposes that there is a healing power in the body that establsihes,maintains, and restores health. Treatments include nutrition and lifestyle counseling, nutrional supplements, medicinal plants, exercise, homeopathy, and treatments from traditional chinese medicine.

Outpatient

Patient who receives care at a health care facility but is not admitted to the facility for 24 hours

Primary care physician

Sometimes referred to as "gate keepers," these general practitioners are the first physicians to see a patient for illness

Propietary

For profit

Resident

A graduate of a medical school who is gaining experience in a hospital

Robotic Surgery

The use of robots in performing surgery

Surfing the web

Using different websites on the internet to locate information

Triage

Nursing interventions. Classification defined as the establishing priorities of patient care, usually according to a three-level model: emergent, urgent, and nonurgent

Voluntary

Not for profit

Web Address (URL, or uniform resorce locator)

Keywords that when entered after "http;//www..." on the Interet will take the user to a specified location, referred to as a website.

ANA

American Nurses Association

ANCC

American Nurses Credentialing Center

CCM

certified case manager

CEO

chief executive officer

CFO

chief operating officer

COO

chief operating officer

DO

doctor of osteopathy

DRG

diagnosis-related group

DSU

day surgery unit

ECF

extended care facility

ED

emergency department

ER

emergency room

HIMS

health information management system

HMO

health maintenence organization

HO

house officer

ICD

International Classification of diseases and related health problems

LTC

Long-term care

MD

medical doctor

Neuro

neurology

OB

obstetrics

OR

operating room

Ortho

orthopedics

PACU

postanesthesia care unit

PCP

primary care physician

Peds

pediatrics

PPO

preferred provider organization

Psych

psychiatry

RR

recovery room

SAD

save a day (patient admitted the day of surgery)

SDS

same-day surgery (patient admitted on the day of surgery)

SNF

skilled nursing facility

Surg

surgical

TJC

The joint commission (formerly the Joint commission on accreditation of health care organizations [JCAHO])

UCR

usual, customary, and reasonable

WHO

World health organization

www

World Wide Web

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