Questions and Answers
Which of the following is one of the largest U.S. employers?
How many new healthcare jobs are projected to be created in the next decade?
5.6 million
Where is the highest employment growth expected in healthcare?
Specialized positions in healthcare reduce flexibility.
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What is necessary to protect citizens from incompetent healthcare practitioners?
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What is the most restrictive type of regulation in healthcare?
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What is one of the shortcomings of state licensure?
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What do state or national certifications provide?
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What did the 1800s movement aim to do in healthcare?
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What is the primary source of health coverage for most working Americans?
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The ACA aims to change the fundamental public/private financing mechanisms of U.S. healthcare.
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Public funding includes _____ and _____ programs.
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What has been a significant tension in healthcare financing?
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What does HEDIS stand for?
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What was a major focus of the National Committee on Quality Assurance (NCQA)?
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What is Medicare Part A?
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What does Medicare Part B cover?
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What is cost sharing in Medicare?
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What is Medicare Part C?
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What is Medicare Part D?
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What did the Comprehensive Health Planning Act aim to do?
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What replaced the Comprehensive Health Planning Act in 1974?
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What are QIOs?
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What is the Tax Equity & Fiscal Responsibility Act (TEFRA)?
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What did Professional Standards Review Organizations do?
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What are DRGs?
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What act requires hospitals to treat all patients presenting in their emergency departments?
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What is 'Hospital Compare'?
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What is Medicaid?
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What is HIPAA?
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What does SCHIP stand for?
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What three types of coverage does Medicaid provide?
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What are the CHIP quality initiatives?
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What is the Individual Mandate?
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What do Health Insurance Exchanges do?
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What is the Bundled Payments for Care Improvement Initiative (BPCI)?
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What are essential health benefits?
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Study Notes
Employment in Healthcare
- Healthcare is one of the largest employers in the U.S.
- The industry is projected to create approximately 5.6 million new jobs in the next decade, outpacing any other sector.
- The highest employment growth rates are seen in health plans, ambulatory clinics, home health, and practitioners' offices.
Impact of Regulations
- Specialized jobs have emerged from medical advancements, which also lead to reduced flexibility and increased service costs.
- Credentialing and regulatory measures are necessary to protect citizens from unethical practices.
- Regulatory restrictions can limit healthcare organizations' personnel usage and innovation in patient care.
Licensure and Certification
- State licensure is the most restrictive regulation that defines practice scopes, education, and testing criteria to prevent misuse of professional titles.
- State licensure primarily assesses qualifications on entry, with minimal ongoing competency evaluation.
- National and state certification programs attest to education and performance but lack legal authority against incompetent practices.
Training and Education in Nursing
- The first nursing training program began in 1861 at Philadelphia Women's Hospital, with a focus on public health and private duty.
- Various nursing education pathways exist: 2-year associate degrees, hospital diploma programs, and bachelor's degrees.
- Licensed Practical Nurses (LPNs) undergo one year of training and require state licensing; Registered Nurses (RNs) often pursue advanced education for specialization.
Employment of Medical Providers
- A significant number of first-year residency positions are filled by graduates from foreign medical schools.
- Physician specialties often require 3-8 years of residency training, with further fellowships for certification in subspecialties.
Allied Health and Administration
- Over 200 allied health occupations support primary providers, categorized into laboratory technologists, therapeutic practitioners, behavioral scientists, and support services.
- Health care administrators manage services and operations within healthcare facilities, requiring various levels of education.
Healthcare Demand Influencers
- Demand for health personnel is influenced by medical and technological advancements and shifts towards community healthcare settings due to an aging population.
- The National Health Care Workforce Commission (NHCWC) is a key agency in addressing healthcare workforce needs.
Financing and Coverage in Healthcare
- The Affordable Care Act (ACA) did not alter public/private financing structures but aimed to decrease uninsured rates.
- Medicare serves the elderly, while Medicaid provides coverage for low-income populations, though public funding remains a significant part of coverage.
Expenditures and Economic Factors
- U.S. healthcare spending comprises a large portion of the national economy yet results in lower life expectancy and poorer health outcomes compared to other developed countries.
- Major expenses include hospitals, physician services, and prescription drugs; approximately 20-40% of spending is estimated to be wasteful or inefficient.
Evolution of Health Insurance
- Health insurance developed in the early 1900s, evolving from indemnity coverage to comprehensive hospital and physician coverage models.
- Managed Care Organizations (MCOs) emerged to control costs and improve service efficiency, with structures including HMOs and PPOs.
Government Regulations and Quality Assurance
- Various acts, including the Health Maintenance Organization Act and the Tax Equity & Fiscal Responsibility Act, have restructured health services to improve quality and cost management.
- The National Committee on Quality Assurance (NCQA) focuses on accreditation standards for MCOs, ensuring quality across health plans.
Medicare Components
- Medicare Part A provides mandatory coverage for various health services, funded through payroll taxes.
- Medicare Part B is voluntary, covering additional medical services for which beneficiaries pay premiums.
Legislative Milestones in Health Planning
- The Comprehensive Health Planning Act and the Health Planning Resources and Development Act established frameworks for health resource planning, highlighting the necessity of state-approved major projects.
Challenges in Healthcare Delivery
- Quality Improvement Organizations (QIOs) were introduced to enhance care quality under Medicare.
- The implementation of DRGs shifted hospital reimbursement models, rewarding efficient care while addressing patient dumping issues in emergency departments.### Emergency Medical Treatment and Labor Act (EMTALA)
- Enacted in 1986 to prevent inappropriate patient transfers by hospitals.
- Non-compliance leads to stiff financial penalties and the risk of losing Medicare certification.
Hospital Compare
- Launched by Medicare with the Hospital Quality Alliance.
- Assesses hospital performance based on evidence-based practice.
- Reporting is mandatory for hospitals to qualify for Medicare rate updates.
Medicaid
- A joint federal-state program administered by the CMS.
- Provides healthcare services for economically needy individuals.
- Established to replace a fragmented system of state and local health services.
- Covers health insurance for low-income families, long-term care for older Americans, and supplemental coverage for low-income Medicare beneficiaries.
CHIP Quality Initiatives
- The CMS and State Operations oversee Medicaid quality assessments.
- Five criteria for Medicaid services quality include prevention, management of acute and chronic conditions, family experience, and availability of services.
Individual Mandate
- A component of the ACA requiring most Americans to have health insurance or incur a penalty.
- Exemptions apply to certain low-income individuals, religious exemptions, undocumented immigrants, incarcerated individuals, and tribal members.
Health Insurance Exchanges (HIE)
- ACA mandates the establishment of health benefit exchanges for individuals and small employers.
- Aimed at creating a competitive insurance market with user-friendly access to plan comparisons and standardized pricing.
Bundled Payments for Care Improvement Initiative (BPCI)
- Developed by the CMS Center for Medicare & Medicaid Innovation.
- Addresses fragmented care due to separate Medicare payments for services.
- Promotes bundled payments to incentivize coordinated care and improve patient outcomes while reducing costs.
Essential Health Benefits
- Health plans participating in exchanges must offer minimum coverage as defined by the ACA.
- Includes ten categories of services:
- Ambulatory patient services
- Emergency services
- Hospitalization
- Maternity and newborn care
- Mental health and substance use disorder services
- Prescription drugs
- Rehabilitative and habilitative services
- Laboratory services
- Preventive and wellness services
- Pediatric services, including oral and vision care.
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Description
Test your knowledge with these flashcards covering key concepts from chapters 7 and 8 of Healthcare Delivery. This interactive quiz includes important terms and definitions relevant to employment and vocations in the healthcare sector.
