01-Manual - Introduction To Healthcare and Public Health in The US

Component 1:
Introduction to
Healthcare and Public
Health in the US
Instructor Manual
Version 3.0/Sprin !01!
"otes to Instructors
This Instructor Manual is a resource for instructors using this component. Each
component is broken down into units, which include the following elements:
Learning objectives
uggested student readings, te!ts, reference links to supplement the
narrated "ower"oint slides
Lectures #voiceover "ower"oint in $lash format%& "ower"oint slides
#Microsoft "ower"oint format%, lecture transcripts #Microsoft 'ord format%&
and audio files #M"( format% for each lecture
elf)assessment *uestions reflecting +nit ,bjectives with answer ke-s
and.or e!pected outcomes
/pplication /ctivities #e.g., discussion *uestions, assignments, projects%
with instructor guidelines, answer ke-s and.or e!pected outcomes
0ealth IT 'orkforce 1urriculum Introduction to 0ealthcare and 2
3ersion (.4.pring 2452 "ublic 0ealth in the +
This material was developed by Oregon Health & Science University, funded by the Department of Health and Human Services,
Office of the National oordinator for Health !nformation Technology under "ward Number !U#$O%%%%&'(
Contents
6otes to Instructors............................................................................................................2
7isclaimer........................................................................................................................((
1omponent 5.+nit 5.........................................................................................................(8
1omponent 5.+nit 2.........................................................................................................(9
5./dministration for 1hildren and $amilies. http:..www.acf.hhs.gov. /ccessed /pril :,
2455.................................................................................................................................(;
2./dministration on /ging. http:..www.aoa.gov. /ccessed /pril <, 2455.......................(;
(./genc- for 0ealth 1are =esearch and >ualit-. http:..www.ahr*.gov. /ccessed /pril 8,
2455.................................................................................................................................(;
8./genc- for To!ic ubstances and 7isease. /genc- for To!ic ubstances and 7isease
=egistr-. http:..www.atsdr.cdc.gov. +pdated March 2(, 2455. /ccessed /pril 8, 2455. (;
:./lliance for /dvancing 6onprofit 0ealth 1are. The value of nonprofit health care.
http:..www.nonprofithealthcare.org.reports.:?value.pdf. /ccessed /pril :, 2455...........(;
<./merican0ospitals.com. 0ospital locator: all hospitals are not created e*ual.
http:..www.americanhospitals.com.hospitals.hospitalse*ual.htm. /ccessed /pril :,
2455.................................................................................................................................(;
@.1enters for 7isease 1ontrol and "revention. http:..www.cdc.gov. /ccessed /pril <,
2455.................................................................................................................................(;
9.1enters for Medicare and Medicaid ervices. 1M programs and information.
http:..www.cms.gov. /ccessed /pril 8, 2455...................................................................(;
;.1orporate 0ealth 1are 1oalition. http:..www.corporatehealthcare.org. /ccessed /pril
:, 2455.............................................................................................................................(;
54.0ealth =esources and ervices /dministration. http:..www.hrsa.gov.inde!.html.
/ccessed /pril 8, 2455....................................................................................................(;
55.00.gov. http:..www.hhs.gov. /ccessed /pril 8, 2455..............................................(;
52.Indian 0ealth ervice. http:..www.ihs.gov. /ccessed /pril 8, 2455...........................(;
5(.Indian 0ealth ervice. I0 fact sheets: Indian health disparities.
http:..info.ihs.gov.7isparities.asp. +pdated Aanuar- 2455. /ccessed /pril 8, 2455. .....(;
0ealth IT 'orkforce 1urriculum Introduction to 0ealthcare and (
58.Medicare.gov. http:..www.medicare.gov. /ccessed /pril 8, 2455.............................(;
5:.Medline "lus. Medicare. http:..www.nlm.nih.gov.medlineplus.medicare.html. +pdated
March 5<, 2455. /ccessed /pril :, 2455.........................................................................(;
5<.6ational /cadem- for tate 0ealth "olic-. http:..www.nashp.org. +pdated March
2455. /ccessed /pril 8, 2455..........................................................................................(;
5@.6ational /ssociation of 1ommunit- 0ealth 1enters. http:..www.nachc.org. /ccessed
/pril :, 2455.....................................................................................................................(;
59.6ational Institutes of 0ealth. http:..www.nih.gov. /ccessed /pril 8, 2455.................(;
5;.,ffice of Inspector Beneral. http:..oig.hhs.gov. /ccessed /pril <, 2455....................(;
24.=ural /ssistance 1enter. 1/0 fre*uentl- asked *uestions.
http:..www.raconline.org.info?guides.hospitals.cahfa*.phpCwhatis. +pdated ,ctober 2<,
2454. /ccessed /pril <, 2455..........................................................................................(;
25.ubstance /buse and Mental 0ealth ervices /dministration.
http:..www.samhsa.gov. /ccessed /pril 8, 2455............................................................(;
22.+.. $ood and 7rug /dministration. http:..www.fda.gov. /ccessed /pril <, 2455.....84
lide :: + 7epartment of 0ealth and 0uman ervices organiDational chart. /vailable
from http:..www.hhs.gov.about.orgchart. ........................................................................84
5.7epartment of 3eterans /ffairs. 2454 ,rganiDational Eriefing Eook. 'ashington, 71:
,ffice of 0uman =esources and /dministration, ,ffice of /dministration& 2454. ..........84
2.0enr- A. Faiser $amil- $oundation. Militar- and veteransG health care.
http:..www.kaiseredu.org.Issue)Modules.Militar-)and)3eterans)0ealth)
1are.Eackground)Erief.asp!. /ccessed /pril :, 2455....................................................84
(.Lumina $oundation. Toda-Gs BI Eill: 1onnecting /mericaGs veterans to higher
educationH$/>. http:..www.toda-sgibill.org.fa*.C<. 244;. /ccessed /pril <, 2455. ....84
8.Militar- 0ealth -stem. $re*uentl- asked *uestions #$/>s%: general M0 *uestions.
http:..www.health.mil. /ccessed /pril :, 2455. ..............................................................84
:.Militar- 0ealth -stem. T=I1/=E. http:..www.tricare.mil. /ccessed /pril <, 2455.....84
<.6ational 6aval Medical 1enter. 6ational 1apital 1onsortium.
http:..www.bethesda.med.nav-.mil.careers.graduate?medical?education.gme?residenci
es.pharmac-."BI5J24=esidenc-J24"acket.pdf. /ccessed /pril @, 2455. ................84
@.+.. /rm- 24th upport 1ommand. 1hemical, Eiological, =adiological, 6uclear, 0igh)
Iield E!plosives. http:..www.cbrne.arm-.mil. /ccessed /pril <, 2455. ..........................84
9.+.. 7epartment of 3eterans /ffairs. http:..www.va.gov. +pdated /pril :, 2455.
/ccessed /pril :, 2455....................................................................................................84
5.2 1hart: ,rganiDational chart for the 7epartment of 3eterans /ffairs. tructure of the
3/. /vailable from http:..www.va.gov.ofcadmin.docs.vaorgchart.pdf ............................84
5.( 1hart: 3/ ervices. .................................................................................................84
5.8 1hart: "ost)traumatic stress disorder, traumatic brain injur-...................................84
Images.............................................................................................................................84
lide 5(: Map of 3eteranGs Integrated ervices 6etwork , or 3I6, units in the +.
/vailable from http:..www2.va.gov.director-.guide.division.aspKdnumL5 .....................84
5./etna. ", health insurance plan choices. http:..healthinsurance.aetna.com.health)
plans.point)of)service. "ublished 2455. /ccessed /pril <, 2455....................................84
2./merican 1ollege of Emergenc- "h-sicians $oundation. Emergenc- care for -ou.
http:..www.emergenc-carefor-ou.org.Emergenc-Manual.'hoTakes1are.7efault.asp!.
/ccessed /pril @, 2455....................................................................................................84
(./merican 0eart /ssociation. Managed health care plans.
http:..www.americanheart.org.presenter.jhtmlKidentifierL8<<(. "ublished 2455.
/ccessed /pril @, 2455....................................................................................................85
8./merican 0ospital /ssociation. http:..www.aha.org. /ccessed /pril <, 2455..............85
:./merican0ospitals.com. 0ospital locator: all hospitals are not created e*ual.
http:..www.americanhospitals.com.hospitals.hospitalse*ual.htm. /ccessed /pril :,
2455.................................................................................................................................85
<./ssociation of /merican Medical 1olleges. Teaching hospitals.
https:..www.aamc.org.about.teachinghospitals. /ccessed /pril 9, 2455........................85
@.1enters for Medicare and Medicaid ervices. 1ommunit- mental health centers.
https:..www.cms.gov.1ertificationand1omplianc.4(?1ommunit-0ealth1enters.asp.
/ccessed /pril 9, 2455....................................................................................................85
9.$eigenbaum E. ,rganiDational structure of hospitals.
http:..smallbusiness.chron.com.organiDational)structure)hospitals)(955.html. "ublished
2455. /ccessed /pril @, 2455..........................................................................................85
0ealth IT 'orkforce 1urriculum Introduction to 0ealthcare and :
;.Breenville 0ospital -stem +niversit- Medical 1enter. http:..www.ghs.org. /ccessed
/pril 9, 2455.....................................................................................................................85
54.0ealth 1areers 1enter. http:..www.mshealthcareers.com. /ccessed /pril 9, 2455.. 85
55.Medline "lus. Emergenc- medical services.
http:..www.nlm.nih.gov.medlineplus.emergenc-medicalservices.html. +pdated /ugust
54, 2454. /ccessed /pril @, 2455....................................................................................85
52.6ational /ssociation of 1ommunit- 0ealth 1enters. http:..www.nachc.org. /ccessed
/pril @, 2455....................................................................................................................85
5(.6ational Institute on /ging. /ge"age: hospital hints. ................................................85
58.http:..www.nia.nih.gov.0ealthInformation."ublications.hospitalhints.htm. +pdated
/pril 24, 2454. /ccessed /pril @, 2455............................................................................85
5:.=ural /ssistance 1enter. 1/0 fre*uentl- asked *uestions.
http:..www.raconline.org.info?guides.hospitals.cahfa*.phpCwhatis. +pdated ,ctober 2<,
2454. /ccessed /pril @, 2455.........................................................................................85
5<.=ust ME, Luepke EL. "ractice organiDations and joint ventures. In: /merican 1ollege
of Legal Medicine. Legal Medicine. <th ed. "hiladelphia: Mosb-& 2448.........................85
5@.ociet- of 1ritical 1are Medicine. M-I1+1are.org. 1ritical care *uestions.
http:..www.m-icucare.org.1ritical?1are?>uestions."ages.default.asp!. /ccessed /pril
@, 2455.............................................................................................................................85
59.The Aoint 1ommission. http:..www.jointcommission.org. /ccessed /pril 9, 2455.....85
5;.Torp- AM. Intensive care units. A/M/. 244;&(45#52%:5(48.......................................85
24.+nited tates 7epartment of Labor. Eureau of Labor tatistics. ,ccupational outlook
handbook, 2454)55 edition. http:..www.bls.gov.oco. /ccessed /pril @, 2455.................85
25.+rgent 1are /ssociation of /merica. http:..www.ucaoa.org.inde!.php. /ccessed
/pril <, 2455. ...................................................................................................................82
5./dministration on /ging. / profile of older /mericans: 2454.
http:..www.aoa.gov./o/=oot./ging?tatistics."rofile.2454.docs.2454profile.pdf.
/ccessed /pril 52, 2455. ................................................................................................82
2./merican 0ealth 1are /ssociation, 6ational 1enter for /ssisted Living. 1onsumer
information about long term care. http:..www.longtermcareliving.com.assess.inde!.htm.
/ccessed /pril 55, 2455..................................................................................................82
0ealth IT 'orkforce 1urriculum Introduction to 0ealthcare and <
(./merican 0ospital /ssociation. Long term acute care hospitals.
http:..www.aha.org.aha?app.issues.Medicare.Long)Term)1are)0ospitals.inde!.jsp.
/ccessed /pril 55, 2455..................................................................................................82
8.1enters for Medicare M Medicaid ervices. https:..www.cms.gov. /ccessed /pril 55,
2455.................................................................................................................................82
:.1ommission on /ccreditation of =ehabilitation $acilities International. 'ho we are.
http:..www.carf.org./bout.'ho'e/re. /ccessed /pril 55, 2455....................................82
<.7ubler 66. Legal and ethical issues. In: The Merck Manual of Beriatrics. 'hitehouse
tation, 6A: Merck M 1o., Inc.& 244;)2454.
http:..www.merckmanuals.com.mm?geriatrics.sec5.ch58.htm. /ccessed /pril 52, 2455.
.........................................................................................................................................82
@.0ospital.com. 1hoosing a long)term ps-chiatric hospital.
http:..www.hospital.com.ps-chiatr-.html. /ccessed /pril 55, 2455................................82
9.Medicare.gov. T-pes of long)term care.
http:..www.medicare.gov.longtermcare.static.T-pes,verview.asp. +pdated March 2:,
244;. /ccessed /pril 55, 2455. ......................................................................................82
;.Medline"lus. 0ealth s-stem. http:..www.nlm.nih.gov.medlineplus.healths-stem.html.
+pdated Ma- 25, 2454. /ccessed /pril 55, 2455...........................................................82
54.6ational /ssembl- on chool)Eased 0ealth 1are.
http:..www.nasbhc.org.site.c.jsA"F'"$Ar0.b.2::84@@.k.EEE@.0ome.htm. /ccessed
/pril 55, 2455...................................................................................................................82
55.6ational /ssociation for 0ome 1are M 0ospice. Easic statistics about home care.
http:..www.nahc.org.facts.5401?tats.pdf. +pdated 2454. /ccessed /pril 55, 2455....82
52.,ffice of 7isabilit-, /ging and Long)Term 1are "olic-. Licensed board and care
homes: preliminar- findings from the 5;;5 6ational 0ealth "rovider Inventor-.
http:..aspe.hhs.gov.daltcp.reports.5;;(.rn4<.htm. "ublished Ma- 5;;(. /ccessed /pril
55, 2455...........................................................................................................................82
5(."ace E. 0ospice care. A/M/. 244<&2;:#<%:@52.........................................................8(
58.The Aoint 1ommission. http:..www.jointcommission.org. /ccessed /pril 55, 2455.. .8(
5:.+.. Beneral /ccounting ,ffice. pecialt- hospitals: geographic location, services
provided, and financial performance. http:..www.gao.gov.new.items.d485<@.pdf.
"ublished ,ctober 244(. /ccessed /pril 55, 2455.........................................................8(
5<.+.. 6ational Institutes of 0ealth. 6ational Institute on /ging. 'orkshop report.
0ealth IT 'orkforce 1urriculum Introduction to 0ealthcare and @
http:..www.nia.nih.gov.=esearchInformation.1onferences/ndMeetings.'orkshop=eport
.Introduction.htm. +pdated /ugust <, 244;. /ccessed /pril 55, 2455............................8(
5@.'iener AM, 0anle- =A, 1lark =, 3an 6ostrand A$. Measuring the activities of dail-
living: comparisons across national surve-s. ,ffice of 7isabilit-, /ging and Long)Term
1are "olic-. March ;, 5;;4. http:..aspe.hhs.gov.daltcp.reports.meacmpes.htm.
/ccessed /pril 55, 2455..................................................................................................8(
59.1harts, Tables, $igures..............................................................................................8(
5;.5.: 1hart: The + "opulation /ging <: -ears and ,lder from 5;;4 to 24:4. $rom
the + 1ensus Eureauum, "opulation "rojections of the + b- /ge, =ace, and
0ispanic ,rigin: 5;;( ) 24:4, pp 2:)5548, 5;;(. /vailable from
http:..www.nia.nih.gov.=esearchInformation.1onferences/ndMeetings.'orkshop=eport
.Introduction.htm .............................................................................................................8(
24.5.< 1hart: Ear chart depicting the percent of people with limitations in activities of
dail- living #/7L% b- age group& 244@. /vailable from
http:..www.aoa.gov./o/=oot./ging?tatistics."rofile.2454.docs.2454profile.pdf .........8(
25.5.@ 1hart: /vailable from
http:..www.medicare.gov.longtermcare.static.T-pes,verview.asp ................................8(
comp5?unit2?discuss.doc...............................................................................................8(
comp5?unit2?discuss?ke-.doc........................................................................................8(
comp5?unit2?self)assess.doc.........................................................................................8(
comp5?unit2?self)assess?ke-.doc .................................................................................8(
1omponent 5.+nit (.........................................................................................................88
5.Institute of Medicine. 7efining "rimar- 1are: /n interim report #5;;8%. 6ational
/cadem- of "ress, 'ashington 71. =etrieved from http:..www.nap.edu.openbook.phpK
record?idL;5:(MpageL=5 ..............................................................................................88
2.$r-, 5;94& Institute of Medicine: "rimar- 1are: /mericaNs 0ealth in a 6ew Era, The
6ational /cademies "ress, 5;;<.....................................................................................88
(.,T/, #5;9<%& "ew 0ealth "rofessions 1ommission, 5;;8. ........................................88
8.I,M. 7efining "rimar- 1are: /n interim report #5;;8%. 6ational /cadem- of "ress,
'ashington 71. http:..www.nap.edu.openbook.phpKrecord?idL;5:(MpageL=5 .........8:
:.I,M. "rimar- 1are in Medicine: / 7efinition. In / Manpower "olic- for "rimar- 0ealth
1are : =eport of a tud-. 'ashington, 7.1. : 6ational /cadem- "ress, 5;@9. 1h. 2....8:
<.I,M: "rimar- 1are: /mericaNs 0ealth in a 6ew Era, The 6ational /cademies "ress,
5;;< ...............................................................................................................................8:
lide 9: Image from Institute of Medicine: "rimar- 1are: /mericaNs 0ealth in a 6ew Era,
The 6ational /cademies "ress, 5;;<. ...........................................................................8:
5./merican Eoard of $amil- "ractice at https:..www.theabfm.org.about.polic-.asp! ....8:
2.http:..www.acponline.org.patients?families.about?internal?medicine. ........................8:
(.https:..www.aamc.org.students.medstudents.cim.specialties. ....................................8:
8.Eodenheimer T. "rimar- 1are )) 'ill It urviveK 6 Engl A Med 244< (::: 9<5)9<8 . 8:
:.http:..www.acponline.org.advocac-.events.state?of?healthcare.statehc4<?5.pdf .....8:
<.Faren E. 0auer, M7& teven A. 7urning, M7& et al., FE& 7urning, A& Fernan, '6&
$agan, MA& MintD, M& ,Nullivan, "& Eattistone, M& 7efer, T et al. #2449)4;)54%.
