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503 Midterm Test

Enter the letter for the matching Answer
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1.
Medicare part B
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2.
Why do rehab’s want accreditation?
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3.
ICF Part II of structure
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rehab team
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coping behaviors (2)
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Med. Model Focus:
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Body Image:
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Medicare part C
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Impact of Managed Care on Individuals with Disabilities
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Inpairment
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Limitations of Managed Care for PWD
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trajectory:
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POS
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How Do TR Professionals Establish the Framework for Coverage of Services
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4 categories of sexual adjustment:
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coping strategies
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3 basic tenets of managed care
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Emotional reactions to disability/ loss
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what services are covered and what are not/ why?
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Different Types of Rehabs
A.
help to manage and reduce stressors associated with major life events most individuals become reliant on a type of coping skill to restore equilibrium when confronted with a stressful situation Compensation: Rationalization: excuses Diversion of feeli
B.
Contextual factors: 1. environmental: more than just the phys env. (building accessibility, accessible transportation) but products and technology(phones and comps), climate, and social environment(attitudes, norms, services)
C.
Mental view of one's body with regard to appearance, sexually, and ability to perform physical tasks
D.
Interdisciplinary Treatment Team Patient, family Physician (physiatrist) Case manager (social work; patient services) Nursing Therapists Peer support
E.
Grief: reaction to loss -body function -role or position -control -privacy -dignity Fear and anxiety -unknown -unfamiliar env (hospital) Anger: -towards self or displaced towards others
F.
Delay in getting appts or test results Denial of referral to specialists Inaccessible equipment in facilities Inadequate skill of docs to treat disability Need for specific MCO approval if med is not on pre-approved list Lmtd servics to assistive dev
G.
Attract patients (more business) Convince referring Dr.’s of quality Get paid by insurance companies Concerned with refining and improving services
H.
Impairment – deviation from certain generally accepted population standards of function (WHO,2001)
I.
sexual disenfranchisement: individs receive inadequate sex edu., have pre-existing asexual tudes toward PWD, concerns about body image, and receive negative feedback regarding sexuality from health prof's and sex partners
J.
effective and adaptive: helps reduce stress and develops life to the fullest potentials ineffective and maladaptive: inhibits growth and potential or contributes to phys +/or mental deterioration
K.
Medicare Part C: Blends Part A & B Services are provided by MCO
L.
Medicare Part B: Services outside hospital: physicians, outpatient care, home health, medical equipment (O&P, wheelchairs, etc)
M.
Point-of-Service Plans (POS): can choose a provider at each point of service
N.
Become familiar with state and federal regulations Familiarize self with Professional Standards of Practice Know your 3rd Party Payers Get administrative support at the facility level
O.
Health care costs for PWD are significant: Doctor’s fees Hospitalization Prescription medications Adaptive equipment/mobility devices
P.
course of an illness over time, plus actions taken by individual and their families to manage or shape this course
Q.
1.Emphasis is on pathology; cause of the disability lies within the individual 2.Has objective and standardized measurements to define and characterize the condition 3.Goal of treatment is to eliminate illness/ disease/ disability
R.
Limited access to the universal providers Payment mechanisms that reward efficiency Enhanced quality through improved monitoring
S.
Covered: standing x 10 mins w/o assistance to complete table top leisure task Identify 1 coping mechanism to assist with Ambulate x 175 feet within community terminology Community reintegration sessions Life mgmt Task sessions – in place of arts &
T.
Acute Nursing facilities Local rehab clinics Large regional facilities Specialty hospitals Veteran’s Administration
Type the Question that corresponds to the displayed Answer.
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Per episode: Providers are given a one-time payment for services with specific dx Large institutions providing medically complex services to specific DRGs
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Acute (ICU, CCU) In-patient Rehabilitation Day Treatment Out-patient Community member
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JCA: Joint Commission on Accreditation (formerly JCAHO) CARF: Commission on Accreditation of Rehab Facilities Certifies programs not whole facilities For example, a rehab can have a CARF accredited SCI program
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Private financing through private insurers (traditional insurers & managed care orgs) Out of pocket
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foam, gel, air, honey comb, alternating pressure
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nature or stages of the chronic illness or disability -stable: managed condition, symptoms not progressing -episodic: sympts not always present but flare occasionally -degenerative: continuing breakdown of structure or funct. -exacerbations: sympts wo
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Health Maintenance Organizations (HMO): has to be within network to be covered (EMR visits are exception) Staff-model HMO Group-model HMO
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1st contact with patient & family Coordinates benefits, insurance coverage Communicates with insurance co. Progress towards goals Length of stay D/C logistics
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Any tool/ apparatus/device/ machine used by a person to accomplish some practical task or purpose in a home, work, or rec setting • Cell phones, computer, glasses, calculator, internet
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Selected group of physicians and hospitals that provide comprehensive services to individuals enrolled in specific healthcare plans Goal is to control healthcare costs while providing high-quality medical care

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