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OTP 510 - Professional Development Final Exam
Terms in this set (70)
The following describes this managed care principle: Panels of health care providers who are contracted with the Managed Care Organization (MCO) provide services, are open or closed, and go through a credentialing process. The primary care physician serves as a gatekeeper to authorize services.
Limited access to the universe of providers
The following describes this managed care product: This managed care product allows individuals greater control over health utilization and spending. Co-payments, health savings account, and high deductible plans often discourage overuse of services under this product.
Consumer-Directed Health Plans
The following describes this managed care product: This managed care product includes a contract between providers and purchasers. Providers have an increased pool of patients while beneficiaries have a choice of providers within the panel overall offering more choice and flexibility.
Preferred Provider Organizations (PPO)
The following describes this managed care product: This managed care product is a highly aggregated form of managed care. It utilizes a gatekeeper to pre-approve. Beneficiaries access with pre-approval only from providers on a panel.
Health Maintenance Organizations (HMO)
There are 4 models of how provider contracts are established. The following describes this model: This model includes a contract with individual providers or small provider groups. Providers keep individual and group practices and see patients from multiple HMOs.
Independent Practice Associations
The following describes this Managed Care Payment Mechanism: Under this payment system the insurer financial risk is limited. One fee is paid to the provider for a set of services. One payment is made for the entire day or visit inclusive of all procedures.
Bundle Payment System
The following describes this Managed Care Payment Mechanism: Under this payment system payments for treatments are separated. Providers are payed a set sum on a regular basis. Financial risk is almost entirely on the provider.
The following describes this managed care principle: Managed Care Organizations (MCOs) perform utilization reviews, use benchmarking, and case management functions to evaluate the appropriateness of therapy services and coordinate care.
Enhanced quality control procedures
There are 4 models of how provider contracts are established. The following describes this model: Within this model providers are employed by the HMO and receive a salary. The model is highly integrated and beneficiaries must receive coverage at a fixed price within the HMO.
Manged Care limits access to providers with the following:
All of the above (open/closed panels, gatekeeper, and credentialing)
The following criteria is required to be eligible for Medicare services EXCEPT:
Married and a past contributor to Medicare
This part of Medicare covers inpatient hospital care, short term skilled nursing facility care, and home health care/hospice.
Medicare Part A
This part of Medicare covers outpatient, home health, durable medical equipment, prosthetics, and orthotics. Patients are responsible for 20% coinsurance rate under this part of Medicare.
Medicare Part B
The following are true about Medicare in Home Health EXCEPT:
OTs can complete the initial evaluation
The following is true about the Therapy Cap EXCEPT:
OT and SLP are lumped into the same category
Consider that the Utilization Review for fraud and abuse has three levels. The following describes this level: This review occurs onsite and includes a review of patient documentation and billing records.
This prospective payment system is found with the SNF (skilled nursing facility) setting. It pays an all-inclusive amount based on 8 categories that are measured including rehab plus extensive services, behavior problems, reduced physical function, rehabilitation, extensive services, special care, clinically complex, and impaired cognition. This also has been listed as an area of fraudulent action completed in SNF by Medicare as many clients were placed in Ultra highs when not clinically appropriate.
Resource Utilization Group (RUG)
An example of an entitlement program where eligible persons have a guarantee to a defined set of benefits identified in the law.
This is a term for economic resources that are transferred from one group to another group to meet a defined social need.
Major Data Sections for the MDS include all of the following except:
The Patient Protection and Affordable Care Act (PPACA) of 2010 had this impact on Medicaid:
Significantly expanded the coverage of Medicaid
All states are required to cover those who fit the criteria in one or more categories. The following populations are eligible for coverage under Medicaid EXCEPT:
Those with Social Security Income at the Federal Poverty Level
The following is an optional benefit of Medicaid (the rest are mandatory benefits):
This service operates the largest health care system in the US. OTs and PTs are important members of the team. A minimum of 2 years of service and an honorable discharge from the military is required.
This service is an agency of the federal government with health care developed and administered by tribal self-determination. OT and PT may be civilian or commissioned members.
