health care delivery systems, payment sources, qia, telemedicine objectives: student will evaluate...
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Health care delivery systems, payment sources, QIA,
telemedicineObjectives: Student will evaluate the use of tele-health in the delivery of health care.
Student will analyze various quality improvement initiatives.
Student will compare and contrast the various
Health care delivery systems and payment sources
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How has health care evolved in the United States?
Timeline of legislative acts affecting health care.
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Contents of Medical Record
Registration Form- Name, address, ss#, insurance #, phone number etc..
Medical History Test Results and graphic charts (including vital signs) Records from other physicians/hospitals Diagnosis, tx plans, progress notes Operative Report (record of surgeries) Informed Consent (permission for invasive procedures) Discharge Summary – condition at discharge and
follow up care
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Quality Improvement Initiative
Goal: track and improve the quality of all aspects of medical practice, record keeping, employee evaluations, finances, legal matters, public image, staff morale, insurance issues and patient education
Contents: written policies on standards of patient care and professional standards, quality control program, training and CEU’s, instrument maintenance procedures, documentation requirements, evaluation methods
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Payment Sources
Universal Health care insurance claim form is the HCFA-1500
DRG- groups of procedures or tests likely to be covered by insurance.
There are almost 500 separate DRG’s
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Federally funded insurance
Medicare- 65 or older Medicaid- low income, blind, disabled Military- champus/Tricare Worker’s Compensation- on the job
injuries- paid for by employer
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Private Insurance
Ex: Blue Cross/Blue Shield- can use any providers coverage varies by areas of the country. Varying amounts of dedctible and then % of copay
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HMO/PPO
HMO- Health Maintenance org. Gatekeeper
PPO- Preferred Provider Org.- list of providers
Deductible Co-pay %
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Health Care Delivery Systems
Hospitals Clinics- school, corporate LTC ECF Hospice- Laboratories Outpatient facilities- diagnostic clinics, surgical
clinics, dialysis clinics, rehabilitation clinics Telehealth or Telemedicine