O$actors /ssociated 'ith Medical tudentsN 1areer 1hoices =egarding Internal
MedicineO. A/M/ (44 #54%: 55:8P55<8...........................................................................8:
@.http:..www.us)government)grants.net.article?info.php.articles?id.5: .........................8:
9.http:..www.vcstar.com.news.2454.jun.5<.health)reform)grants)e!pected)to)ease)
primar-. ...........................................................................................................................8:
5.http:..www.ucaoa.org.home?abouturgentcare.php .....................................................8:
2.6ational 1enter for 0ealth tatistics: O610 7ata Erief 6o. (9, Ma- 2454.Q
http:..www.cdc.gov.nchs.data.nhsr.nhsr44@.pdf .............................................................8:
(. http:..www.cdc.gov.nchs.data.nhsr.nhsr44@.pdf
https:..www.e!cellusbcbs.com.wps.wcm.connect.c8f5@:9482;;2:8@b494b2dc:c;c4b;
9.E=R3isitsR$)ESR$I6/L.pdfKM,7L/A"E=E .........................................................8:
8."itts =, 6iska =', Su A, Eurt 1'. 6ational 0ospital /mbulator- Medical 1are
urve-: 244< emergenc- department summar-. 6ational health statistics reports& no @.
0-attsville, M7: 6ational 1enter for 0ealth tatistics, 2449...........................................8:
:.6ational 1enter for 0ealth tatistics: O610 7ata Erief 6o. (9, Ma- 2454.O .............8:
<.http:..www.cdc.gov.nchs.data.nhsr.nhsr44@.pdf ..........................................................8:
@.http:..www.ucaoa.org.home?abouturgentcare.php .....................................................8:
0ealth IT 'orkforce 1urriculum Introduction to 0ealthcare and ;
5.=ontgen, 'ilhelm #59;:%& "icture of first S)ra- taken of his wifeNs hand. The bones
and her ring can be seen, similar to modern !)ra-s.
http:..www.molecularpatholog-.org.uk.............................................................................8<
(.2 Image of first S)ra- taken b- 'ilhelm =ontgen in 59;:, of his wifeNs hand. The
bones and her ring can be seen, similar to modern !)ra-s. ...........................................8<
5.Bottschalk /, $ocke /. Time pent in $ace)to)$ace "atient 1are and 'ork ,utside
the E!amination =oom. /nn $am Med 244: (: 899)8;(................................................8<
comp5?unit(?discuss.doc...............................................................................................8<
comp5?unit(?discuss?ke-.doc........................................................................................8<
comp5?unit(?self)assess.doc.........................................................................................8<
comp5?unit(?self)assess?ke-.doc .................................................................................8<
1omponent 5.+nit 8.........................................................................................................8@
5.Elue1ross Elue hield /ssociation.
http:..en.wikipedia.org.wiki.Elue?1ross?Elue?hield?/ssociation. /ccessed 7ecember
54, 2455. .........................................................................................................................89
2.1alifornia ,ffice of the "atient /dvocate. 'hat is an 0M,K 2455.
http:..www.opa.ca.gov.report?card.hmowhatis.asp!. /ccessed /pril 8, 2455..............89
(.1enters for Medicare and Medicaid ervices. Medicaid program: general Information
Hoverview. http:..www.cms.gov.medicaidgeninfo. +pdated $ebruar- 2(, 2455.
/ccessed /pril <, 2455....................................................................................................89
8.Illinois 7epartment of 0uman ervices. 0ealth insurance carriers and managed care.
http:..www.dhs.state.il.us.page.asp!KitemL(5:9(. /ccessed /pril 8, 2455. ................89
:.Indian 0ealth ervice. Indian 0ealth ervice fact sheet.
http:..www.ihs.gov.aboutihs.thisfacts.asp. /ccessed /pril :, 2455. ..............................89
<.,ur7ocuments.gov. ocial ecurit- /ct #5;(:%.
http:..www.ourdocuments.gov.doc.phpKflashLtrueMdocL<9. /ccessed /pril 52, 2455.89
@.+.. 7epartment of 0ealth and 0uman ervices. Medical treatment in 0ill)Eurton
funded healthcare facilities. http:..www.hhs.gov.ocr.civilrights.understanding.Medical
J24TreatmentJ24atJ240illJ24EurtonJ24$undedJ24Medical
J24$acilities.inde!.html. /ccessed /pril 8, 2455. .........................................................89
9.+.. 7epartment of 0ealth and 0uman ervices. +nderstanding health information
privac-. http:..www.hhs.gov.ocr.privac-.hipaa.understanding.inde!.html. /ccessed /pril
8, 2455. ...........................................................................................................................89
;.+.. 7epartment of 0ealth and 0uman ervices, ,ffice of the Beneral 1ounsel. 7rug
"rice 1ompetition and "atent Term =estoration /ct.
http:..librar-.findlaw.com.5;;;.Mar.54.5(4@4(.html. 5;;;. /ccessed /pril 5(, 2455.. . .89
54.+.. 7epartment of Austice, 1ivil =ights 7ivision. /mericans with 7isabilities /ct:
*uestions and answers. http:..www.ada.gov.*J2<aeng42.htm. +pdated 6ovember 58,
2449. /ccessed /pril 5(, 2455........................................................................................89
55.+.. 7epartment of Labor, Eureau of Labor tatistics. 1areer Buide to Industries.
2454P55 ed. http:..www.bls.gov.oco.cg. /ccessed /pril 8, 2455....................................8;
5.1enters for Medicare and Medicaid ervices. 6ational health e!penditure data, Table
5: 6ational health e!penditures aggregate, per capita amounts, percent distribution, and
average annual percent growth, b- source of fundsHselected calendar -ears 5;<4P
244;. https:..www.cms.gov.6ational0ealthE!pend7ata.2:?60E?$act?heet.asp .
+pdated Aanuar- 5(, 2455. /ccessed /pril 5(, 2455.....................................................8;
2.tarkLaw.org. tark lawPinformation on penalties, legal practices, latest news and
advice. http:..www.starklaw.org. /ccessed /pril 5(, 2455..............................................8;
(.The 0enr- A Faiser $amil- $oundation. +.. health care costs e!plained.
http:..www.kaiseredu.org.Issue)Modules.+)0ealth)1are)1osts.Eackground)Erief.asp!.
+pdated March 2454. /ccessed /pril :, 2455................................................................8;
8.The 0enr- A Faiser $amil- $oundation. 0ealthcare 1osts: / "rimer& available from:
http:..www.kff.org.insurance. @<@4.cfm Fe- information on health care costs. Last
accessed March 22, 2455................................................................................................8;
:.The 0enr- A Faiser $amil- $oundation. Menlo "ark, 1/: 2454 + 0ealthcare 1osts&
available from: http:..www.kaiseredu.org.inde!.asp "rovides background information,
links to ke- data and polic- information on + healthcare costs. Last accessed March
22, 2455...........................................................................................................................8;
8.5 1hart: The Faiser $amil- $oundation, Faiser $ast $acts. 7ata source: 1enters for
Medicare and Medicaid ervices, ,ffice of the /ctuar-, 6ational 0ealth tatistics
Broup, at http:..www.cms.hhs.gov.6ational0ealthE!pend7ata. #see 0istorical& 60E
summar- including share of B7", 1I 5;<4)244;& file nhegdp4;.Dip%. /ccessed 55 7ec
2455. #1M, 2455, "7)+, 11 EI)61)/ (.4%. .........................................................8;
8.2 1hart: The Faiser $amil- $oundation, Faiser $ast $acts. 7ata ource: 1enters for
2455. /vailable at http:..facts.kff.org.chart.asp!KchL9:8. #F$$, 1M, 2455, "7)+,
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comp5?unit:?self)assess.doc.........................................................................................<5
comp5?unit:?self)assess?ke-.doc .................................................................................<5
1omponent 5.+nit <.........................................................................................................<2
5./merican Eoard of Medical pecialties. http:..www.abms.org. /ccessed /pril 52,
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2./merican 0ospital /ssociation. http:..www.aha.org. /ccessed /pril 52, 2455............<(
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52, 2455...........................................................................................................................<(
<.The Aoint 1ommission.
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2455.................................................................................................................................<(
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9.+ $ood and 7rug /dministration. http:..www.fda.gov. /ccessed /pril 52, 2455.......<(
;.+=/1. http:..www.urac.org. /ccessed /pril 52, 2455. ...............................................<(
Lecture <a 1harts, Tables, $igures.................................................................................<(
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2./dministrative ,ffice of the + 1ourts. +nderstanding federal and state courts.
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erstanding$ederal/ndtate1ourts.asp!. /ccessed /pril 9, 2455..................................<(
(./dministrative ,ffice of the + 1ourts. +nited tates 1ourts.
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8.1enters for Medicare and Medicaid ervices. Buidance to laws and regulations:
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:.1ornell +niversit- Law chool Legal Information Institute. Tort.
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<.ocial ecurit- ,nline. Information about ocial ecurit-Ns hearings and appeals
process. http:..www.ssa.gov.appeals. /ccessed /pril 54, 2455.....................................<(
@.The Librar- of 1ongress. Law Librar- of 1ongress. http:..www.loc.gov.law. /ccessed
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<.2 Table: E!ample of court jurisdiction on various levels of government...................<8
<. ( $igure: Two important sub classifications of civil law are contract law and tort law.
,0+ #2454%...................................................................................................................<8
<.8 $igure: The two t-pes of "ublic Law that have the most effect on individuals are
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malpractice)basics)2;9::.html. /ccessed /pril 55, 2455...............................................<:
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Medicaid fraud and abuse. http:..oig.hhs.gov.fraud."h-sicianEducation. /ccessed /pril
55, 2455...........................................................................................................................<:
55.,hio tate Ear /ssociation. Law -ou can use: ,hioGs QBood amaritanY law protects
volunteers. ,ctober 22, 244<.
http:..www.ohiobar.org."ages.LawIou1an+se7etail.asp!KitemI7L8@@. /ccessed /pril
55, 2455...........................................................................................................................<:
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Medicare and protect ta!pa-er dollars. Aanuar- 28, 2455.
http:..www.healthcare.gov.news.factsheets.new?tools?to?fight?fraud.html. /ccessed
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/ct. http:..www.healthcare.gov.law.introduction.inde!.html. /ccessed /pril 54, 2455.. .<:
<.: $igure: 7iagram showing a few of the man- sources that can contribute to a
medical standard of care. ,0+ #2454%........................................................................<:
<. < 1hart: 7iagram showing how Tort law is the part of private or civil law that deals
with malpractice. ,0+ #2454%.......................................................................................<:
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=eport. "ublication 6o. 55)4448. $ebruar- 2455.
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http:..healthit.ahr*.gov.portal.server.ptK
openL:58MobjI7L:<<8MparentnameL1ommunit-"ageMparentidL:4MmodeL2.
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0I"// Transactions and 1ode et =ule. 244;. http:..www.ama)
assn.org.resources.doc.psa.hipaa)tcs.pdf. /ccessed /pril 52, 2455..............................<:
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http:..www.cms.gov.0I"//BenInfo.4<?/reIoua1overedEntit-.asp. /ccessed /pril 5(,
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severit-)of)medical)malpractice)claims)to)rise)in)2455.html. /ccessed /pril 5(, 2455..<<
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5;;;. http:..www.iom.edu.=eports.5;;;.To)Err)is)0uman)Euilding)/)afer)0ealth)
-stem.asp!. /ccessed /pril 5(, 2455...........................................................................<<
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assn.org.ama5.pub.upload.mm.(<(.prp)245445)claim)fre*.pdf. /ccessed /pril 5(,
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9.=einberg . 0ospital errors ma- be far more common than suspected. 0ealth7a-.
/pril @, 2455. http:..www.usnews.com.mobile.articles?mobile.report)hospital)errors)
ma-)be)far)more)common)than)suspected. /ccessed /pril 5(, 2455............................<<
;.The Aoint 1ommission. http:..www.jointcommission.org. /ccessed /pril 5(, 2455.....<<
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mone- penalt- for violations of the 0I"// "rivac- =ule. $ebruar- 22, 2455.
http:..www.hhs.gov.news.press.2455pres.42.24554222a.html. /ccessed /pril 52, 2455.
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<.9 Table: The bottom of the /0=> home page, which can be found at
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bottom of the /0=> home page, which can be found at http:..www.ahr*.gov.. Last
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http:..healthit.ahr*.gov.portal.server.ptK
openL:58MobjI7L:<<8MparentnameL1ommunit-"ageMparentidL:4MmodeL2. $rom
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<.55 $igure #right%. Menu of articles on background information and the latest evidence
on ke- topics from the field of health IT.
http:..healthit.ahr*.gov.portal.server.pt.communit-.knowledge?librar-.<:(.ke-?topics.:<
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@.LaTour M Eichenwald, 0ealth Information Management, concepts, "rinciples, and
"ractice, Third Edition, 2454 /0IM/ "ress: 1hicago....................................................<@
9.=usso, =. 1linical documentation improvement, 2454 /0IM/ "ress: 1hicago........<@
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54.,ffice of the Inspector Beneral.
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Medicaid fraud and abuse. http:..oig.hhs.gov.fraud."h-sicianEducation. /ccessed
55.55.2455.......................................................................................................................<@
52.,ffice of the Inspector Beneral. http:..oig.hhs.gov.newsroom.video.inde!.asp.
accessed on 55.55.2455..................................................................................................<@
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55.55.2455. .....................................................................................................................<@
58.1orporate integrit- agreements. http:..oig.hhs.gov.compliance.corporate)integrit-)
agreements.inde!.asp. /ccessed on 55.;.55 ................................................................<@
comp5?unit<?activit-.doc................................................................................................<@
comp5?unit<?activit-?ke-.doc.........................................................................................<@
comp5?unit<?discuss.doc...............................................................................................<@
comp5?unit<?discuss?ke-.doc........................................................................................<@
comp5?unit<?self)assess.doc.........................................................................................<@
comp5?unit<?self)assess?ke-.doc .................................................................................<9
1omponent 5.+nit @.........................................................................................................<;
1omponent 5.+nit 9.........................................................................................................@5
1omponent 5.+nit ;.........................................................................................................@(
;.5 1hart: The 0ierarch- of tud- 7esigns P adapted from ,!ford 1enter for Evidence)
based Medicine ) Levels of Evidence . #244;, March%. =etrieved 7ecember <, 2455,
from 1enter for Evidence Eased Medicine website: http:..www.cebm.net.inde!.asp!K
oL542:.............................................................................................................................@8
;.2 1hart: ,!ford 1enter for Evidence)based Medicine ) Levels of Evidence . #244;,
March%. =etrieved 7ecember <, 2455, from 1enter for Evidence Eased Medicine
website: http:..www.cebm.net.inde!.asp!KoL542:.........................................................@8
1omponent 5.+nit 54.......................................................................................................@<
comp5?unit54?discuss.doc.............................................................................................@9
comp5?unit54?discuss?ke-.doc......................................................................................@9
comp5?unit54?self)assess.doc.......................................................................................@9
comp5?unit54?self)assess?ke-.doc................................................................................@9
1omponent /cron-m Blossar-........................................................................................@;
1reative 1ommons /ttribution)6on1ommercial)hare/like (.4 +nported ....................95
Component #$er$ie%
This component is a surve- of how healthcare and public health are organiDed and
services delivered in the +. It covers public polic-, relevant organiDations and their
interrelationships, professional roles, legal and regulator- issues, and pa-ment s-stems.
It also addresses health reform initiatives in the +.
Component #b&ecti$es
/t the completion of this component, the student will be able to:
5. 7efine healthcare terms.
2. 7escribe paradigm shifts in healthcare.
(. 7escribe the medical model of healthcare in the +.
8. 7escribe the administrative and functional organiDation of entities that deliver
healthcare in the +, both in the inpatient as well as the outpatient settings.
:. 7iscuss the role of various healthcare professionals, their education, and
certification.licensure re*uirements.
<. 7istinguish between public and private funding for healthcare.
@. 7escribe healthcare financing structures, including insurance plans, third)part-
pa-ers, Medicare, and Medicaid.
9. 7escribe the organiDation and structures of 0ealth Maintenance ,rganiDations
#0M,s%, "referred "rovider ,rganiDations #"",s%, and Independent "ractice
/ssociations #I"/s%.
;. 7escribe methods of billing and reimbursement in healthcare.
54. 7escribe elements of coding and charge capture in healthcare.