Indian Health Service
There are 2 sets of criteria for Medicaid eligibility including categorical eligibility and medically needy eligibility. One area of categorical eligibility includes income. Income for eligibility for Medicaid is compared to this to determine eligibility:
The Federal Poverty Level (FPL)
This services is for active military personnel and retired military and their families. This service includes 3 insurance options (Prime, Extra, and Standard). This service mandates rehab coverage for its' participants.
According to 2008 records the Service that individuals are utilizing the most through Medicaid is:
This is the group that utilizes Medicaid the most according to 2011 statistics in your text and continues to be the most as of today
This is the provision that prevents an individual from going bankrupt on account of there partners long term care costs:
Spousal Impoverishment protection
Hospital ownership falls under 3 categories. The following describes this category. These hospitals are managed by community boards or religious organizations. Charity care often provides them federal and state tax exemptions.
The following describes this level of care: Care can be provided in an ambulatory or inpatient basis. More intensive care is provided and often over a longer period of time. Often includes chronic conditions requiring continuous care such as arthritis and diabetes.
The following describes this level of care: This level of care is the main entry point into the US health care system. Illnesses are general, episodic, common, and non-chronic in nature. There is a push for OT involvement within this area of care.
Within the article, "Occupational therapy practice in acute physical hospital settings", 4 themes were identified. One theme compared the practice of novice and experienced OTs in acute care. This is the determined outcome of the theme:
Novice therapists note the importance of quality supervision as essential but often feel they do not get it
Within the article, "Occupational therapy practice in acute physical hospital settings", 4 themes were identified. One theme highlighted the personal skills needed and organization factors affecting acute care practice. This was described as an important personal skill to have EXCEPT:
The use of occupational performance within daily interventions and treatments
These are all examples of Post-Acute medical Care except for:
All these services typically fall under Administration in a traditional hospital setting except for:
This level of care treats uncommon acute and chronic disorders and is associated with academic medical centers.
This group of professionals makes up the majority of clinicians in a hospital setting according to data from 2011 Occupational Employment statistics:
This term represents two or more hospitals that are owned, leased, or contract-manged by the same organization.
The following illustrates this form of Post-Acute care: Betty cares for her mother who is in the early stages of Dementia. She helps her mother shower once a week and stops in once a day to deliver meals and help her mother take her medication.
The Improving Medicare Post-Acute Transformation Act of 2014 (IMPACT) focuses on the development and implementation of post-acute quality measures with a specific timetable for each of the 4 post-acute settings EXCEPT:
Assisted Living Facilities (ALFs)
The Improving Medicare Post-Acute Transformation Act of 2014 (IMPACT) requires as collection and reporting of data using 3 different methods. The following describes this method: The facility must report on total Medicare spending per beneficiary, whether the patient was discharged to the community, and all preventable hospital readmissions.
Resource use measures
This change in legislation determined that individuals with disabilities have the right to integrated into community-based services reinforcing the need for alternatives to institution-based care for long term needs.
The Olmstead decision
The Improving Medicare Post-Acute Transformation Act of 2014 (IMPACT) requires as collection and reporting of data using 3 different methods. The following describes this method: This method includes information on diagnosis and comorbidities, impairments, functional status, cognitive function, and services and treatment required. This method of reporting allows for different measures to be used in different settings. Examples of measures include the MDS, OASIS, Patient Assessment Instrument, and the CARE tool.
Patient assessment data
The following illustrates this form of Post-Acute care: John has Cancer and has been given a prognosis of 3 months left to live. He has begun to receive services for his terminal illness including pain management and emotional counseling while his family is also supported.
Non-residential formal care: Hospice
The following illustrates this form of Post-Acute care: Caroline recently celebrated her 90th birthday. She has been having a harder time remembering to take her medications and is too tired to cook 3 meals a day. Caroline moves to this level of care where her meals are provided and someone can setup her medications for her.
