Working in Health Care
-Licensure, certification, registration and accreditation
-Licensure- a mandatory credentialing process established by law, usually at the
state level, that grants the right to practice certain skills and endeavors
-Certification- a voluntary credentialing process whereby applicants who meet
specific requirements may receive a certification
-Registration- an entry in an official registry or record, listing the names of
persons in a certain occupation who have satisfied specific requirements
-Accreditation- official authorization or approval for conforming to a specified
standard
-Refer to p. 26-27, about joint Commission on accreditation of Healthcare
Organizations (JCAHO)
-Reciprocity- the process by which a professional license obtained in one state may be
accepted as valid in other states by prior agreement without reexamination
-Medical practice acts and medical boards
-Medical practice acts- state laws written for the express purpose of governing the
practice of medicine
-Medical boards- bodies established by the authority of each state’s medical
practice acts for the purpose of protecting the health, safety, and welfare of
health care consumers through proper licensing and regulation of
physicians and other health care practitioners
-Health care professions
-Share responsibility for delivery of health services
-Have generally received a certificate, associate’s drgree, bachelor’s degree,
master’s degree, doctoral degree, or post baccalaureate training in a
science related to health care and have met all state requirements
concerning licensure, certificate, and registration
-Anesthesiologist
-Athletic trainer
-Audiologist
-Cardiovascular technologist
-Clinical exercise specialist
-Cytotechnologist
-Dental hygienist
-Diagnostic medical sonographer
-Dietician and nutritionist
-ECG technician
-EEG technician and technologist
-Electroneurodiagnostic technologist
-Emergency medical technician-paramedic
-Health and fitness specialist
-Health information administrator
-Health information technician
-Kinesiotherapist
-LPN/LVN
-Medical assistant
-Medical illustrator
-Medical laboratory technician and medical technologist
-Medical massage therapist
-Medical transcriptionist
-Nurse practitioner
-Nursing assistant
-Occupational therapist
-Occupational therapy assistant
-Ophthalmic medical technician/technologist
-Optician
-Optometrist
-Orthotist and prosthetist
-Perfusionist
-Phlebotomist
-Physical therapist
-Physical therapist assistant
-Physician assistant
-Polysomnographic technologist
-Radiologic or medical imaging technologist
-Registered nurse
-Respiratory therapist
-Specialist in blood bank technology
-Surgical technologist
-Respondeat superior- literally, “Let the master answer.” A doctrine under which an
employer is legally liable for the acts of his or her employees, if such acts were
performed within the scope of the employees’ duties
-Medical practice management system
-4 basic types of medical practice
-Sole proprietorship- a form of medical practice management in which a
physician practices alone, assuming all benefits and liabilities for
the business
-Partnership- a form of medical management system whereby two or more
parties practice together under a written agreement specifying the
rights, obligations, and responsibilities of each partner
-Professional corporation- a body formed and authorized by law to act as a
single person
-Group practice- a medical management system in which three or more
licensed physicians share the collective income, expenses,
facilities, equipment, records, and personnel for the business
-Types of managed care- a system in which financing, administration, and delivery of
health care are combined to provide medical services to subscribers for a prepaid
fee
-Health maintenance organizations (HMO)- a health plan that combines coverage
of health care costs and delivery of health care for a prepaid premium
-Preferred provider organizations (PPO)- a network of independent physicians,
hospitals, and other health care providers who contract with an insurance
carrier to provide medical care at a discount rate to patients who are part
of the insurer’s plan
-Physician-hospital organizations (PHO)- a health care plan in which physicians
join with hospitals to provide a medical care delivery system and then
contract for insurance with a commercial carrier or an HMO
-Other variations in managed care plans
-Gatekeeper or primary care plan- primary care physician directs all of a
patient’s medical care and generates any referrals to specialists or
other health care practitioners
-Point-of-service (POS)- a health care plan that allows members to seek
health care from nonnetwork physicians but pays the highest
benefits for care when it is given by the PCP or via a referral from
the PCP
-Open access- a managed care feature whereby subscribers may see any
innetwork health care provider without a referral
-Legislation affecting health care plans
-Health care quality improvement act of 1986-a federal statute passed to improve
the quality of medical care nationwide. One provision established the
National Practitioner Data Bank (NPDB)
-NPDB- a repository of information about health care practitioners
-Health insurance portability and accountability act- helps workers keep
continuous health insurance coverage for themselves and their dependents
when they change jobs, protects confidential medical information from
unauthorized disclosure or use, and helps curb the rising cost of fraud and
abuse
-Controlling health care fraud and abuse- laws have been passed to control 3 types
of illegal conduct
-False claims in billing
-Kickbacks
-Self-referrals
-Risk management- steps taken to minimize danger, hazard, and liability
-Quality improvement- measures taken by health care providers and practitioners
to uphold the quality of patient care
-Telemedicine- remote consultation by patients with physicians or other health
professionals via telephone, closed-circuit television, or the internet
-Cybermedicine- a form of telemedicine that involves direct contact between
patients and physicians over the internet, usually for a fee
-E-health- the term for the use of the internet as a source of consumer information
about health and medicine
- Refer to court case
-Physician disciplined by board of medical examiners, p. 30
-Board upheld in permanently revoking physician’s license, p. 30
-Medical group liable under respondeat superior, p. 39
-Nurse sues under false claims act, p. 46
-Illegal telemedicine drug sale, p. 49