55. 1ompare and contrast the function of the Aoint 1ommission, $ood and 7rug
/dministration #$7/%, 1enters for 7isease 1ontrol #171%, and 6ational Institutes of
0ealth #6I0%, with an emphasis on Electronic 0ealth =ecords #E0=s%.
52. 7iscuss legal issues in medicine including the 0ealth Insurance "ortabilit- and
/ccountabilit- /ct #0I"//%, confidentialit-, medical malpractice, and tort reform.
5(. 7escribe the organiDation of public health in the + at the federal, state, and local
levels, and discuss the role of public health in averting epidemics and bioterrorism.
58. 7escribe evidence)based medicine, clinical practice guidelines, and *ualit-
indicators in medicine. Identif- ke- organiDations involved in developing clinical
guidelines.
5:. 7iscuss the ke- issues driving healthcare reform in the +.
5<. 7escribe the implementation of meaningful use of health information technolog- in
the conte!t of the 0ealth Information Technolog- for Economic and 1linical 0ealth
#0ITE10% /ct.
Component 'uthors
'ssined Institution
,regon 0ealth M cience +niversit-
"ortland, ,=
(eam )ead
3ishnu Mohan, M7
Primar* Contributin 'uthors
Thomas Elehl, M7
3alencia 1ommunit- 1ollege, $L
Faren Eden, "h7
Eill 0ersh, M7
A/ Magnuson, "h7
3ishnu Mohan, M7
Aoanne 3alerius, M"0, =0I/
)ecture "arration
3oiceover Talent
1onnie Eowman
http:..www.conniebowman.com

Sound +nineer
Mike 1ollins, Blenwood ound
Ealtimore, M7 . 'ashington, 71
http:..www.glenwoodsound.com
0ealth IT 'orkforce 1urriculum Introduction to 0ealthcare and (4
(eam Members
helb- /cteson, MEd
Instructional pecialist
1orke- 7evlin, E$/, "M"
"roject Manager
'illiam 0ersh, M7
"rincipal Investigator
"rofessor and 1hair of the 7epartment of Medical Informatics
6athan kidmore, E/
Instructional 7esign /ssistant
1hris 'eldon, E
'eb pecialist
,isclaimer
These materials were prepared under the sponsorship of an agency of the United
States )overnment( Neither the United States )overnment nor any agency thereof, nor
any of their employees, ma*es any warranty, e+press or implied, or assumes any legal
liability or responsibility for the accuracy, completeness, or usefulness of any
information, apparatus, product, or process disclosed, or represents that its use would
not infringe privately owned rights( ,eference herein to any specific commercial
product, process, or service by trade name, trademar*, manufacturer, or otherwise
does not necessarily constitute or imply its endorsement, recommendation, or favoring
by the United States )overnment or any agency thereof( The views and opinions of
authors e+pressed herein do not necessarily state or reflect those of the United States
)overnment or any agency thereof(

-i*ewise, the above also applies to the urriculum Development enters .including
olumbia University, Du*e University, /ohns Hop*ins University, Oregon Health &
Science University, University of "labama at 0irmingham, and their affiliated entities1(
The information contained in the Health !T 2or*force urriculum materials is intended
to be accessible to all( To help ma*e this possible, the materials are provided in a
variety of file formats( Some people may not find the 3lash video and (S23 files
accessible and should instead utili4e the 5ower5oint slides together with the (mp6
audio file and7or 2ord transcript to access the lectures( 3or more information, please
visit the website of the National Training and Dissemination enter at http877www(onc9
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statement(
Component 1/Unit 1
Unit (itle
Introduction and Histor* o- Modern Healthcare in the US
Unit ,escription
This introductor- unit covers definitions of terms used in the component, with an
emphasis on paradigm shifts in healthcare, including the transition from ph-sician)
centric to patient)centric care, the transition from individual care to interdisciplinar-
team)based care, and the central role of technolog- in healthcare deliver-. This unit
also emphasiDes the core values in + healthcare.
Unit #b&ecti$es
E- the end of this unit the student will be able to:
5. 7elineate ke- definitions in the healthcare domain #Lectures a, b, c, d%
2. E!plore components of healthcare deliver- and healthcare s-stems
#Lecture a%
(. 7efine public health and review e!amples of improvements in public
health #Lecture b%
8. 7iscuss core values and paradigm shifts in + healthcare #Lecture c%
:. 7escribe in overview terms, the technolog- used in the deliver- and
administration of healthcare #Lecture d%
Unit (opics/)ecture (itles
5. 7escription of terms commonl- used in healthcare including:
a% 0ealth
b% 0ealthcare
c% 0ealthcare 7eliver-
d% 0ealthcare Industr-
e% 0ealthcare -stems
f% "ublic 0ealth
2. 1ore values in + healthcare
(. 7iscussion of critical paradigm shifts in medicine including
a% "h-sician)centric to patient)centric care
b% Individual to team)based care
c% "h-sician)kept records to personal health records
d% 7ominance of technolog- in healthcare deliver-
8. The dominant role of technolog- in healthcare deliver- ) technolog- used in the
deliver- and administration of healthcare, with emphasis on technolog- used in:
a% 1linical medicine
b% Telemedicine
c% "harmac-
d% =adiolog-
0ealth IT 'orkforce 1urriculum Introduction to 0ealthcare and ((
e% =ehabilitation
f% 7entistr-
g% 0ealthcare education
Unit .e-erences
)ecture 1a
1. #%%# N"!S Definitions 9 :#& "mbulatory Health are Services. #2442%.
=etrieved 7ecember <, 2455, from + 1ensus Eureau website:
http://%%%.census.o$/epcd/naics0!/de-/",+/0!1.H(M.
!. areer )uide to !ndustries, #%&%9&& ;dition. #2455%. =etrieved 7ecember <,
2455, from Eureau of Labor tatistics, +.. 7epartment of Labor website:
http://%%%.bls.o$/oco/c/.
(. 7efinition of 0ealthcare. "reamble to the 1onstitution of the 'orld 0ealth
,rganiDation as adopted b- the International 0ealth 1onference, 6ew Iork, 5;
Aune ) 22 Aul- 5;8<& signed on 22 Aul- 5;8< b- the representatives of <5 tates
#,fficial =ecords of the 'orld 0ealth ,rganiDation, no. 2, p. 544% and entered
into force on @ /pril 5;89.
8. 7uckett, . A., M 'ard, M. #2449%. 7eveloping [robust performance benchmarksG
for the ne!t /ustralian healthcare /greement: The need for a new framework.
"ustralia and New <ealand Health 5olicy , '#5%.
1. Health are areers Directory 9 "llied Health . #2455%. =etrieved 7ecember <,
2455, from /merican Medical /ssociation website: http://%%%.ama2
assn.or/ama/pub/education2careers/careers2health2care/director*.shtml.
0. 0ospital. #2455%. In ;ncyclop=dia 0ritannica. =etrieved from
http://%%%.britannica.com/+3chec4ed/topic/!5!0!0/hospital .
5. Subacute care definition( #2455%. =etrieved 7ecember <, 2455, from 1a.gov
7epartment of 0ealthcare ervices website:
http://%%%.dhcs.ca.o$/pro$o$part/Paes/SubacuteCare.asp6.
7. 2orld Health ,eport #%%% 9 Health systems8 improving performance. #2444%.
=etrieved 7ecember <, 2455, from '0, website:
http://%%%.%ho.int/%hr/!000/en/.
)ecture 1a Charts8 (ables and /iures
5.5 Table: 0-S >uarterly ensus of ;mployment and 2ages, #%%?. #2449%.
=etrieved 7ecember <, 2455, from + Eureau of Labor tatistics website:
http:..www.bls.gov.cew..
)ecture 1b
5. 1enters for 7isease 1ontrol and "revention ) Ten great public health
achievementsH+nited tates, 5;44P5;;;. #5;;;, /pril 2%. @@2,, $?#52%, 285)
28(.
!. Definition of ;pidemiology from 5rinciples of ;pidemiology, #nd edition, D
Self Study ourse 6%6%9). #2449%. =etrieved 7ecember <, 2455, from 1enters
for 7isease 1ontrol and "revention website:
http://%%%!a.cdc.o$/phtn/catalo/pd-2-ile/+pi9course.pd-.
3. =ipa, L. '. #5;;(%. / 0alf)centur- of 1ommunit- 'ater $luoridation in the +nited
tates: =eview and 1ommentar-. Dept( of hildrenAs DentistryB SUNC Stony
0roo*, '6#5%, =etrieved from http://aaphd.or/docs/position:!0papers/'
:!0Hal-2Centur*:!0o-:!0Communit*:!0;ater1<<3.pd-.
=. Smallpo+. #2445%. =etrieved 7ecember <, 2455, from 'orld 0ealth ,rganiDation
) Media 1enter website:
http://%%%.%ho.int/mediacentre/-actsheets/smallpo6/en/.
1. Typhoid 3ever in the United States 9 NH 0ac*grounder. #2445, /pril 2:%.
=etrieved 7ecember <, 2455, from 6ational Institutes of 0ealth, 6ational Institute
of 1hild 0ealth and 0uman 7evelopment website:
http://%%%.nichd.nih.o$/ne%s/releases/t*phoid9bac4round.c-m.
0. Typhoid 3ever, 3reDuently "s*ed >uestions. #244:, Aanuar- 54%. =etrieved
7ecember <, 2455, from 1enters for 7isease 1ontrol and "revention ) 6ational
1enter for Emerging and \oonotic Infectious 7iseases website:
http://%%%.cdc.o$/nc>$ed/di$isions/d-bmd/diseases/t*phoid9-e$er/.
5. 3andenbroucke, A. ". #5;;9%. 1linical investigation in the 24th centur-: the
ascendenc- of numerical reasoning. -ancet, 6'# .suppl #1#52%, <. =etrieved from
http://%%%.rods.pitt.edu/site.
7. 2illiam 0( Eannel, @D 9 5ioneer in ardiovascular ;pidemiology, &F#6G#%&&.
#2455, Aanuar- 54%. =etrieved 7ecember <, 2455, from $ramingham 0eart tud-
website: http://%%%.-raminhamheartstud*.or/inde6.html.
;. 'inslow, 1. E. #5;24%. The +ntilled $ields of "ublic 0ealth. Science, n(s( '&, 2(.
)ecture 1c
5. /rvantes, A. #2449%. ;mergency ,oom Hisits limb "mid 5rimary are
Shortages, Study ,esults Show. =etrieved 7ecember <, 2455, from /merican
/cadem- of $amil- "h-sicians website:
http:..www.aafp.org.online.en.home.publications.news.news)now.health)of)the)
public.2449492@er)visits.html.
2. The electronic medical record at @ayo linic( #2455%. =etrieved 7ecember <,
2455, from Ma-o 1linic website: http:..www.ma-oclinic.org.emr..
(. Health 5olicy ;+plained8 US Health are osts G 0ac*ground 0rief. #2454,
March%. =etrieved 7ecember <, 2455, from Faiser E7+ website:
http:..www.kaiseredu.org.Issue)Modules.+)0ealth)1are)1osts.Eackground)
Erief.asp!.
8. A/M/ pecial 1ommunication P +ninsured /dults "resenting to + Emergenc-
7epartments. /ssumptions vs. 7ata. #2449%. /ournal of the "merican @edical
"ssociation, 6%%#5<%, 5;58)5;28. =etrieved from http:..jama.ama)
assn.org.content.(44.5<.5;58.abstract.
:. /oint 5rinciples of the 5atient entered @edical Home. #244@%. =etrieved
7ecember <, 2455, from "atient)centered "rimar- 1are 1ollaborative ) /merican
/cadem- of $amil- "h-sicians #//$"%& /merican /cadem- of "ediatrics #//"%&
0ealth IT 'orkforce 1urriculum Introduction to 0ealthcare and (:
/merican 1ollege of "h-sicians #/1"%& /merican ,steopathic /ssociation #/,/%
website: http:..www.pcpcc.net.node.58.
<. Overview of Healthcare 3inancing, from ,egional Overview of Social Health
!nsurance in South ;ast "sia. #2448%. =etrieved 7ecember <, 2455, from 'orld
0ealth ,rganiDation E/=, website:
http:..www.searo.who.int.Link$iles.ocial?0ealth?Insurance?07)2@8.pdf.
)ecture 1d
5. Ealdr-, M., $isher, E., Billett, M., M 0uet, 3. #5;9<%. Biving patients their own
records in general practice: e!perience of patients and staff. 0@/, #F#, :;<):;9.
2. Ear 1ode Label for 0uman 7rug "roducts and Eiological "roducts& $inal =ule.
#2448%. In 3ederal ,egister #<; ed., 3ol. (9, pp. ;55;);5@5%.
(. Eates, 7. '., Bawande, /. /., M Bill #244(%. : Improving safet- with information
technolog-. New ;ngland /ournal of @edicine, 6$?, 2:2<)2:(8.
8. 1oleman, 3. #5;98%. 'h- patients should keep their own records. /ournal of
@edical ;thics, &%, 2@)29.
:. Aones, =., "earson, A., McBregor, ., Bilmour, '. 0., /tkinson, A. M., M Earrett,
/., et. al. #5;;;%. =andomiDed trial of personaliDed computer based information
for cancer patients. 0@/, 6&F, 5285)528@.
<. "owsner, . M., '-att, A. 1., M 'ritght, ". #5;;9%. ,pportunities for and
challenges of computeriDation. The -ancet, 6'#, 5<5@)5<22.
@. ittig, 7. #2455%. Data collection in private practice and implementation with
electronic medical records. =etrieved 7ecember <, 2455, from 1linfo'iki
website:
http:..clinfowiki.org.wiki.inde!.php.7ata?collection?in?private?practice?and?impl
ementation?with?electronic?medical?records.
9. mith, 7. B., M Eurgess, E. M. #2445, Ma-%. The use of 1/7.1/M technolog- in
prosthetics and orthoticsH 1urrent clinical models and a view to the future.
/ournal of ,ehabilitation ,esearch and Development, 6?#(%, (2@)((8. =etrieved
from http:..www.rehab.research.va.gov.jour.45.(9.(.pdf.smith.pdf.
Student 'pplication 'cti$ities
comp5?unit5?discuss.doc
comp5?unit5?discuss?ke-.doc
comp5?unit5?self?assess.doc
comp5?unit5?self?assess?ke-.doc
0ealth IT 'orkforce 1urriculum Introduction to 0ealthcare and (<
Component 1/Unit !
Unit (itle
,eli$erin Healthcare ?Part 1@
Unit ,escription
This unit depicts the medical model of healthcare in the +, with an overview of the
organiDation of healthcare and the ph-sical structure of healthcare deliver- in the
outpatient, inpatient and long)term care settings, including an overview of the
organiDation of the 3eterans /ffairs #3/% s-stem. This unit is intended primaril- for the
student who does not have a background in healthcare, though the topics of this unit will
be described at a relativel- advanced level.
Unit #b&ecti$es
5. 7escribe the organiDation of healthcare at the federal, state and local
levels #Lecture a%
2. 7escribe the organiDation of the 3/ s-stem and Militar- 0ealth -stem
#Lecture b%
(. 7escribe the structure and function of hospital clinical and administrative
units #Lecture c%
8. 7escribe different t-pes of long term care facilities, with an emphasis on
their function #Lecture d%
Unit (opics/)ectures
5. The organiDation of healthcare at the federal, state and local levels
2. The organiDation of the 3/ s-stem and Militar- 0ealth -stem
(. ,utpatient clinics and hospitals
a% Individual and group practices
b% Managed care
c% +rgent care
d% 1ommunit- health centers
e% T-pes of hospitals #communit-, teaching.research, critical access%
8. "ost)acute care, long)term care, non)traditional settings
a% chool)based healthcare
b% 0ealth issues for older adults
c% T-pes of long)term care facilities and services for older adults
d% ,ther long)term healthcare settings
e% ,ther hospitals #pecialt-, =ehabilitation 1are, "s-chiatric, 7a-%
f% 1ommunit- Mental 0ealth 1enters, ubstance /buse Treatment 1enters%
Unit .e-erences
0ealth IT 'orkforce 1urriculum Introduction to 0ealthcare and (@
)ecture !a
1. /dministration for 1hildren and $amilies. http://%%%.ac-.hhs.o$. /ccessed /pril
:, 2455.
!. /dministration on /ging. http://%%%.aoa.o$. /ccessed /pril <, 2455.
3. /genc- for 0ealth 1are =esearch and >ualit-. http://%%%.ahrA.o$. /ccessed
/pril 8, 2455.
=. /genc- for To!ic ubstances and 7isease. /genc- for To!ic ubstances and
7isease =egistr-. http://%%%.atsdr.cdc.o$. +pdated March 2(, 2455. /ccessed
/pril 8, 2455.
1. /lliance for /dvancing 6onprofit 0ealth 1are. The value of nonprofit health care.
http://%%%.nonpro-ithealthcare.or/reports/19$alue.pd-. /ccessed /pril :, 2455.
0. /merican0ospitals.com. 0ospital locator: all hospitals are not created e*ual.
http://%%%.americanhospitals.com/hospitals/hospitalseAual.htm. /ccessed
/pril :, 2455.
5. 1enters for 7isease 1ontrol and "revention. http://%%%.cdc.o$. /ccessed /pril <,
2455.
7. 1enters for Medicare and Medicaid ervices. 1M programs and information.
http://%%%.cms.o$. /ccessed /pril 8, 2455.
<. 1orporate 0ealth 1are 1oalition. http://%%%.corporatehealthcare.or. /ccessed
/pril :, 2455.
10. 0ealth =esources and ervices /dministration.
http://%%%.hrsa.o$/inde6.html. /ccessed /pril 8, 2455.