Residential formal care: Assisted Living Facility (ALF)
The following illustrates this form of Post-Acute care: Thomas was just discharged home from the Hospital with a total knee replacement (TKR). He is unable to leave his home without exceptional effort. The OT comes to his house to instruct in compensatory strategies for ADLs.
Non-residential formal care: Home Health Care
The following case study is most appropriate for this form of Post-Acute care: This form of care is the most expensive form of post-acute care. Mae was discharged from the hospital after a COPD exacerbation and is unable to return home alone. She requires skilled rehab and nursing services to get her back to per prior level of functioning (PLOF).
Residential formal care: Skilled Nursing Facility (SNF)
The following is a characteristic of informal caregivers as of data from the National Alliance for Caregiving in collaboration with AARP as of 2004:
5 out of 6 rate their health as excellent, very good, or good
The following provides an example of this required component of an Individualized Education Plan (IEP): Janie has difficulty with writing, cutting, and coloring activities in the classroom environment affecting her ability to participate in her course work.
Present level and impact on education
Often if a pediatrician does not refer a client to the SPEd system this method is the way of entry. This method is a comprehensive system mandated by IDEA that varies by state to identify, locate, and evaluate children with disabilities who are in need of special education services.
A majority of children received services under this disability category under IDEA but this category only applies to those between the ages of 3 - 9 years old.
This traditional mental health practice settings is the best placement for the case study described: John has a diagnosis of schizophrenia. He recently has been experiencing an increase of symptoms (hallucinations) and has stopped taking his medications. He needs symptom management as he is a danger to himself. He requires medical stabilization and supervision.
Acute and subacute hospitalization
This community-based mental health settings is described below: Suzie has lived with a diagnosis of Bipolar for the past 15 years, managing her illness. She works in this setting to provide peer support programs to others struggling with mental illness. She uses her knowledge as an art teacher to teach her peers ways to relieve stress through art.
Consumer Operated Services
This community-based mental health settings is described below: Bobby attends this setting during the weekdays. Here he works side by side with staff in the kitchen for lunch as part of the work order day. He hopes that his work in the kitchen will allow him to eventually get supported employment within the community.
This traditional mental health practice settings is the best placement for the case study described: Jane has depression and has been taking her medications but recently feels at an all-time low and feels if she does not get help a hospitalization is around the corner and she may be a risk to herself. To prevent an unneeded hospitalization Jane seeks out help from this setting which provides immediate, short term, residential care 24/7.
Required members of an IEP include all except the following:
Required components of an IEP include all of the following except:
Projected date of terminating services
The highest disability category for children 4 years of age under IDEA part B were:
Speech or language impairments and Developmental Delay
The following best describes this area of performance of health care systems: The US ranked last in this area as the US spends the most on health care but does not have the best outcomes of health. It is the measure of a health care systems ability to maximize quality of care and outcomes given the resources and investment.
The following best describes this area of performance of health care systems: The lack of health care coverage in the US causes the country to rank low in this area. Countries with universal coverage to all residents rank high on this area.
Access and expenditure
The following best illustrates this public health goal: An occupational therapist runs a diabetes management group at the local hospital. They educate individuals on safe eating and exercise to decrease the impact of diabetes on their health and associated risk factors. They are also taught to do daily self-skin inspection by the OT.
Promote and encourage healthy behaviors
The following best describes this country's health care system: This was the first nation to enact a compulsory health insurance. Both employers and employees pay into a sickness fund for all individuals to pull from as needed. This country has similar wait times for health services as the US.
The following best describes this country's health care system: This country's health care system is funded by general revenue from national taxes providing services to all residents. Insurance coverage has no tie to employment and the health system employs general practitioners and health care providers to help control costs.
The following best describes this country's health care system: This country has a single payer system providing universal access to health care. Physician fees are set by both federal and provincial governments. Funds come from both personal and corporate incomes along with sales and lottery proceeds.
This country has a statutory health insurance system. High income can opt out for private insurance.
This country had the highest percentage of individuals having to wait two months or longer for a specialist appointment.
Which is not listed as a twentieth century achievement in Public Health:
Increased use of technology
Goals of Public Health include all of the following except:
Increase revenue for business
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