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

How has health care evolved in the United States?

Timeline of legislative acts affecting health care.

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

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

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

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

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

HMO/PPO

HMO- Health Maintenance org. Gatekeeper

PPO- Preferred Provider Org.- list of providers

Deductible Co-pay %

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