11. 00.gov. http://%%%.hhs.o$. /ccessed /pril 8, 2455.
1!. Indian 0ealth ervice. http://%%%.ihs.o$. /ccessed /pril 8, 2455.
13. Indian 0ealth ervice. I0 fact sheets: Indian health disparities.
http://in-o.ihs.o$/,isparities.asp. +pdated Aanuar- 2455. /ccessed /pril 8,
2455.
1=. Medicare.gov. http://%%%.medicare.o$. /ccessed /pril 8, 2455.
11. Medline "lus. Medicare. http://%%%.nlm.nih.o$/medlineplus/medicare.html.
+pdated March 5<, 2455. /ccessed /pril :, 2455.
10. 6ational /cadem- for tate 0ealth "olic-. http://%%%.nashp.or. +pdated
March 2455. /ccessed /pril 8, 2455.
15. 6ational /ssociation of 1ommunit- 0ealth 1enters. http://%%%.nachc.or.
/ccessed /pril :, 2455.
17. 6ational Institutes of 0ealth. http://%%%.nih.o$. /ccessed /pril 8, 2455.
1<. ,ffice of Inspector Beneral. http://oi.hhs.o$. /ccessed /pril <, 2455.
!0. =ural /ssistance 1enter. 1/0 fre*uentl- asked *uestions.
http://%%%.raconline.or/in-o9uides/hospitals/cah-aA.phpB%hatis. +pdated
,ctober 2<, 2454. /ccessed /pril <, 2455.
!1. ubstance /buse and Mental 0ealth ervices /dministration.
http://%%%.samhsa.o$. /ccessed /pril 8, 2455.
!!. +.. $ood and 7rug /dministration. http://%%%.-da.o$. /ccessed /pril <,
2455.
)ecture !a Imaes
lide :: + 7epartment of 0ealth and 0uman ervices organiDational chart. /vailable
from http://%%%.hhs.o$/about/orchart/
)ecture !b
5. 7epartment of 3eterans /ffairs. #%&% Organi4ational 0riefing 0oo*. 'ashington,
71: ,ffice of 0uman =esources and /dministration, ,ffice of /dministration&
2454.
!. 0enr- A. Faiser $amil- $oundation. Militar- and veteransG health care.
http://%%%.4aiseredu.or/Issue2Modules/Militar*2and2Veterans2Health2
Care/3ac4round23rie-.asp6. /ccessed /pril :, 2455.
3. Lumina $oundation. Toda-Gs BI Eill: 1onnecting /mericaGs veterans to higher
educationH$/>. http://%%%.toda*sibill.or/-aA/B0. 244;. /ccessed /pril <,
2455.
=. Militar- 0ealth -stem. $re*uentl- asked *uestions #$/>s%: general M0
*uestions. http://%%%.health.mil. /ccessed /pril :, 2455.
1. Militar- 0ealth -stem. T=I1/=E. http://%%%.tricare.mil. /ccessed /pril <,
2455.
0. 6ational 6aval Medical 1enter. 6ational 1apital 1onsortium.
http://%%%.bethesda.med.na$*.mil/careers/raduate9medical9education/
me9residencies/pharmac*/PCD1:!0.esidenc*:!0Pac4et.pd-. /ccessed
/pril @, 2455.
5. +.. /rm- 24th upport 1ommand. 1hemical, Eiological, =adiological, 6uclear,
0igh)Iield E!plosives. http://%%%.cbrne.arm*.mil. /ccessed /pril <, 2455.
7. +.. 7epartment of 3eterans /ffairs. http://%%%.$a.o$. +pdated /pril :, 2455.
/ccessed /pril :, 2455.
)ecture !b Charts8 (ables8 /iures
5.2 1hart: ,rganiDational chart for the 7epartment of 3eterans /ffairs. tructure of the
3/. /vailable from http://%%%.$a.o$/o-cadmin/docs/$aorchart.pd-
5.( 1hart: 3/ ervices.
5.8 1hart: "ost)traumatic stress disorder, traumatic brain injur-
Images
lide 5(: Map of 3eteranGs Integrated ervices 6etwork , or 3I6, units in the +.
/vailable from http://%%%!.$a.o$/director*/uide/di$ision.aspEdnumF1
)ecture !c
1. /etna. ", health insurance plan choices.
http://healthinsurance.aetna.com/health2plans/point2o-2ser$ice. "ublished
2455. /ccessed /pril <, 2455.
!. /merican 1ollege of Emergenc- "h-sicians $oundation. Emergenc- care for
0ealth IT 'orkforce 1urriculum Introduction to 0ealthcare and (;
-ou.
http://%%%.emerenc*care-or*ou.or/+merenc*Manual/;ho(a4esCare/,e
-ault.asp6. /ccessed /pril @, 2455.
3. /merican 0eart /ssociation. Managed health care plans.
http://%%%.americanheart.or/presenter.&htmlEidenti-ierF=003. "ublished
2455. /ccessed /pril @, 2455.
=. /merican 0ospital /ssociation. http://%%%.aha.or. /ccessed /pril <, 2455.
1. /merican0ospitals.com. 0ospital locator: all hospitals are not created e*ual.
http://%%%.americanhospitals.com/hospitals/hospitalseAual.htm. /ccessed
/pril :, 2455.
0. /ssociation of /merican Medical 1olleges. Teaching hospitals.
https://%%%.aamc.or/about/teachinhospitals. /ccessed /pril 9, 2455.
5. 1enters for Medicare and Medicaid ervices. 1ommunit- mental health centers.
https://%%%.cms.o$/Certi-icationandComplianc/039Communit*HealthCent
ers.asp. /ccessed /pril 9, 2455.
7. $eigenbaum E. ,rganiDational structure of hospitals.
http://smallbusiness.chron.com/orani>ational2structure2hospitals2
3711.html. "ublished 2455. /ccessed /pril @, 2455.
<. Breenville 0ospital -stem +niversit- Medical 1enter. http://%%%.hs.or.
/ccessed /pril 9, 2455.
10. 0ealth 1areers 1enter. http://%%%.mshealthcareers.com. /ccessed
/pril 9, 2455.
11. Medline "lus. Emergenc- medical services.
http://%%%.nlm.nih.o$/medlineplus/emerenc*medicalser$ices.html.
+pdated /ugust 54, 2454. /ccessed /pril @, 2455.
1!. 6ational /ssociation of 1ommunit- 0ealth 1enters.
http://%%%.nachc.or. /ccessed /pril @, 2455.
5(. 6ational Institute on /ging. /ge"age: hospital hints.
1=. http://%%%.nia.nih.o$/HealthIn-ormation/Publications/hospitalhints.
htm. +pdated /pril 24, 2454. /ccessed /pril @, 2455.
11. =ural /ssistance 1enter. 1/0 fre*uentl- asked *uestions.
http://%%%.raconline.or/in-o9uides/hospitals/cah-aA.phpB%hatis. +pdated
,ctober 2<, 2454. /ccessed /pril @, 2455.
5<. =ust ME, Luepke EL. "ractice organiDations and joint ventures. In: /merican
1ollege of Legal Medicine. -egal @edicine. <th ed. "hiladelphia: Mosb-& 2448.
15. ociet- of 1ritical 1are Medicine. M-I1+1are.org. 1ritical care *uestions.
http://%%%.m*icucare.or/Critical9Care9Guestions/Paes/de-ault.asp6.
/ccessed /pril @, 2455.
17. The Aoint 1ommission. http://%%%.&ointcommission.or. /ccessed /pril
9, 2455.
5;. Torp- AM. Intensive care units. /"@". 244;&(45#52%:5(48.
!0. +nited tates 7epartment of Labor. Eureau of Labor tatistics.
,ccupational outlook handbook, 2454)55 edition. http://%%%.bls.o$/oco.
!1. +rgent 1are /ssociation of /merica. http://%%%.ucaoa.or/inde6.php.
/ccessed /pril <, 2455.
)ecture !d
1. /dministration on /ging. / profile of older /mericans: 2454.
http://%%%.aoa.o$/'o'.oot/'in9Statistics/Pro-ile/!010/docs/!010pro-ile
.pd-. /ccessed /pril 52, 2455.
!. /merican 0ealth 1are /ssociation, 6ational 1enter for /ssisted Living.
1onsumer information about long term care.
http://%%%.lontermcareli$in.com/assess/inde6.htm. /ccessed /pril 55,
2455.
3. /merican 0ospital /ssociation. Long term acute care hospitals.
http://%%%.aha.or/aha9app/issues/Medicare/)on2(erm2Care2
Hospitals/inde6.&sp. /ccessed /pril 55, 2455.
=. 1enters for Medicare M Medicaid ervices. https://%%%.cms.o$. /ccessed
/pril 55, 2455.
1. 1ommission on /ccreditation of =ehabilitation $acilities International. 'ho we
are. http://%%%.car-.or/'bout/;ho;e're. /ccessed /pril 55, 2455.
0. 7ubler 66. Legal and ethical issues. In: The @erc* @anual of )eriatrics.
'hitehouse tation, 6A: Merck M 1o., Inc.& 244;)2454.
http://%%%.merc4manuals.com/mm9eriatrics/sec1/ch1=.htm. /ccessed
/pril 52, 2455.
5. 0ospital.com. 1hoosing a long)term ps-chiatric hospital.
http://%%%.hospital.com/ps*chiatr*.html. /ccessed /pril 55, 2455.
7. Medicare.gov. T-pes of long)term care.
http://%%%.medicare.o$/lontermcare/static/(*pes#$er$ie%.asp. +pdated
March 2:, 244;. /ccessed /pril 55, 2455.
<. Medline"lus. 0ealth s-stem.
http://%%%.nlm.nih.o$/medlineplus/healths*stem.html. +pdated Ma- 25,
2454. /ccessed /pril 55, 2455.
10. 6ational /ssembl- on chool)Eased 0ealth 1are.
http://%%%.nasbhc.or/site/c.&sHPI;P/HrH/b.!11=055/4.3++5/Home.htm.
11. 6ational /ssociation for 0ome 1are M 0ospice. Easic statistics about
home care. http://%%%.nahc.or/-acts/10HC9Stats.pd-. +pdated 2454.
1!. ,ffice of 7isabilit-, /ging and Long)Term 1are "olic-. Licensed board and
care homes: preliminar- findings from the 5;;5 6ational 0ealth "rovider
Inventor-. http://aspe.hhs.o$/daltcp/reports/1<<3/rn00.htm. "ublished Ma-
5;;(. /ccessed /pril 55, 2455.
5(. "ace E. 0ospice care. /"@". 244<&2;:#<%:@52.
1=. The Aoint 1ommission. http://%%%.&ointcommission.or. /ccessed /pril
55, 2455.
11. +.. Beneral /ccounting ,ffice. pecialt- hospitals: geographic location,
services provided, and financial performance.
http://%%%.ao.o$/ne%.items/d0=105.pd-. "ublished ,ctober 244(.
10. +.. 6ational Institutes of 0ealth. 6ational Institute on /ging. 'orkshop
report.
http://%%%.nia.nih.o$/.esearchIn-ormation/Con-erences'ndMeetins/;or
4shop.eport/Introduction.htm. +pdated /ugust <, 244;. /ccessed /pril 55,
2455.
15. 'iener AM, 0anle- =A, 1lark =, 3an 6ostrand A$. Measuring the activities of
dail- living: comparisons across national surve-s. ,ffice of 7isabilit-, /ging and
Long)Term 1are "olic-. March ;, 5;;4.
http://aspe.hhs.o$/daltcp/reports/meacmpes.htm. /ccessed /pril 55, 2455.
59. 1harts, Tables, $igures
1<. 5.: 1hart: The + "opulation /ging <: -ears and ,lder from 5;;4 to
24:4. $rom the + 1ensus Eureauum, "opulation "rojections of the + b- /ge,
=ace, and 0ispanic ,rigin: 5;;( ) 24:4, pp 2:)5548, 5;;(. /vailable from
http://%%%.nia.nih.o$/.esearchIn-ormation/Con-erences'ndMeetins/;or
4shop.eport/Introduction.htm
!0. 5.< 1hart: Ear chart depicting the percent of people with limitations in
activities of dail- living #/7L% b- age group& 244@. /vailable from
http://%%%.aoa.o$/'o'.oot/'in9Statistics/Pro-ile/!010/docs/!010pro-ile
.pd-
!1. 5.@ 1hart: /vailable from
http://%%%.medicare.o$/lontermcare/static/(*pes#$er$ie%.asp
comp5?unit2?self)assess.doc
comp5?unit2?self)assess?ke-.doc
Component 1/Unit 3
Unit (itle
,eli$erin Healthcare ?Part !@
Unit ,escription:
This unit depicts the medical model of healthcare in the +, with an overview of the
organiDation of healthcare and the ph-sical structure of healthcare deliver- in the
outpatient setting, including an overview of the people involved in the deliver- of
healthcare, their education and licensing. This unit is intended primaril- for the student
who does not have a background in healthcare, though the topics of this unit will be
described at a relativel- advanced level.
Unit #b&ecti$es
5. 7escribe the organiDation of clinical healthcare deliver- in the outpatient
setting, and the organiDation of outpatient healthcare #Lectures a, b, c%
2. 7escribe the organiDation of ancillar- healthcare deliver- in the outpatient
setting #Lecture d%
(. 7iscuss the role of different healthcare providers, with an emphasis on the
deliver- of care in an interdisciplinar- setting #Lecture e%
5. ,utpatient care
a% T-pes of outpatient clinics
b% "rimar- care
c% "rimar- 1are pecialties
d% pecialt- 1are
e% +rgent care clinics and walk)in clinics
f% Emergenc- =oom visits
2. ,utpatient laboratories, radiological services, and ancillar- services # e.g. home
health, hospice, ph-sical therap-, occupational therap-%
(. ,rganiDation of "rimar- 1are P the 1linical Team
Unit .e-erences
)ecture 3a
1. Institute of Medicine. 7efining "rimar- 1are: /n interim report #5;;8%. 6ational
/cadem- of "ress, 'ashington 71. =etrieved from
http://%%%.nap.edu/openboo4.phpErecord9idF<113JpaeF.1
2. $r-, 5;94& Institute of Medicine: "rimar- 1are: /mericaNs 0ealth in a 6ew Era,
The 6ational /cademies "ress, 5;;<.
(. ,T/, #5;9<%& "ew 0ealth "rofessions 1ommission, 5;;8.
=. I,M. 7efining "rimar- 1are: /n interim report #5;;8%. 6ational /cadem- of
"ress, 'ashington 71. http://%%%.nap.edu/openboo4.phpE
record9idF<113JpaeF.1
:. I,M. "rimar- 1are in Medicine: / 7efinition. In " @anpower 5olicy for 5rimary
Health are 8 ,eport of a Study( 'ashington, 7.1. : 6ational /cadem- "ress,
5;@9. 1h. 2.
<. I,M: "rimar- 1are: /mericaNs 0ealth in a 6ew Era, The 6ational /cademies
"ress, 5;;<
)ecture 3a Imaes
lide 9: Image from Institute of Medicine: "rimar- 1are: /mericaNs 0ealth in a 6ew Era,
The 6ational /cademies "ress, 5;;<.
)ecture 3b
1. /merican Eoard of $amil- "ractice at
https://%%%.theab-m.or/about/polic*.asp6
!. http://%%%.acponline.or/patients9-amilies/about9internal9medicine/
3. https://%%%.aamc.or/students/medstudents/cim/specialties/
8. Eodenheimer T. "rimar- 1are )) 'ill It urviveK 6 Engl A Med 244< (::: 9<5)
9<8
1. http://%%%.acponline.or/ad$ocac*/e$ents/state9o-9healthcare/statehc0091
.pd-
<. Faren E. 0auer, M7& teven A. 7urning, M7& et al., FE& 7urning, A& Fernan,
'6& $agan, MA& MintD, M& ,Nullivan, "& Eattistone, M& 7efer, T et al. #2449)4;)
54%. O$actors /ssociated 'ith Medical tudentsN 1areer 1hoices =egarding
Internal MedicineO. A/M/ (44 #54%: 55:8P55<8
5. http://%%%.us2o$ernment2rants.net/article9in-o.php/articles9id/11
7. http://%%%.$cstar.com/ne%s/!010/&un/10/health2re-orm2rants2e6pected2to2
ease2primar*/
)ecture 3c
1. http://%%%.ucaoa.or/home9abouturentcare.php
!. 6ational 1enter for 0ealth tatistics: O610 7ata Erief 6o. (9, Ma- 2454.K
http://%%%.cdc.o$/nchs/data/nhsr/nhsr005.pd-
3. http://%%%.cdc.o$/nchs/data/nhsr/nhsr005.pd-
https://%%%.e6cellusbcbs.com/%ps/%cm/connect/c=-15170=!<<!1=5b070b!
dc1c<c0b<7/+.LVisitsL/S2+ML/I"').pd-EM#,F'HP+.+S
8. "itts =, 6iska =', Su A, Eurt 1'. 6ational 0ospital /mbulator- Medical 1are
urve-: 244< emergenc- department summar-. 6ational health statistics reports&
no @. 0-attsville, M7: 6ational 1enter for 0ealth tatistics, 2449.
:. 6ational 1enter for 0ealth tatistics: O610 7ata Erief 6o. (9, Ma- 2454.O
0. http://%%%.cdc.o$/nchs/data/nhsr/nhsr005.pd-
5. http://%%%.ucaoa.or/home9abouturentcare.php
)ecture 3d
1. =ontgen, 'ilhelm #59;:%& "icture of first S)ra- taken of his wifeNs hand. The
bones and her ring can be seen, similar to modern !)ra-s.
http://%%%.molecularpatholo*.or.u4
)ecture 3d Imaes
(.2 Image of first S)ra- taken b- 'ilhelm =ontgen in 59;:, of his wifeNs hand. The
bones and her ring can be seen, similar to modern !)ra-s.
