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18 Cards in this Set
- Front
- Back
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Case management
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a method for delivering nursing care in which the nurse is responsible for a caseload of clients across the health care continuum
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Coinsurance
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"an insurance plan in which the client pays a percentage of the payment and some other group (e.g., employer, government) pays the remaining percentage"
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Critical pathways
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multidisciplinary guidelines for client care based on specific medical diagnoses designed to achieve predetermined outcomes
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Diagnosis-related groups (DRGs)
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a Medicare payments system to hospitals and physicians that establishes fees according to diagnosis
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Differentiated practice
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a system in which the best possible use of nursing personnel is based on their educational preparation and resultant skill sets
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Health care system
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the totality of services offered by all health disciplines
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Health maintenance organization (HMO)
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a group health care agency that provides basic and supplemental health maintenance and treatment services to voluntary enrollees
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Independent practice associations (IPAs)
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provide care in offices; clients pay a fixed prospective payment and IPA pays the provider; earnings or losses are assumed by the IPA
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Integrated delivery system (IDS)
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"a system that incorporates acute care services, home health care, extended and skilled care facilities, and outpatient services"
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Licensed vocational (practical) nurse (LVN/LPN)
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"a nurse who practices under the supervision of a registered nurse, providing basic direct technical care to clients"
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Managed care
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a method of organizing care delivery that emphasizes communication and coordination of care among all health care team members
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Medicaid
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a U.S. federal public assistance program paid out of general taxes and administered through the individual states to provide health care for those who require financial assistance
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Medicare
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a national and state health insurance program for U.S. residents older than 65 years of age
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Patient-focused care
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delivery model that brings all services and care providers to the client
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Preferred provider arrangements (PPAs)
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"similar to PPOs, but PPAs can contract with individual health care providers; the plan can be limited or unlimited"
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Preferred provider organization (PPO)
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a group of physicians or a hospital that provides companies with health services at a discounted rate
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Supplemental Security Income (SSI)
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"special payments for people with disabilities, those who are blind, and people who are not eligible for Social Security; these payments are not restricted to health care costs"
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Team nursing
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the delivery of individualized nursing care to clients by a team led by a professional nurse
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