Health care delivery systems, payment sources, QIA, telemedicine Objectives: 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. 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 Outpatient facilities- diagnostic clinics, surgical clinics, dialysis clinics, rehabilitation clinics Telehealth or Telemedicine