)ecture 3e
5. Bottschalk /, $ocke /. Time pent in $ace)to)$ace "atient 1are and 'ork
,utside the E!amination =oom. /nn $am Med 244: (: 899)8;(
comp5?unit(?discuss.doc
comp5?unit(?discuss?ke-.doc
comp5?unit(?self)assess.doc
comp5?unit(?self)assess?ke-.doc
Component 1/Unit =
Unit (itle
/inancin Healthcare ?Part 1@
Unit ,escription
This unit provides an overview of the role of healthcare in the econom- and a
description of various models of healthcare financing. The unit provides a histor- of the
current + s-stem and laws that have influenced its development. It also includes
discussion of healthcare financing at the governmental, enterprise, and consumer
levels.
Unit #b&ecti$es
5. +nderstand the importance of the healthcare industr- in the + econom-
and the role of financial management in healthcare. #Lecture b%
2. 7escribe models of health care financing in the + and in selected other
countries. #Lecture c%
(. 7escribe the histor- and role of the health insurance industr- in financing
healthcare in the +nited tates, and $ederal laws that have influenced the
development of the industr-. #Lecture a%
8. +nderstand the differences among various t-pes of private health
insurance and describe the organiDation and structure of network)based
managed care health insurance programs. #Lecture d%
:. +nderstand the various roles pla-ed b- government as polic- maker,
pa-er, provider, and regulator of healthcare. #Lecture d%
<. 7escribe the organiDation and function of Medicare and Medicaid.
#Lecture e%
5. ,verview: healthcare, the econom-, and finance
a% =ole of healthcare in the econom- )) statistics
b% 7istinction between publicall-)funded and privatiDed healthcare
c% 6eed for sound financial management of the healthcare s-stem
2. ingle pa-er s-stems versus multiple pa-er s-stems
(. 7evelopment of the + health insurance industr-
8. Insurance and third part- pa-ers
a% 1ommercial health insurance
b% ,rganiDation and structure of network)based managed care health insurance
programs including
o health maintenance organiDations #0M,s%
o preferred provider organiDations#"",s%
o independent practice associations #I"/s%
:. Bovernment roles and pa-ment programs
a% Bovernment roles in healthcare
b% Bovernment financing of healthcare
o Medicare
o Medicaid
Unit .e-erences
)ecture =a
1. Elue1ross Elue hield /ssociation.
http://en.%i4ipedia.or/%i4i/3lue9Cross93lue9Shield9'ssociation.
/ccessed 7ecember 54, 2455.
!. 1alifornia ,ffice of the "atient /dvocate. 'hat is an 0M,K 2455.
http://%%%.opa.ca.o$/report9card/hmo%hatis.asp6. /ccessed /pril 8,
2455.
3. 1enters for Medicare and Medicaid ervices. Medicaid program: general
InformationHoverview. http://%%%.cms.o$/medicaidenin-o. +pdated
$ebruar- 2(, 2455. /ccessed /pril <, 2455.
=. Illinois 7epartment of 0uman ervices. 0ealth insurance carriers and managed
care. http://%%%.dhs.state.il.us/pae.asp6EitemF31173. /ccessed /pril 8,
2455.
1. Indian 0ealth ervice. Indian 0ealth ervice fact sheet.
http://%%%.ihs.o$/aboutihs/this-acts.asp. /ccessed /pril :, 2455.
0. ,ur7ocuments.gov. ocial ecurit- /ct #5;(:%.
http://%%%.ourdocuments.o$/doc.phpE-lashFtrueJdocF07. /ccessed /pril
52, 2455.
5. +.. 7epartment of 0ealth and 0uman ervices. Medical treatment in 0ill)Eurton
funded healthcare facilities.
http://%%%.hhs.o$/ocr/ci$ilrihts/understandin/Medical:!0(reatment
:!0at:!0Hill:!03urton:!0/unded:!0Medical:!0/acilities/inde6.html.
7. +.. 7epartment of 0ealth and 0uman ervices. +nderstanding health
information privac-.
http://%%%.hhs.o$/ocr/pri$ac*/hipaa/understandin/inde6.html. /ccessed
/pril 8, 2455.
<. +.. 7epartment of 0ealth and 0uman ervices, ,ffice of the Beneral 1ounsel.
7rug "rice 1ompetition and "atent Term =estoration /ct.
http://librar*.-indla%.com/1<<</Mar/10/130503.html. 5;;;. /ccessed /pril 5(,
2455.
10. +.. 7epartment of Austice, 1ivil =ights 7ivision. /mericans with
7isabilities /ct: *uestions and answers. http://%%%.ada.o$/A:!0aen0!.htm.
+pdated 6ovember 58, 2449. /ccessed /pril 5(, 2455.
11. +.. 7epartment of Labor, Eureau of Labor tatistics. areer )uide to
!ndustries( 2454P55 ed. http://%%%.bls.o$/oco/c. /ccessed /pril 8, 2455.
)ecture =b
1. 1enters for Medicare and Medicaid ervices. 6ational health e!penditure data,
Table 5: 6ational health e!penditures aggregate, per capita amounts, percent
distribution, and average annual percent growth, b- source of fundsHselected
calendar -ears 5;<4P244;.
https://%%%.cms.o$/"ationalHealth+6pend,ata/!19"H+9/act9Sheet.asp .
+pdated Aanuar- 5(, 2455. /ccessed /pril 5(, 2455.
2. tarkLaw.org. tark lawPinformation on penalties, legal practices, latest news
and advice. http:..www.starklaw.org. /ccessed /pril 5(, 2455.
(. The 0enr- A Faiser $amil- $oundation. +.. health care costs e!plained.
http:..www.kaiseredu.org.Issue)Modules.+)0ealth)1are)1osts.Eackground)
Erief.asp!. +pdated March 2454. /ccessed /pril :, 2455.
=. The 0enr- A Faiser $amil- $oundation. 0ealthcare 1osts: / "rimer& available
from: http://%%%.4--.or/insurance/ 5050.c-m Fe- information on health care
costs. Last accessed March 22, 2455
1. The 0enr- A Faiser $amil- $oundation. Menlo "ark, 1/: 2454 + 0ealthcare
1osts& available from: http://%%%.4aiseredu.or/inde6.asp "rovides
background information, links to ke- data and polic- information on +
healthcare costs. Last accessed March 22, 2455
)ecture =b Charts8 (ables8 /iures
8.5 1hart: The Faiser $amil- $oundation, Faiser $ast $acts. 7ata source: 1enters for
Broup, at http://%%%.cms.hhs.o$/"ationalHealth+6pend,ata/ #see 0istorical& 60E
2455. #1M, 2455, "7)+, 11 EI)61)/ (.4%.
8.2 1hart: The Faiser $amil- $oundation, Faiser $ast $acts. 7ata ource: 1enters for
2455. /vailable at http://-acts.4--.or/chart.asp6EchF71=. #F$$, 1M, 2455, "7)+,
11 EI)61)/ (.4%.
8.( 1hart: The Faiser $amil- $oundation, Faiser $ast $acts. 7ata ource:
7ataO, O;D Health Statistics #database%. doi: 54.5@9@.data)44(:4)en. /ccessed on
55 7ec 2455. /vailable at http://-acts.4--.or/chart.asp6EchF1<1!. #F$$, 1M,
2455, "7)+, 11 EI)61)/ (.4%. 6otes: 7ata from /ustralia and Aapan are 244@
data. $igures for Eelgium, 1anada, 6etherlands, 6orwa- and witDerland, are ,E17
estimates. 6umbers are """ adjusted.
8.8 Table: /dapted from the 6ational 0ealth 1are pending b- 1ategor- of ervice
244;. ource: 1enters for Medicare and Medicaid ervices, ,ffice of the /ctuar-,
http://%%%.cms.hhs.o$/"ationalHealth+6pend,ata/. /ccessed on 55 7ec 2455.
#see 0istorical& 60E summar- including share of B7", 1I 5;<4)244;& file
nhegdp4;.Dip%. #1M, nd., "7)+, 11 EI)61)/ (.4%.
8.: 1hart: 244; 6ational 0ealth E!penditures b- 1ategor- #J% /dapted from data
source: 1enters for Medicare and Medicaid ervices, ,ffice of the /ctuar-, 6ational
0ealth tatistics Broup, at http://%%%.cms.hhs.o$/"ationalHealth+6pend,ata/
/ccessed 7ec 55, 2455. #see 0istorical& 60E summar- including share of B7", 1I
5;<4)244;& file nhegdp4;.Dip%. #1M, nd., "7)+, 11 EI)61)/ (.4%.
8.< 1hart: 6ational 0ealthcare E!penditures 7istribution b- 1ontributor #244;%, 7ata
ource: 1enters for Medicare and Medicaid ervices #1M%, ,ffice of the /ctuar-.
=etrieved 55 7ec 2455 from: http://%%%.chc-.or/N/media/M+,I':!0)I3.'.D
:!0/iles/P,//H/P,/:!0HealthCareCosts11.pd-. .@S, H3, #%&&, 5D9US1(
8.@ Table: 6ational 0ealth E!penditures b- "a-er, 244; 7ata source:
http://%%%.cms.hhs.o$/"ationalHealth+6pend,ata/ #see 0istorical& 60E summar-
including share of B7", 1I 5;<4)244;& file nhegdp4;.Dip%. /ccessed 7ecember 55,
2455 from:
https://%%%.cms.o$/"ationalHealth+6pend,ata/!19"H+9/act9Sheet.asp.
8.9 1hart: + 0ealthcare E!penditures b- "a-er. 1M, 101$#244;%. 7ata ource:
1enters for Medicare and Medicaid ervices #1M%, ,ffice of the /ctuar-.
https://%%%.cms.o$/"ationalHealth+6pend,ata/!19"H+9/act9Sheet.asp.
=etrieved Aan 2452 from: www.chcf.org/~/media/.../PDF/H/PDF
%20HealthCareCosts11.pdf( .@S, H3, #%&&, 5D9US1(
)ecture =c
1. Eritish Eroadcasting 1orporation. Eirth of the 6ational 0ealth ervice: the earl-
histor- of the 60. http://%%%.bbc.co.u4/archi$e/nhs. /ccessed /pril @, 2455.
!. Eritish Eroadcasting 1orporation. The 60 at :4: making Eritain better.
http://ne%s.bbc.co.u4/!/hi/e$ents/nhs9at910/special9report/11<703.stm. Aul-
5, 5;;9. /ccessed /pril @, 2455.
3. 1anadian 0ealth 1are. %%%.canadian2healthcare.or. /ccessed /pril <, 2455.
=. 1itiDens /dvice Eureau U+nited FingdomV. 6ational insuranceHcontributions and
benefits.
http://%%%.ad$iceuide.or.u4/inde6/li-e/bene-its/national9insurance9contri
butions9and9bene-its.htm. /ccessed /pril 9, 2455.
1. 1itiDenship and Immigration 1anada. 0ealth care in 1anada.
http://%%%.cic.c.ca/enlish/ne%comers/a-ter2health.asp. +pdated March 54,
2455. /ccessed /pril 54, 2455.
0. 1ommonwealth $und. International profiles of health care s-stems.
http://%%%.common%ealth-und.or/N/media//iles/Publications//und
:!0.eport/!010/Hun/1=159SAuires9Intl9Pro-iles90!!.pd-. Hune !010.
5. 7epartment of 0ealth U+nited FingdomV. 0istor- of the department.
http://%%%.dh.o$.u4/en/'boutus/Ho%,H%or4s/,H905=713. +pdated Ma-
2(, 244@. /ccessed /pril 9, 2455.
7. 7epartment of 0ealth U+nited Fingdom V. 0ow 70 works.
http://%%%.dh.o$.u4/en/'boutus/Ho%,H%or4s/,H9=1001=7. +pdated Ma-
5(, 2454. /ccessed /pril 9, 2455.
<. 0ealth 1anada. /bout 0ealth 1anada: activities and responsibilities.
http://%%%.hc2sc.c.ca/ahc2asc/acti$it/inde62en.php. +pdated Ma- (, 2449.
/ccessed /pril <, 2455.
10. 0uman =esources and kills 7evelopment 1anada. Indicators of well)
being in 1anada. http://%%%=.hrsdc.c.ca/.3ndic.1t.=rO2en.&spEiidF!..
11. Madore ,. The 1anada 0ealth /ct: overview and options. Librar- of
"arliament, "arliamentar- Information and =esearch ervices.
http://%%%!.parl.c.ca/content/lop/researchpublications/<==2e.htm. +pdated
Ma- 5<, 244:. /ccessed /pril 54, 2455.
1!. 6ational 0ealth ervice. 0elp with health costs.
http://%%%.nhs.u4/"HS+nland/Healthcosts/Paes/'bouthealthcosts.asp6.
+pdated. Aune 5, 2454. /ccessed /pril 9, 2455.
13. 6ational 0ealth ervice. 0ow do I get assisted living e*uipmentK
http://%%%.nhs.u4/chA/Paes/11=<.asp6E
Cateor*I,F111JSubCateor*I,F111. +pdated Aanuar- 5:, 244;. /ccessed
/pril 9, 2455.
1=. 6ational 0ealth ervice. 60 histor-. +pdated Aul- :, 244@.
http://%%%.nhs.u4/"HS+nland/thenhs/nhshistor*/Paes/"HShistor*1<=7.a
sp6./ccessed /pril <, 2455.
11. 6ational 0ealth ervice. 'hat is the national framework for 60
continuing healthcare and 60)funded nursing careK
http://%%%.nhs.u4/chA/Paes/!3<!.asp6E
Cateor*I,F111JSubCateor*I,F111. +pdated eptember 2:, 244@.
10. 6ational 0ealth ervice /ct. Enc-clopaedia Eritannica.
http://%%%.britannica.com/+3chec4ed/topic/=0=<10/"ational2Health2
Ser$ice2'ct. /ccessed /pril @, 2455.
15. "rime Minister of 1anada. 1anadaGs new government announces patient
wait times guarantee. http://pm.c.ca/en/media.aspEidF1011. /pril 8, 244@.
59. teinbrook =. "rivate health care in 1anada. N ;ngl / @ed( 244<&(:8:5<<5)
5<<8.
)ecture =d
1. /merican /ssociation of "referred "rovider ,rganiDations. "", resources.
http://%%%.aappo.or/inde6.c-mEpaeidF10. /ccessed /pril 54, 2455.
0ealth IT 'orkforce 1urriculum Introduction to 0ealthcare and :4
!. /merican /ssociation of "referred "rovider ,rganiDations. "", Toolkit.
http://%%%.aappo.or/''PP#9(ool4it9/I"').htm. /ccessed /pril 2, 2455.
3. Eihari M. +nderstanding the Medicare "art 7 donut hole: learn about the
Medicare "art 7 coverage gap.
http://healthinsurance.about.com/od/medicare/a/understandin9part9d.htm
. /ccessed /pril @, 2455.
=. 1enters for Medicare and Medicaid ervices. 1hildrenGs 0ealth Insurance
"rogram #10I"%. http://%%%.cms.o$/home/chip.asp. /ccessed /pril @, 2455.
1. 1enters for Medicare and Medicaid ervices. http://%%%.cms.o$. /ccessed
/pril @, 2455.
0. 1ongressional Eudget ,ffice. tatement of 7ouglas '. Elmendorf, 7irector.
1E,Gs anal-sis of the major health care legislation enacted in March 2454 before
the ubcommittee on 0ealth, 1ommittee on Energ- and 1ommerce, +.. 0ouse
of =epresentatives. March (4, 2455.
%%%.cbo.o$/-tpdocs/1!166/doc1!11</032302HealthCare)eislation.pd-.
/ccessed /pril (, 2455
5. 1ornell +niversit- Law chool. 'orkersG 1ompensation: an overview.
http://topics.la%.cornell.edu/%e6/;or4ers9compensation. /ccessed /pril @,
2455.
7. Faiser $amil- $oundation. 0ealth care costs: a primer. /ugust 244@.
%%%.4--.or/insurance/upload/5050.pd-. /ccessed /pril 2, 2455.
<. Faiser $amil- $oundation. 0ow private health care coverage works: a primerH
2449 +pdate. /pril 2449. %%%.4--.or/insurance/upload/5500.pd-. /ccessed
/pril 2, 2455.
10. Leve- 6M. >uestions and answers about new rules on appealing
rejections of health insurance claims. Los /ngeles Times. Aul- 2(, 2454.
http://articles.latimes.com/!010/&ul/!!/nation/la2na2health2rules2Aa2
!01005!3. /ccessed /pril 52, 2455.
11. Marcinko 7E. +nderstanding the Medicare "rospective "a-ment -stem.
eptember 5@, 244;.
http://medicale6ecuti$epost.com/!00</0</15/understandin2the2medicare2
prospecti$e2pa*ment2s*stem. /ccessed /pril @, 2455.
1!. M1,L. Managed care fact sheets.
http://%%%.mcareol.com/-actshts/-actnati.htm. 2455. /ccessed /pril ;, 2455
13. Medicare.gov. Medicare /dvantage #"art 1%.
http://%%%.medicare.o$/na$iation/medicare2basics/medicare2
bene-its/part2c.asp6. /ccessed /pril @, 2455.
1=. 6ational /ssociation of 'orkersG 1ompensation Audiciar-.
http://%%%.na%c&.or. /ccessed /pril @, 2455.
11. 6ational Eureau of Economic =esearch. "rospective "a-ment -stem
#""% data. http://%%%.nber.or/data/pps.html. /ccessed /pril @, 2455.
