1
Q
Primary wellness
A
reduce risk factors before pathology
2
Q
secondary wellness
A
reduce duration of illness or impairment
3
Q
tertiary wellness
A
limit degrees of disability in person with chronic disease
4
Q
primary care
A
-first contact
5
Q
secondary care
A
ER, hospitals
6
Q
Tertiary care
A
academic med center, transplant, burn, cancer
7
Q
ambulatory care
A
outpatient
8
Q
restorative care
A
home, IRF, sub-acute, LTAC
9
Q
continuing care
A
assisted living, long term, hospice
10
Q
primary prevention
A
before it happens
11
Q
secondary prevention
A
reduce duration
12
Q
tertiary prevention
A
limit disability with chronic disease
13
Q
Commercial health insurance
A
access: everything
cost: most expensive. fee for service
quality: best money can buy
14
Q
Managed care: access
A
-payer limits access to the menu of services
PPO, HMO, co-pays
15
Q
PPO - preferred provider organization
A
-choice of providers (in and out of network)
16
Q
HMO - health maintenance organization
A
closed panel or out-of-network
17
Q
Managed care: Cost
A
- employer: purchase plan and pay premium
- employee: pay portion of premium, deductible, coinsurance, and co-payment
- Health saving account (HSA)
18
Q
Managed care: quality
A
- affected by the providers on the preferred list
- providers need to balance cost of service with discounted fee schedule
- patient may not get what they need if insurance denies
19
Q
Tax-funded health care
A
Social security act. Established medicare (Title 18) and medicaid (title 19) and state children health insurance program (SCHIP)
*made govt largest provider of health care
20
Q
Tax-funded health care: access
A
- limited to armed services, disabled, kids, low income, or people over 65
- providers must approve for medicare and medicaid
- access to services when deemed necessary by govt
21
Q
Medicare: covers who?
A
> 64 y/o
administered by centers for medicare and medicaid services (CMS)
22
Q
Medicare A:
A
- hospital services
- hospital, skilled nursing, home health, hospice
- no premium. annual deductible with daily coinsurance after first 20 days of hospital stay
23
Q
Under med A: hospitals are reimbursed by
A
diagnostic related groups. DRGs
24
Q
under med A: SNF is reimbursed by:
A
RUGs
25
MED B covers
* *physician services
- covers OP services, SNF and home health not covered under A, diagnostic and lab services, DME
- monthly premium, annual deductible, and 20% coinsurance
- reimbursed by CPT codes
26
Medicaid: for who?
for low income
-covers: IP/OP, labs, SNF/home health, doc services, family planning, check ups, kids stuff
27
HIPAA: title I,II, III
- I: health care access, portability, and renewability
- II: fraud and abuse prevention, administrative simplification, med liability reform
- III: security, electronic transaction, and privacy
28
in order for patients to have care under OBRA (omnibus budget reconciliation act) they have to be able to do what?
walk, talk, eat, dress, bathe, understand, and communicate with others
OBRA- limits self-referral of patients with Medicare for stuffffff
29
Americans with disabilities act: covers?
- employment (cannot discriminate based on disability)
- communications (accommodates deaf)
- public accommodation (modify facilities if possible. new buildings need to be accessible )
- public transportation (cannot be denied services)
30
Accountability
-acceptance of responsibility for stuff as a PT
31
Altruism
primary regard for or devotion to the interest of patients/clients.
32
Compassion/caring
- desire to identify with another
| - caring is the concern, empathy, and considerations for the needs and values of others.
33
Excellence
- use current knowledge and theory
| - work towards developing new knowledge
34
integrity
-ethical principles or standards
35
professional duty
obligation to provide effective PT services
36
social responsibility
-promotion of a mutual trust btw profession and public
37
What does the philosophical statement express?
the organization's guiding principles and values
38
mission statement is
- usually no more than a sentence or 2
- states purpose of organization
- sets the broad aims for the organization
39
vision statement is
- long term aspiration of the business
| - serves to guide and motivate efforts over time
40
Elements of a business plan
- business description and purpose
- operations/management
- marketing
- finances
41
Executive summary
- most important section of the document
- written last
- summary (can bullet)
42
Sole proprietor business (pro/cons)
- one person or family run business
- advantage: easy to form, full control by owner, income from business is considered personal
- disadvantages: owner has unlimited personally liability
43
General partnership business (pros/cons)
- simple structure with more than one owner
- advantage: easy to form, full control by owners, income from business is considered personal
- disadvantages: all partners equally personally liable for all aspects of business
44
Limited partnership business (pros/cons)
-one partner has limited risk but is silent on the management of the business
45
C-corportation business
- legal entity distinct from its owners and formed under state law
- advantage: limited personal liability, easy ownership transfer
- disadvantages: income is taxed as a business then taxed as individual income, increased regulation and restrictions.
46
S-corporation business (pro/con)
- corporation where all profit is passed through to owners (shareholders)
- advantages: income not taxed twice, only taxed at personal income tax rate, limited personal liability
- disadvantages: high regulation and legal restriction
47
Personal service corporation (SC or PC) structure. (pro/com)
- all owners must be providers of the service
- Advantages: able to deduct health care costs, salaries, continuing education, etc. to show profit spent on these expenses, leaving no corporate tax, taxes paid at personal income tax rate, easy to form
- disadvantages: no personal liability protection, if show profit, pay a flat 35% tax rate
48
Limited liability company (LLC) structure (pros/cons)
- members govern and own the business as a member committee (similar to shareholders)
- advantages: income taxable under personal income tax rate and no corporate taxes, limited personal liability, not a corporation, one person can form an LLC
- disadvantages: new and not undergone robust legal challenges, lack of uniformity among states, more complex, more formal
49
For-profit structures
- provide goods and services to make money for the owners
- pay taxes on profits
- remaining used to improve financial position of business
- pay out dividend payment to owners
- re-invest to increase owner's equity
50
Not-for-profit structure
- business that is exempt from taxes
- purpose must relate to some form of community service
- not to show a financial benefit to any individual (able to pay reasonable compensation. Must reinvest all excess revenue into the business)
51
business plan vs strategic plan
business = blueprint of company
strategic plan: way to identify long term goals and direct your company towards fulfilling those goals.
52
SWOT (stands for what?)
strengthes
weaknesses
opportunities
threats
53
Who makes up the operating core?
those who do the work.
54
Technical support services
enhance the performance of the operating core (lead PT, aides, receptionists)
55
General support services
not directly related to operating core (marketing, legal, accounting)
56
5 Ps of marketing
product, promotion, pricing, place, and packaging.
PTH 620 - Pro practice III
flashcards
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