5 basic principals of ethical practice for CM - ANSJ-justice ( treat all fairly)
A-autonomy-respect pt right to make own decision
N-non-malfeasance-do no harm
F-fidelity-keep your promise
B-beneficence-to do good
6 major aims of health care - ANSsafe, effective, patient -centered, timely, efficient and
equitable.
AAAHC accreditation assoc for ambulatory health care - ANSaccredits over 5k ambulatory
health care orgs.
AAASF-American ass for accreditation of ambulatory surg facilities - ANS- improve the
quality of medical and surgical care in ambulatory surg facilities
ACA- Affordable Care Act - ANSMarch 2010- 10 Titles
1-mandate health care coverage
3-test new ways to deliver care to pts-better care, lower cost
ACO-accountable care org - ANScreated under Medicare Shared Savings Program, of the
PPAC (patient protection and affordable care act)
-effective organization will lead to heath care system maximize their resources and minimize
their dysfunction
-network to manage at least 5k Medicare for at least for 3 years
-Needs own governing body
-receive shared savings, held liable for losses
ACR-American college of radiology - ANS-medical imaging
Active Error - ANSwhose effects are felt immediately
-sharp end
Adverse Events- stats: - ANS1991-in 3.7% of hospitalization
27.6% due to negligence
70.5% of adverse events gave disability of >6m,
2.6% permanent
13.6% death
Anti-Markup Rule - ANSMedicare Diagnostic tests- prohibits the markup of the technical
component and professional component
if the CPT codes exists on the CMS list, it is a diagnostic test
, APSF- anesthesia patient safety foundation - ANSFirst org to develop just to improve pt
safety
Dr. Pierce "40 y behind the mask" 1982
The Deep Sleep-6000 will dies was on 20/20 1982
Avedis Donabedian MD - ANSBrought modern quality assurance techniques to modern
medicine.
BBA-balanced budget Act - ANS1997-comprehensive revision of federal statutes governing
Medicaid
Revised 1999. Uses QISMC to set quality assurance provisions.
C-SNP Chronic Special Needs plan - ANSListed special conditions,
Others D-SNP dual eligible Medicare and Medicaid
CAP-college of pathologists - ANSlaboratories
Capitated payment - ANSEnrollee is at full risk
CARF-commission of accreditation of Rehab facilities - ANSdisability, addiction and
substance abuse facility
CER-comparative effectiveness research - ANSgoal is to improve health outcomes by
developing and disseminating evidence based info to pt, providers of different health
treatment options.
CHAP-community health accreditation prog - ANSnot for profit accrediting body for health
hospice and DME
claims made - ANSonly during the time the policy was in effect
need tail coverage
CMSA- Case Mgt Society of America - ANS1995- put forth first standards of practice for CM.
-communication, coordination and collaboration of health care
CNC-Compromised Number Checklist - ANS2011-Updated monthly of Medicare beneficiary
and provider ID # looking if any have been compromised
-appx 5000 providers and 280K beneficiaries were compromised.
Continuous Quality Improvement - ANSuses a systematic process, enhance performance.
Looks at processes, not individual. ( ex laparoscopy, less hospt stay)
CPI=center for program integrity - ANS2010-integrate prevention, detection, recovery and
transparency and accountability
credential vs competency - ANScredential-peer recommendation and aggregated info re
performance
competency- direct observation
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