10. ,bringer L/, Aeffries M. 0ow health insurance works.
http://health.ho%stu--%or4s.com/medicine/healthcare/insurance/health2
insurance.htm. /ccessed /pril 2, 2455.
15. "artners 0uman =esearch 1ommittee. ,verview of the 0I"// final
privac- regulations. http://healthcare.partners.or/phsirb/hipaao$.htm.
17. "urcell ", taman A. ummar- of the Emplo-ee =etirement Income
ecurit- /ct #E=I/%. 1ongressional =esearch ervice report =L(888(. Ma- 5;,
244;. http://ain.senate.o$/crs/pension5.pd-. /ccessed /pril (, 2455.
1<. Tufts Managed 1are Institute. Managed care models and products. 5;;9.
%%%.thci.or/do%nloads/ModelsProducts.pd-. /ccessed /pril 54, 2455.
!0. +.. 7epartment of 0ealth and 0uman ervices and +.. 7epartment of
Austice. top Medicare fraud: learn more about fighting fraud.
http://%%%.stopmedicare-raud.o$. /ccessed /pril @, 2455.
!1. +.. 7epartment of Labor. 0ealth plans and benefits.
http://%%%.dol.o$/dol/topic/health2plans. /ccessed /pril 55, 2455.
!!. +.. 7epartment of Labor. 'orkersG 1ompensation.
http://%%%.dol.o$/dol/topic/%or4comp/inde6.htm. /ccessed /pril @, 2455.
!3. 'orkers1ompensation.com. http://%%%.%or4erscompensation.com.
)ecture =d Chart8 (ables8 /iures
8.; Table: Indemnit- vs. Managed 1are "rograms #2455, 11 EI)61)/ (.4%.
)ecture =e
1. /merican /ssociation of "referred "rovider ,rganiDations. "", resources.
http://%%%.aappo.or/inde6.c-mEpaeidF10. /ccessed /pril 54, 2455.
!. /merican /ssociation of "referred "rovider ,rganiDations. "", Toolkit.
http://%%%.aappo.or/''PP#9(ool4it9/I"').htm. /ccessed /pril 2, 2455.
3. Eihari M. +nderstanding the Medicare "art 7 donut hole: learn about the
Medicare "art 7 coverage gap.
http://healthinsurance.about.com/od/medicare/a/understandin9part9d.htm
. /ccessed /pril @, 2455.
=. 1enters for Medicare and Medicaid ervices. 1hildrenGs 0ealth Insurance
"rogram #10I"%. http://%%%.cms.o$/home/chip.asp. /ccessed /pril @, 2455.
1. 1enters for Medicare and Medicaid ervices. http://%%%.cms.o$. /ccessed
/pril @, 2455.
0. 1ongressional Eudget ,ffice. tatement of 7ouglas '. Elmendorf, 7irector.
1E,Gs anal-sis of the major health care legislation enacted in March 2454 before
the ubcommittee on 0ealth, 1ommittee on Energ- and 1ommerce, +.. 0ouse
of =epresentatives. March (4, 2455.
%%%.cbo.o$/-tpdocs/1!166/doc1!11</032302HealthCare)eislation.pd-.
/ccessed /pril (, 2455
5. 1ornell +niversit- Law chool. 'orkersG 1ompensation: an overview.
http://topics.la%.cornell.edu/%e6/;or4ers9compensation. /ccessed /pril @,
2455.
7. Faiser $amil- $oundation. 0ealth care costs: a primer. /ugust 244@.
%%%.4--.or/insurance/upload/5050.pd-. /ccessed /pril 2, 2455.
<. Faiser $amil- $oundation. 0ow private health care coverage works: a primerH
2449 +pdate. /pril 2449. %%%.4--.or/insurance/upload/5500.pd-. /ccessed
/pril 2, 2455
10. Leve- 6M. >uestions and answers about new rules on appealing
rejections of health insurance claims. Los /ngeles Times. Aul- 2(, 2454.
http://articles.latimes.com/!010/&ul/!!/nation/la2na2health2rules2Aa2
!01005!3. /ccessed /pril 52, 2455.
11. Marcinko 7E. +nderstanding the Medicare "rospective "a-ment -stem.
eptember 5@, 244;.
http://medicale6ecuti$epost.com/!00</0</15/understandin2the2medicare2
prospecti$e2pa*ment2s*stem. /ccessed /pril @, 2455.
1!. M1,L. Managed care fact sheets.
http://%%%.mcareol.com/-actshts/-actnati.htm. !011. /ccessed /pril ;, 2455
13. Medicare.gov. Medicare /dvantage #"art 1%.
http://%%%.medicare.o$/na$iation/medicare2basics/medicare2
bene-its/part2c.asp6. /ccessed /pril @, 2455.
1=. 6ational /ssociation of 'orkersG 1ompensation Audiciar-.
http://%%%.na%c&.or. /ccessed /pril @, 2455.
11. 6ational Eureau of Economic =esearch. "rospective "a-ment -stem
#""% data. http://%%%.nber.or/data/pps.html. /ccessed /pril @, 2455.
10. ,bringer L/, Aeffries M. 0ow health insurance works.
http://health.ho%stu--%or4s.com/medicine/healthcare/insurance/health2
insurance.htm. /ccessed /pril 2, 2455.
15. "artners 0uman =esearch 1ommittee. ,verview of the 0I"// final
privac- regulations. http://healthcare.partners.or/phsirb/hipaao$.htm.
17. "urcell ", taman A. ummar- of the Emplo-ee =etirement Income
ecurit- /ct #E=I/%. 1ongressional =esearch ervice report =L(888(. Ma- 5;,
244;. http://ain.senate.o$/crs/pension5.pd-. /ccessed /pril (, 2455.
1<. Tufts Managed 1are Institute. Managed care models and products. 5;;9.
%%%.thci.or/do%nloads/ModelsProducts.pd-. /ccessed /pril 54, 2455.
!0. +.. 7epartment of 0ealth and 0uman ervices and +.. 7epartment of
Austice. top Medicare fraud: learn more about fighting fraud.
http://%%%.stopmedicare-raud.o$. /ccessed /pril @, 2455.
!1. +.. 7epartment of Labor. 0ealth plans and benefits.
http://%%%.dol.o$/dol/topic/health2plans. /ccessed /pril 55, 2455.
!!. +.. 7epartment of Labor. 'orkersG 1ompensation.
0ealth IT 'orkforce 1urriculum Introduction to 0ealthcare and :(
http://%%%.dol.o$/dol/topic/%or4comp/inde6.htm. /ccessed /pril @, 2455.
!3. 'orkersG1ompensation.com. http://%%%.%or4erscompensation.com.
Component 1/Unit 1
Unit (itle
/inancin Healthcare ?Part !@
Unit ,escription
This unit continues the discussion of healthcare financing at the governmental,
organiDational, and consumer levels. It describes the revenue c-cle for healthcare
organiDations, identifies the different reimbursement methodologies and standards
developed for the billing #reimbursement% process. $inall-, this unit reviews some of the
factors responsible for the escalating healthcare e!penditures in the + and discusses
some methods for controlling rising medical costs.
Unit #b&ecti$es
5. 7escribe the revenue c-cle and the billing process undertaken b- different
healthcare enterprises. #Lecture a%
2. +nderstand the billing and coding processes, and standard code sets
used in the claims process. #Lecture a%
(. Identif- different fee)for)service and episode)of)care reimbursement
methodologies used b- insurers and healthcare organiDations in the
claims process. #Lecture a%
8. =eview factors responsible for escalating healthcare e!penditures in the
+nited tates. #Lecture b%
:. 7iscuss methods of controlling rising medical costs. #Lecture c%
5. "rivate healthcare plans, the revenue c-cle, and medical billing and coding
a% =evenue c-cle
b% Eilling and reimbursement in medicine
c% ,verview of coding concepts ) 7=Bs, I17);, 1"T
2. =eimbursement methodologies and managed care
a% =eimbursement methodologies
b% 1apitation and managed care techni*ues
(. Medical e!penditures: costs gone wildK
a% $actors escalating healthcare e!penditures
b% The Emergenc- Medical Treatment and /ctive Labor #EMT/L/% /ct and its
effect on medicine
c% The cost of uninsured care
d% The trend of inappropriate use of the Emergenc- 7epartment #E7% for the
deliver- of primar- care
8. 1ontrolling medical costs
a% 1ontrolling costs in medicine
0ealth IT 'orkforce 1urriculum Introduction to 0ealthcare and ::
o =educing e!cessive e!penses in diagnosis
o =educing e!cessive e!penses in management
b% The medical home
o 1oncierge medicine
Unit .e-erences
)ecture 1a
1. /braham, M. #2455%. In 5T urrent 5rocedural Terminology #tandard ed.%.
1hicago, IL: /merican Medical /ssociation. =etrieved Aan 2452 from:
http://%%%.ama2assn.or/ama/pub/ph*sician2resources/solutions2
manain2*our2practice/codin2billin2insurance/cpt/about2cpt.paeK
2. Euck, 1. A. #2452%. I17);)1M, for "h-sicians. In 5T urrent 5rocedural
Terminology #"rofessional ed., 3ol. 5, 2%. 1hicago, IL: The /merican 0ealth
Information Management /ssociation.
(. 1astro, /. E. and La-man, E #244<%. "rinciples of 0ealthcare =eimbursement. In
5T urrent 5rocedural Terminology #tandard ed., 1h. 5 ) (, 9%. 1hicago, IL:
The /merican 0ealth Information Management /ssociation.
=. urrent 5rocedural Terminology. #n.d.%. =etrieved 7ecember 5<, 2455, from
'ikipedia website:
http://en.%i4ipedia.or/%i4i/Current9Procedural9(erminolo*.
1. Definition of Health !nsurance Terms. #2454, /ugust 5%. =etrieved March 22,
2455, from Eureau of Labor tatistics website:
http://%%%.bls.o$/ncs/ebs/sp/healthterms.pd-.
0. H!5"" ode Sets. #n.d.%. =etrieved 7ecember 5<, 2455, from 1enters for
Medicare and Medicaid ervices website:
https://%%%.cms.o$/IC,<Pro$ider,ianosticCodes/
)ecture 1b
5. /dapted from: 7eLia, 7., 1antor, A., Emergenc- department utiliDation and
capacit-& The -nthesis "roject, =obert 'ood Aohnson $oundation. =esearch
-nthesis =eport 5@, Aul- 244;.
!. 1enters for 7isease 1ontrol and "reventionX1hronic 7isease "revention and
0ealth "romotionXTools and =esources. =ecommendations, Eest "ractices,
and Buidelines. /vailable from:
http://%%%.cdc.o$/chronicdisease/resources/uidelines.htm. Last
accessed 7ecember 52,, 2455.
3. $isher E, E-num A, kinner A. The "olic- Implications of 3ariations in Medicare
pending Browth. The 7artmouth /tlas: The 7artmouth Institute for 0ealth
"olic- and 1linical "ractice 1enter for 0ealth "olic- =esearch, $ebruar- 2@,
http://%%%.dartmouthatlas.or/do%nloads/reports/Polic*9Implications93rie
-90!!50<.pd-. Last accessed March 22, 2455.
=. $isher E, Boodman 7, kinner A, Eronner F. 0ealth 1are pending, >ualit-,
0ealth IT 'orkforce 1urriculum Introduction to 0ealthcare and :<
and ,utcomes More IsnGt /lwa-s Eetter. The 7artmouth /tlas: The 7artmouth
Institute for 0ealth "olic- and 1linical "ractice 1enter for 0ealth "olic-
=esearch, $ebruar- 2@, 244;. Ucited 2454 Aul- (5V. /vailable at:
http://%%%.dartmouthatlas.or/do%nloads/reports/Spendin93rie-90!!50<.
pd- Last accessed March 22, 2455.
:. McFinse- Blobal Institute, /ccounting for the cost of + health care: / new look
at wh- /mericans spend more, 6ovember 2449 available at:
0. http://%%%.mc4inse*.com/mi/publications/US9healthcare/pd-/US9healthca
re9Chapter1.pd-. Last accessed /ug 5, 2454.
5. 6elson /=, 1osts of 0ealth 1are: 6ew olutions for an ,ld "roblem. The
http://%%%.common%ealth-und.or/Content/Publications/Commentaries/!0
01/Ma*/Costs2o-2Health2Care22"e%2Solutions2-or2an2#ld2Problem.asp6.
Last accessed March 22, 2455
7. =obert 'ood Aohnson $oundation. /vailable at: http://%%%.r%&-.or/. ource
for health issue research and health polic-. Last accessed Aanuar- 2452.
<. The 1ongress of the +nited tates 1ongressional Eudget ,ffice. 'ashington
71: 2449 Ucited Aul- (5, 2454V. Technological 1hange /nd The Browth ,f 0ealth
1are pending. /vailable at: http://%%%.cbo.o$/-tpdocs/7<66/doc7<=5/012
312(echHealth.pd-. Last accessed 7ecember 52, 2455.
10. The 0astings 1enter #nd.%. 0ealth 1are 1osts and Medical Technolog-
$rom Eirth to 7eath and Eench to 1linic: The 0astings 1enter Eioethics Eriefing
Eook for Aournalists, "olic-makers, and 1ampaigns, available at:
http://%%%.thehastinscenter.or/uploaded/iles/Publications/3rie-in93oo
4/health:!0care:!0costs:!0chapter.pd-. /ccessed 7ecember 52, 2455.
11. The 0enr- A Faiser $amil- $oundation. Menlo "ark, 1/ #244;% Ucited
2454 /ugust 5V. 0ealthcare 1osts: / "rimer& available from:
http://%%%.4--.or/insurance/ 5050.c-m. Fe- information on health care costs.
Last accessed March 22, 2455.
1!. The 0enr- A Faiser $amil- $oundation. Menlo "ark, 1/ #2454% Ucited
2454 /ugust 5V. Faiseredu.org X 1ost and pending X + 0ealthcare 1osts&
/vailable from: http://%%%.4aiseredu.or/inde6.asp. "rovides background
information, links to ke- data and polic- information on + healthcare costs.
13. The 0enr- A Faiser $amil- $oundation. Menlo "ark, 1/ #2454%. Ucited
2454 /ugust 5V. "rescription 7rug Trends. /vailable at:
http://%%%.4--.or/r6drus/inde6.c-m. Last accessed March 22, 2455.
1=. The 0enr- A Faiser $amil- $oundation. Menlo "ark, 1/ #2454%. Ucited
2454 /ugust 5V. The Faiser 1ommission on Medicaid and the +ninsured&
+ninsured and +ntreated: / Look at +ninsured /dults 'ho =eceived 6o Medical
1are for Two Iears& /vailable at: http://%%%.4--.or/uninsured/7073.c-m. Last
accessed March 22, 2455.
5:. 'eber EA, howstack A/, 0unt F/, et al. Q/re the +ninsured =esponsible for the
0ealth IT 'orkforce 1urriculum Introduction to 0ealthcare and :@
Increase in Emergenc- 7epartment 3isits in the +nited tatesKY /nnals of
Emergenc- Medicine :2#2%: 549P55:, 2449.
)ecture 1b Charts8 (ables and /iures
:.5 1hart: ource: 1enters for Medicare and Medicaid ervices, ,ffice of the /ctuar-,
http://%%%.cms.hhs.o$/"ationalHealth+6pend,ata/ #see 0istorical& 60E summar-
including share of B7", 1I 5;<4)244;& file nhegdp4;.Dip%. #1M, 2455, "7)+, 11
EI)61)/ (.4%.
:.2 1hart: The Faiser $amil- $oundation, Faiser $ast $acts. 7ata ource: 1enters for
2455. /vailable at http://-acts.4--.or/chart.asp6EchF71=. #F$$, 1M, 2455, "7)+,
11 EI)61)/ (.4%.
:.( 1hart: 1hart: The Faiser $amil- $oundation, Faiser $ast $acts. 7ata ource:
7ataO, O;D Health Statistics #database%. doi: 54.5@9@.data)44(:4)en #/ccessed on 58
$ebruar- 2455%. /vailable at http://-acts.4--.or/chart.asp6EchF1<1!. #F$$, 1M,
2455, "7)+, 11 EI)61)/ (.4%.
:.8 1hart: 1oncentration of 0ealth pending in the Total +.. "opulation 244@.
/dapted from: 0ealthcare 1osts P / "rimer 244;. ource: Faiser $amil- $oundation
calculations using data from +.. 7epartment of 0ealth and 0uman ervices, /genc-
for 0ealthcare =esearch and >ualit-, Medical E!penditure "anel urve- #ME"%, 2449.
/vailable at: http://-acts.4--.or/chart.asp6EchF13==. #00, ME",, F$$, 2449, "7)
+, 11 EI)61)/ (.4%.
:.: Table: 7istribution of /verage pending "er "erson, 2449. ource: Faiser $amil-
$oundation calculations using data from +.. 7epartment of 0ealth and 0uman
ervices, /genc- for 0ealthcare =esearch and >ualit-, Medical E!penditure "anel
urve- #ME"%, 2449. /dapted from: 0ealthcare 1osts P / "rimer, 244;. /vailable at:
http://-acts.4--.or/chart.asp6EchF13<0. Last accessed 7ecember 52, 2455. #00,
ME", F$$, 2449, "7)+, 11 EI)61)/ (.4%
1harts, Tables and $igures #cotinued%
:.< 1hart: 6umber of 6onelderl- +ninsured /mericans, 2444 P 244;. ource: Faiser
1ommission on Medicaid and the +ninsured.+rban Institute anal-sis of 2445)2454
/E1 upplements to the 1". #F$$, "7)+, 11 EI)61)/ (.4%.
:.@ 1hart: The =ecession and +ninsured, 2449)244;. ource: Eased on Aohn 0olahan
and Eowen Barrett, Rising nemplo!ment" #edicaid" and the nins$red, prepared
for the Faiser 1ommission on Medicaid and the +ninsured, Aanuar- 244;. #F$$, 244;,
"7)+%.
)ecture 1c
1. /merican /cadem- of $amil- "h-sicians #//$"%, /merican /cadem- of
"ediatrics #//"%, /merican 1ollege of "h-sicians #/1"%, /merican ,steopathic
/ssociation #/,/% 244@ Ucited /ugust 5, 2454V. Aoint "rinciples of the "atient)
1entered Medical 0ome available at:
http://%%%.aa-p.or/online/etc/medialib/aa-p9or/documents/
polic*/-ed/&ointprinciplespcmh0!05.Par.0001./ile.dat/0!!105medicalhome.p
d-. Last accessed March 22, 2455.
!. $isher E, E-num A, kinner A. The "olic- Implications of 3ariations in Medicare
pending Browth. The 7artmouth /tlas: The 7artmouth Institute for 0ealth
"olic- and 1linical "ractice 1enter for 0ealth "olic- =esearch, $ebruar- 2@,
http://%%%.dartmouthatlas.or/do%nloads/reports/Polic*9Implications93rie
-90!!50<.pd-. Last accessed March 22, 2455.
3. $isher E, Boodman 7, kinner A, Eronner F. 0ealth 1are pending, >ualit-,
and ,utcomes More IsnGt /lwa-s Eetter. The 7artmouth /tlas: The 7artmouth
Institute for 0ealth "olic- and 1linical "ractice 1enter for 0ealth "olic-
=esearch, $ebruar- 2@, 244;. Ucited 2454 Aul- (5V. /vailable at:
http://%%%.dartmouthatlas.or/do%nloads/reports/Spendin93rie-90!!50<.
pd- Last accessed March 22, 2455.
=. 6elson /=, 1osts of 0ealth 1are: 6ew olutions for an ,ld "roblem. The
http://%%%.common%ealth-und.or/Content/Publications/Commentaries/!0
01/Ma*/Costs2o-2Health2Care22"e%2Solutions2-or2an2#ld2Problem.asp6.
1. =obert 'ood Aohnson $oundation. /vailable at: http://%%%.r%&-.or/. ource
for health issue research and health polic-.
0. The 1ongress of the +nited tates 1ongressional Eudget ,ffice. 'ashington
71: 2449 Ucited Aul- (5, 2454V. Technological 1hange /nd The Browth ,f 0ealth
1are pending. /vailable at: http://%%%.cbo.o$/-tpdocs/7<66/doc7<=5/012
312(echHealth.pd-. Last accessed 7ecember 52, 2455.
5. The 0astings 1enter, 1hapter 5@ 0ealth 1are 1osts and Medical Technolog- in
$rom Eirth to 7eath and Eench to 1linic: The 0astings 1enter Eioethics Eriefing
Eook for Aournalists, "olic-makers, and 1ampaigns, available at:
http://%%%.thehastinscenter.or/uploaded/iles/Publications/3rie-in93oo
4/health:!0care:!0costs:!0chapter.pd-. /ccessed 7ecember 52, 2455.
7. The 0enr- A Faiser $amil- $oundation. Menlo "ark, 1/: 244; Ucited 2454
/ugust 5V. 0ealthcare 1osts: / "rimer& available from:
http://%%%.4--.or/insurance/ 5050.c-m Fe- information on health care costs.
Last accessed March 22, 2455
<. The 0enr- A Faiser $amil- $oundation. Menlo "ark, 1/: 2454 Ucited 2454
/ugust 5V. Faiseredu.org X 1ost and pending X + 0ealthcare 1osts& available
from: http://%%%.4aiseredu.or/inde6.asp. "rovides background information,
links to ke- data and polic- information on + healthcare costs. Last accessed
March 22, 2455.
10. The 0enr- A Faiser $amil- $oundation. Menlo "ark, 1/: 2454 Ucited 2454
0ealth IT 'orkforce 1urriculum Introduction to 0ealthcare and :;
/ugust 5V. "rescription 7rug Trends. /vailable at:
http://%%%.4--.or/r6drus/inde6.c-m Last accessed March 22, 2455.
11. The 0enr- A Faiser $amil- $oundation. Menlo "ark, 1/: 2454 Ucited 2454
/ugust 5V. The Faiser 1ommission on Medicaid and the +ninsured& +ninsured
and +ntreated: / Look at +ninsured /dults 'ho =eceived 6o Medical 1are for
Two Iears #2454%& available at: http://%%%.4--.or/uninsured/7073.c-m. Last
accessed March 22, 2455.
comp5?unit:?discuss.doc
comp5?unit:?discuss?ke-.doc
comp5?unit:?self)assess.doc
comp5?unit:?self)assess?ke-.doc
0ealth IT 'orkforce 1urriculum Introduction to 0ealthcare and <4
Component 1/Unit 0
Unit (itle
.eulatin Healthcare
Unit ,escription
This unit provides an overview of the regulation of healthcare, including regulator- and
professional organiDations, the regulation of safet- in medicine, and ke- legal aspects of
medicine. This unit also covers compliance issues including privac- violations,
reimbursement and fraud and abuse.
Unit #b&ecti$es
5. 7escribe the role of accreditation, regulator- bodies, and professional
associations in healthcare in the +. #Lecture a%
2. 7escribe the basic concepts of law in the +nited tates: the legal s-stem,
sources of law, classification of laws, the court s-stem, and the trial
process. #Lecture b%
(. 7escribe legal aspects of medicine involving the /ffordable 1are /ct,
professional standards in healthcare, medical malpractice, Tort reform,
and Medicare and Medicaid $raud and /buse #Lecture c%
8. 7escribe ke- components of the 0ealth Insurance "ortabilit- and
/ccountabilit- /ct #0I"//% and current issues of privac- and patient
safet- in the + #Lecture d%
:. 7iscuss the need for *ualit- clinical documentation for the use of the
health record as a legal document, communication tool and a ke- to prove
compliance for healthcare organiDations. #Lecture e%
5. The role of accreditation, regulator- bodies, and professional organiDations in health
care promoting standardiDed care and safet- for patients.
2. The basic concepts of law in the + including branches of law, sources of law, the
court s-stem, classification of laws, and the trial process
(. =eview of the /ffordable 1are /ct, medical malpractice and professional standards
of care, tort reform and fraud and abuse
8. The role of 0I"// "rivac- =ule, the Aoint 1ommissionGs afet- Initiatives and the
/genc- for 0ealthcare =esearch and >ualit- #/0=>%
:. The use of health record as the legal and communication document, *ualit- clinical
documentation, compliance with privac- and reimbursement laws and regulations.
Unit .e-erences
)ecture 0a
1. /merican Eoard of Medical pecialties. http://%%%.abms.or. /ccessed /pril
52, 2455.
!. /merican 0ospital /ssociation. http://%%%.aha.or. /ccessed /pril 52, 2455.
3. /merican Medical /ssociation. http://%%%.ama2assn.or. /ccessed /pril 52,
2455.
=. "eck ". /M/: after one)-ear increase, /M/ membership declines again. Aune
2:, 244@. http://%%%.medpaetoda*.com/MeetinCo$erae/'M'/0000.
1. =egulator- agenc- #definition%. Enc-clopedia Eritannica.
http://%%%.britannica.com/+3chec4ed/topic/=<0!01/reulator*2aenc*.
0. The Aoint 1ommission.
http://%%%.&ointcommission.or/-acts9about9the9&oint9commission /
5. + 7epartment of 0ealth M 0uman ervices. +nderstanding health information
privac-. http://%%%.hhs.o$/ocr/pri$ac*/hipaa/understandin/inde6.html.
7. + $ood and 7rug /dministration. http://%%%.-da.o$. /ccessed /pril 52,
2455.
<. +=/1. http://%%%.urac.or. /ccessed /pril 52, 2455.
)ecture 0a Charts8 (ables8 /iures
<.5 $igure: "art of 7epartment of 0ealth and 0uman ervices, charged with oversight
of the areas displa-ed. http://%%%.-da.o$/ . /ccessed /pril 52, 2455.
)ecture 0b
1. /dministrative ,ffice of the + 1ourts. The federal court s-stem in the +nited
tates. 2454. (rd ed.
http://%%%.uscourts.o$/uscourts//ederalCourts/Publications/+nlish.pd-.
!. /dministrative ,ffice of the + 1ourts. +nderstanding federal and state courts.
http://%%%.uscourts.o$/+ducational.esources//ederalCourt3asics/Court
Structure/Understandin/ederal'ndStateCourts.asp6. /ccessed /pril 9,
2455.
3. /dministrative ,ffice of the + 1ourts. +nited tates 1ourts.
http://%%%.uscourts.o$/Home.asp6. /ccessed /pril 9, 2455.
=. 1enters for Medicare and Medicaid ervices. Buidance to laws and regulations:
overview. https://%%%.cms.o$/Cuidance-or)a%s'nd.eulations. /ccessed
/pril 54, 2455.
1. 1ornell +niversit- Law chool Legal Information Institute. Tort.
http://topics.la%.cornell.edu/%e6/tort. /ccessed /pril 54, 2455.
0. ocial ecurit- ,nline. Information about ocial ecurit-Ns hearings and appeals
process. http://%%%.ssa.o$/appeals. /ccessed /pril 54, 2455.
5. The Librar- of 1ongress. Law Librar- of 1ongress. http://%%%.loc.o$/la%.
7. + 1itiDenship and Immigration ervices. 'elcome to the +nited tates: / guide
for new immigrants. ttp://%%%.uscis.o$/-iles/nati$edocuments/M2017.pd-.
<. +/.gov. $ederal e!ecutive branch.
http://%%%.usa.o$/'encies//ederal/+6ecuti$e.shtml. /ccessed /pril 54,
2455.
)ecture 0bCharts8 (ables and Imaes
<.2 Table: E!ample of court jurisdiction on various levels of government.
<. ( $igure: Two important sub classifications of civil law are contract law and tort law.
,0+ #2454%.
<.8 $igure: The two t-pes of "ublic Law that have the most effect on individuals are
criminal law and administrative law. ,0+ #2454%.
)ecture 0c
1. /genc- for 0ealthcare =esearch and >ualit-. "atient safet- primers: never
events. http://%%%.psnet.ahrA.o$/primer.asp6EprimerI,F3. /ccessed /pril
54, 2455.
!. /merican 1ancer ociet-. Informed consent. +pdated /ugust 54, 2454.
http://%%%.cancer.or/acs/roups/cid/documents/%ebcontent/00301=2
pd-.pd-. /ccessed /pril 55, 2455.
3. /merican 1ollege of Emergenc- "h-sicians $oundation. Emergenc- manual:
legal issuesHBood amaritan laws.
http://%%%.emerenc*care-or*ou.or/+merenc*Manual/,e-ault.asp6E
idF!00. /ccessed /pril 55, 2455.
=. /merican Medical /ssociation. "h-sician resources: patient ph-sician
relationship topicsHinformed consent. http://%%%.ama2
assn.or/ama/pub/ph*sician2resources/leal2topics/patient2ph*sician2
relationship2topics/in-ormed2consent.pae. /ccessed /pril 55, 2455.
1. $ederation of tate Medical Eoards. / guide to the essentials of a modern
medical practice act. 54
th
ed. 244(.
http://%%%.-smb.or/pd-/!0039rpol9Modern9Medical9Practice9'ct.pd-.
0. $ederation of tate Medical Eoards. tate of the states: ph-sician regulation
244;. http://%%%.-smb.or/pd-/!00<9state9o-9states.pd-. /ccessed /pril 55,
2455.
5. Finne- E7. The origins and promise of medical standards of care. Hirtual
@entor8 "merican @edical "ssociation /ournal of ;thics( 2448&<#52%.
http://$irtualmentor.ama2assn.or/!00=/1!/mhst120=1!.html. /ccessed /pril
55, 2455.
0ealth IT 'orkforce 1urriculum Introduction to 0ealthcare and <(
7. Mello MM, Fachalia /. Evaluation of options for medical malpractice s-stem
reform: a report to the Medicare "a-ment /dvisor- 1ommission #Med"/1%.
Aanuar- 2;, 2454.
http://%%%.medpac.o$/documents/'pr109MedicalMalpractice9C#"(.'C(
#..pd-. /ccessed /pril 55, 2455.
<. 6olo. Medical malpractice basics. http://%%%.nolo.com/leal2
enc*clopedia/medical2malpractice2basics2!<711.html. /ccessed /pril 55,
2455.
10. ,ffice of Inspector Beneral. / roadmap for new ph-sicians: avoiding
Medicare and Medicaid fraud and abuse.
http://oi.hhs.o$/-raud/Ph*sician+ducation. /ccessed /pril 55, 2455.
11. ,hio tate Ear /ssociation. Law -ou can use: ,hioGs QBood amaritanY
law protects volunteers. ,ctober 22, 244<.
http://%%%.ohiobar.or/Paes/)a%DouCanUse,etail.asp6EitemI,F=55.
1!. + 7epartment of 0ealth and 0uman ervices. 6ew tools to fight fraud,
strengthen Medicare and protect ta!pa-er dollars. Aanuar- 28, 2455.
http://%%%.healthcare.o$/ne%s/-actsheets/ne%9tools9to9-iht9-raud.html.
13. + 7epartment of 0ealth and 0uman ervices. +nderstanding the /ffordable
1are /ct. http://%%%.healthcare.o$/la%/introduction/inde6.html. /ccessed
/pril 54, 2455.
)ecture 0c Charts8 (ables8 /iures
<.: $igure: 7iagram showing a few of the man- sources that can contribute to a
medical standard of care. ,0+ #2454%.
<. < 1hart: 7iagram showing how Tort law is the part of private or civil law that deals
with malpractice. ,0+ #2454%.
)ecture 0c Imaes
lide @: creenshot of the /ffordable 1are /ct #/1/% Timeline. 0ealth1are.gov #nd.%.
http://%%%.healthcare.o$/la%/timeline/inde6.html. =etrieved 6ov. 2455 from the
0ealth1are.gov website, http://%%%.healthcare.o$.
)ecture 0d
1. /genc- for 0ealthcare =esearch and >ualit-. 2454 6ational 0ealthcare >ualit-
=eport. "ublication 6o. 55)4448. $ebruar- 2455.
http://%%%.ahrA.o$/Aual/nhAr10/nhAr10.pd-. /ccessed /pril 5(, 2455.
!. /genc- for 0ealthcare =esearch and >ualit-. 0ealth information technolog-
UportalV. http://healthit.ahrA.o$/portal/ser$er.ptE
openF11=Job&I,F100=JparentnameFCommunit*PaeJparentidF10JmodeF
!. /ccessed /pril 5(, 2455.
3. /merican Medical /ssociation. +nderstanding the 0I"// standard transactions:
the 0I"// Transactions and 1ode et =ule. 244;. http://%%%.ama2
assn.or/resources/doc/psa/hipaa2tcs.pd-. /ccessed /pril 52, 2455.
=. 1enters for Medicare and Medicaid ervices. /re -ou a covered entit-K
http://%%%.cms.o$/HIP''CenIn-o/009'reDouaCo$ered+ntit*.asp.
/ccessed /pril 5(, 2455.
1. Bamble M. $re*uenc-, severit- of medical malpractice claims to rise in 2455.
0ec*erAs Hospital ,eview( ,ctober 5(, 2454.
http://%%%.bec4ershospitalre$ie%.com/hospital2-inancial2and2business2
ne%s/-reAuenc*2se$erit*2o-2medical2malpractice2claims2to2rise2in2
!011.html. /ccessed /pril 5(, 2455.
0. Institute of Medicine. To ;rr is Human8 0uilding a Safer Health System(
6ovember 5, 5;;;. http://%%%.iom.edu/.eports/1<<</(o2+rr2is2Human2
3uildin2'2Sa-er2Health2S*stem.asp6. /ccessed /pril 5(, 2455.
5. Fane 1F. Medical liabilit- claim fre*uenc-: a 244@P2449 snapshot of ph-sicians.
/merican Medical /ssociation. 2454. http://%%%.ama2
assn.or/ama1/pub/upload/mm/303/prp2!010012claim2-reA.pd-. /ccessed
/pril 5(, 2455.
7. =einberg . 0ospital errors ma- be far more common than suspected.
0ealth7a-. /pril @, 2455.
http://%%%.usne%s.com/mobile/articles9mobile/report2hospital2errors2ma*2
be2-ar2more2common2than2suspected. /ccessed /pril 5(, 2455.
<. The Aoint 1ommission. http://%%%.&ointcommission.or. /ccessed /pril 5(,
2455.
10. + 7epartment of 0ealth and 0uman =esources. 00 imposes a Z8.(
million civil mone- penalt- for violations of the 0I"// "rivac- =ule. $ebruar- 22,
2455. http://%%%.hhs.o$/ne%s/press/!011pres/0!/!0110!!!a.html.
11. + 7epartment of 0ealth and 0uman =esources. +nderstanding health
information privac-.
http://%%%.hhs.o$/ocr/pri$ac*/hipaa/understandin/inde6.html. /ccessed
/pril 52, 2455.
)ecture 0d Charts8 (ables8 /iures
<.@ $igure: /dapted from
http://%%%.cms.o$/HIP''CenIn-o/,o%nloads/Co$ered+ntit*charts.pd-. 1M
#nd.% /c*uired from http://%%%.cms.o$. Last accessed Aan. 2452.
<.9 Table: The bottom of the /0=> home page, which can be found at
http://%%%.ahrA.o$/ /0=> #nd.%. Last accessed Aan. 2452.
<.; Table: Listing the attributes of >ualit- M "atient afet-. /0=>.gov #nd.%. $rom the
bottom of the /0=> home page, which can be found at http://%%%.ahrA.o$/. Last
accessed Aan. 2452.
<.54 $igure #left%: /0=>.gov #nd.%
http://healthit.ahrA.o$/portal/ser$er.ptE
0ealth IT 'orkforce 1urriculum Introduction to 0ealthcare and <:
openF11=Job&I,F100=JparentnameFCommunit*PaeJparentidF10JmodeF!.
$rom the /0=> website, http://%%%.ahrA.o$/ . Last accessed Aan. 2452.
<.55 $igure #right%. Menu of articles on background information and the latest evidence
on ke- topics from the field of health IT.
http://healthit.ahrA.o$/portal/ser$er.pt/communit*/4no%lede9librar*/013/4e*9to
pics/100=. $rom the /0=> website, http://%%%.ahrA.o$/ . Last accessed Aan. 2452.
)ecture 0e
1. /merican health Information Management /ssociation.
http://ahima.or/resources/in-ocenter/ehr.asp6. accessed on 55.55.2455.
!. /merican 0ealth Information Management /ssociation.
http://ahima.or/resources/cdi.asp6. accessed on 55.55.2455.
3. /merican 0ealth Information Management /ssociation.
http://ahima.or/resources/psc.asp6. accessed on 11/11/!011
8. Ea-es, 6., 6ewb-, A, eggern, A, 3alerius A. Medical Insurance /n integrated
claims process approach :
th
edition, 2452. McBraw 0ill 1ompanies: 6ew Iork
:. 7avis, 6. =evenue 1-cle Management Eest "ractices, 2455, /0IM/ "ress:
1hicago
0. 0ealthcare 1ompliance "rogram Tips accessed on 55.;.55:
http://oi.hhs.o$/compliance/pro$ider2compliance2trainin/inde6.asp
@. LaTour M Eichenwald, 0ealth Information Management, concepts, "rinciples,
and "ractice, Third Edition, 2454 /0IM/ "ress: 1hicago
9. =usso, =. 1linical documentation improvement, 2454 /0IM/ "ress: 1hicago
<. ,ffice of the Inspector Beneral. http://oi.hhs.o$/. accessed on 55.55.2455.
10. ,ffice of the Inspector Beneral.
http://oi.hhs.o$/ne%sroom/$ideo/!011/heat9modules.asp. accessed on
55.55.2455.
11. ,ffice of Inspector Beneral. / roadmap for new ph-sicians: avoiding
Medicare and Medicaid fraud and abuse.
http://oi.hhs.o$/-raud/Ph*sician+ducation. /ccessed 55.55.2455.
1!. ,ffice of the Inspector Beneral.
http://oi.hhs.o$/ne%sroom/$ideo/inde6.asp. accessed on 55.55.2455.
13. 1enters for Medicare and Medicaid. http://%%%.cms.o$/de-ault.asp.
/ccessed on 55.55.2455.
1=. 1orporate integrit- agreements. http://oi.hhs.o$/compliance/corporate2
interit*2areements/inde6.asp. /ccessed on 55.;.55
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0ealth IT 'orkforce 1urriculum Introduction to 0ealthcare and <@
Component 1/Unit 5
Unit (itle
Public Health ?Part 1@
Unit ,escription
This unit provides a discussion of public health origins and histor-, the differentiation
from private health, and the significant value provided b- public health. It also reviews
important terminolog- and includes an e!amination of the general organiDation of public
health agencies and the flow of data within public health.
Unit #b&ecti$es
5. 7iscern the main differences and similarities between public and private
health #Lecture a%
2. 7elineate the historic timeline and achievements of public health in the +
#Lecture a%
(. 7efine and discuss ke- terminolog- of public health #Lecture b%
8. Illustrate the general organiDation of public health agencies and public
health data flow #Lecture b%
:. Evaluate and e!plain the impact and value of public health #Lecture c%
Unit (opics / )ecture (itles
5. 0istor- of public health
2. "ublic health terminolog- and organiDation
(. 3alue and impact of public health
Unit .e-erences
)ecture 5a
5. Historical Highlights. #2454%. =etrieved 7ecember <, 2455, from + 7epartment
of 0ealth M 0uman ervices website: http:..www.hhs.gov.about.hhshist.html.
2. Our History 9 Our Story. #2455%. =etrieved 7ecember <, 2455, from 1enters for
7isease 1ontrol and "revention website:
http:..www.cdc.gov.about.histor-.ourstor-.htm.
)ecture 5a Charts8 (ables and /iures
@.5 $igure: everit-, "reventabilit-, "revalence P 1reated b- Magnuson, A/ #2454%.
)ecture 5b
5. Nationally Notifiable !nfectious onditions 9 United States #%&%. #2454%.
=etrieved 7ecember <, 2455, from 1enters for 7isease 1ontrol and "revention )
,ffice of urveillance, Epidemiolog-, and Laborator- ervices website:
http:..www.cdc.gov.osels.ph?surveillance.nndss.phs.infdis2454.htm.
)ecture 5b Charts8 (ables and /iures
I(# hart8 "dvancing the Health, Safety, and 2ell90eing of Our 5eople 9 3C #%&&
5residentAs 0udget for HHS( .#%&&1( ,etrieved December :, #%&&, from Department of
Health and Human Services website8
http877dhhs(gov7asfr7ob7docbudget7#%&&budgetinbrief(pdf
I(6 hart8 The generali4ed flow of public health data G reated by @agnuson, /"
.#%&&1(
)ecture 5c
5. -eading auses of Death. #244@%. =etrieved 7ecember <, 2455, from 1enters for
http:..www.cdc.gov.nchs.fastats.lcod.htm.
2. "ublic 0ealth /chievements in the 24th 1entur-. #5;;;%. @orbidity & @ortality
2ee*ly ,eport , $?#52%, 285)28(.
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0ealth IT 'orkforce 1urriculum Introduction to 0ealthcare and <;
Component 1/Unit 7
Unit (itle
Public Health ?Part !@
Unit ,escription
This unit provides an overview of public health topics including: important
communicable diseases and public health responses& terrorism, including biological,
agricultural, and chemical terrorism& and chronic diseases and environmental health.
Unit #b&ecti$es
5. Bive e!amples of and e!plain the general program categories of public
health, including communicable disease, chronic disease, terrorism
response, and environmental public health #Lecture a%
2. 7iscuss the activities and achievements of public health in the realm of
communicable disease #Lecture a %
(. 1ompare and contrast the different t-pes of terrorism and the different
public health responses #Lecture b %
8. 7escribe chronic disease activities and achievements of public health, and
the work of public health in the realm of environmental health haDards
#Lecture c %
5. "ublic health and communicable disease
2. "ublic health and terrorism
(. "ublic health and chronic disease and environmental haDards
Unit .e-erences
)ecture 7a
5. Nationally Notifiable !nfectious onditions 9 United States #%&%. #2454%.
=etrieved 7ecember <, 2455, from 1enters for 7isease 1ontrol and "revention )
,ffice of urveillance, Epidemiolog-, and Laborator- ervices website:
http:..www.cdc.gov.osels.ph?surveillance.nndss.phs.infdis2454.htm
)ecture 7b
1. ;mergency 5reparedness and ,esponse 9 0ioterrorism "gents7Diseases. #n.d.%.
=etrieved 7ecember <, 2455, from 1enters for 7isease 1ontrol and "revention
website: http://%%%.bt.cdc.o$/aent/aentlist2cateor*.asp
!. ;mergency 5reparedness and ,esponse 9 hemical ;mergencies. #n.d.%.
website: http://%%%.bt.cdc.o$/chemical
0ealth IT 'orkforce 1urriculum Introduction to 0ealthcare and @4
3. ;mergency 5reparedness and ,esponse 9 ,adiation ;mergencies. #n.d.%.
website: http://%%%.bt.cdc.o$/radiation
)ecture 7c
5. hronic Disease 5revention and Health 5romotion. #n.d.%. =etrieved 7ecember
<, 2455, from 1enters for 7isease 1ontrol and "revention website:
http:..www.cdc.gov.chronicdisease.inde!.htm
2. hronic Diseases. #n.d.%. =etrieved 7ecember <, 2455, from 'orld 0ealth
,rganiDation website: http:..www.who.int.topics.chronic?diseases.en.
(. -eading auses of Death. #244@%. =etrieved 7ecember <, 2455, from 1enters for
http:..www.cdc.gov.nchs.fastats.lcod.htm
comp5?unit9?self?assess.doc
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Component 1/Unit <
Unit (itle
Healthcare .e-orm
Unit ,escription
This unit provides an overview of healthcare trends including evidence based medicine,
*ualit- and practice)care recommendations, comparative effectiveness research, and
an overview of healthcare reform initiatives in the +.
Unit #b&ecti$es
5. 7escribe evidence)based medicine, clinical practice guidelines, and
*ualit- indicators in medicine #Lecture a, b, c%
2. 7escribe the patient)centered medical home model #Lecture d%
(. 7iscuss the ke- issues driving healthcare reform in the + #Lecture e%
5. Evidence based practice
2. 1linical practice guidelines
(. >ualit- indicators and comparative effectiveness
8. The patient)centered medical home
:. 0ealthcare reform in the +
Unit .e-erences
)ecture <a
5. linical Decision Support. #n.d.%. =etrieved 7ecember <, 2455, from 0IM
website: http:..www.himss.org./".topics?$ocus7-namic.aspKfaidL(5(
2. Manchikanti, L., ingh, 3., 0elm II, ., chultD, 7. M., 7atta, ., M 0irsch, A.
#244;%. Evidence)Eased Medicine ) /n Introduction to an Evidence)Eased
/pproach to Interventional Techni*ues in the Management of 1hronic pinal
"ain. 5ain 5hysician, &##E5)E((%, =etrieved from
http:..www.painph-sicianjournal.com.244;.jul-.244;&52&E5)E((.pdf
(. ackett, 7. L., =osenberg, '. M., Muir Bra-, A. /., 0a-nes, =. E., M =ichardson,
'. . #5;;<, Aanuar- 5(%. Editorial ) Evidence)Eased medicine: what it is and
what it isnNt. 0@/, 6&##@5%, =etrieved from
http:..www.hsl.unc.edu.ervices.Tutorials.EEM.whatis.htm
8. chardt, 1., M Ma-er, A. #2454, Aul-%. The 2ell90uilt linical >uestion. =etrieved
7ecember <, 2455, from +niversit- of 6orth 1arolina at 1hapel 0ill ) 0ealth
ciences Librar-, Tutorials website:
http:..www.hsl.unc.edu.ervices.Tutorials.EEM.>uestion.htm
)ecture <a Charts8 (ables and /iures
;.5 1hart: The 0ierarch- of tud- 7esigns P adapted from O+ford enter for ;vidence9
based @edicine 9 -evels of ;vidence . #244;, March%. =etrieved 7ecember <, 2455,
from 1enter for Evidence Eased Medicine website: http://%%%.cebm.net/inde6.asp6E
oF10!1
;.2 1hart: O+ford enter for ;vidence9based @edicine 9 -evels of ;vidence . #244;,
March%. =etrieved 7ecember <, 2455, from 1enter for Evidence Eased Medicine
website: http://%%%.cebm.net/inde6.asp6EoF10!1
)ecture <b
5. 0arris, =. "., 0elfand, M., M 'oolf, . 0., et al. #2445%. 1urrent methods of the
+ "reventive ervices Task $orce: a review of the process. "merican /ournal
of 5reventative @edicine, #% .suppl 61, 25)(:.
2. U(S( 5reventive Services Tas* 3orce .US5ST31. #n.d.%. =etrieved 7ecember <,
2455, from +.. 7epartment of 0ealth M 0uman ervices ) /genc- for
0ealthcare =esearch and >ualit- website: http:..www.ahr*.gov.clinic.uspstfi!.htm
(. U(S( 5reventive Services Tas* 3orce. #n.d.%. =etrieved 7ecember <, 2455, from
+.. "reventative ervices Task $orce website:
http:..www.uspreventiveservicestaskforce.org.
)ecture <c
5. 1ommittee on >ualit- 0ealthcare in /merica, Institute of Medicine, . #2445%.
rossing the Duality chasm8 a new health system for the #&st century.
'ashington,, 71: 6ational /cadem- "ress.
!. omparative ;ffectiveness ,esearch 3unding. #n.d.%. =etrieved 7ecember <,
2455, from +.. 7epartment of 0ealth M 0uman ervices.=ecover- website:
http://%%%.hhs.o$/reco$er*/prorams/cer/inde6.html
3. !nitial National 5riorities for omparative ;ffectiveness ,esearch. #244;%.
=etrieved from 6ational /cademies "ress, 'ashington 71 244:: website:
http://%%%.nap.edu/catalo.phpErecord9idF1!0=7Btoc
=. o!, 0. 1., 0elfand, M., Brimshaw, A., 7ickersin, F., M the "Lo Medicine
Editors, et.al. #2454, /pril 2;%. 1omparative effectiveness research: 1hallenges
for medical journals UeditorialV. The ochrane -ibrary, =etrieved from
http://%%%.thecochranelibrar*.com/details/editorial/075<51/Comparati$e2
+--ecti$eness2.esearch2Challenes2-or2Medical2Hournals.html
)ecture <d
5. /merican /cadem- of "ediatrics, Medical 0ome Initiatives for 1hildren with
pecial 6eeds "roject /dvisor- 1ommittee #2442%. The medical home.
5ediatrics, &&%, 598)59<.
2. /oint 5rinciples of the 5atient entered @edical Home. #244@%. =etrieved
7ecember <, 2455, from "atient)centered "rimar- 1are 1ollaborative ) /merican
/cadem- of $amil- "h-sicians #//$"%& /merican /cadem- of "ediatrics #//"%&
/merican 1ollege of "h-sicians #/1"%& /merican ,steopathic /ssociation #/,/%
0ealth IT 'orkforce 1urriculum Introduction to 0ealthcare and @(
website: http:..www.pcpcc.net.node.58.
(. "ediatric =ecords and a OMedical 0omeO. #5;<@%. In Standards of hild are #pp.
@@)@;%. Evanston, IL: /merican /cadem- of "ediatrics.
8. 5hysician 5ractice onnectionsJK5atient9entered @edical Home .559
5@HL1 ,ecognition 5rogram( "ttestation7"greement. #244@, 7ecember%.
=etrieved 7ecember <, 2455, from The 6ational 1ommittee fro >ualit-
/ssurance website: http:..www.coloradoafp.org.pdf.""1)"1M0?/ttestation.pdf
)ecture <e
5. /dam-, A. #2454, Aune 5%. )rants "im to ,educe @edical @alpractice -awsuits.
=etrieved 7ecember <, 2455, from The 'all treet Aournal. "olitics website:
http:..online.wsj.com.article.E544458284:2@89@48(52548:@:2;;2<4@94:@(22
4.html
2. Eihari, M. #2454%. Understanding the @edicare 5art D Donut Hole -earn "bout
the @edicare 5art D overage )ap 9 Hitting the Donut Hole. =etrieved
7ecember <, 2455, from /bout.com 0ealth Insurance website:
http:..healthinsurance.about.com.od.medicare.a.understanding?part?d.htm
(. ;mergency @edical Treatment & -abor "ct .;@T"-"1 9 Overview. #2455%.
=etrieved 7ecember <, 2455, from 1enters for Medicare and Medicaid ervices
website: https:..www.cms.gov.emtala.
8. )ood News for 5eople with @edicare. #2454%. =etrieved 7ecember <, 2455, from
0ealth1are.gov. website: http:..www.healthcare.gov.
:. !nvestigation of Defensive @edicine in @assachusetts. =etrieved 7ecember <,
2455, from Massachusetts Medical ociet- website:
http:..www.massmed.org./M.Template.cfmK
ectionL=esearch?=eports?and?tudies2MTEM"L/TEL.1M.1ontent7ispla-.cf
mM1,6TE6TI7L2@@;@
<. @edicaid and H!5 5rogram !nformation. #n.d.%. =etrieved 7ecember <, 2455,
from Medicaid.gov website: https:..www.cms.gov.home.chip.asp
@. 5atient 5rotection and "ffordable are "ct .55""1. #2454%. =etrieved
7ecember <, 2455, from Marrs Maddocks R /ssociates Insurance ervices, Inc.
website: http:..ppaca.com.inde!.phpKpageLhcr)timeline
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Component 1/Unit 10
Unit (itle
Meanin-ul Use o- Health In-ormation (echnolo*
Unit ,escription
The 0ealth Information Technolog- for Economic and 1linical 0ealth #0ITE10% /ct of
the /merican =ecover- and =einvestment /ct #/==/% legislated incentives for the
meaningful use of health information technolog-. This unit describes the meaningful use
program of 0ITE10, eligibilit- for incentive pa-ments, and the criteria for achieving
those pa-ments in tages 5 and 2 of the program. It also describes the standards
specified for tages 5 and 2 of meaningful use, including those devoted to privac- and
securit-.
Unit #b&ecti$es
5. 7efine meaningful use of health information technolog- in the conte!t of the
0ealth Information Technolog- for Economic and 1linical 0ealth #0ITE10% /ct
#Lecture a%
2. 7escribe the major goals of meaningful use #Lecture a%
(. 7efine the criteria for tages 5 and 2 of meaningful use for eligible professionals
and eligible hospitals #Lecture b%
8. 7escribe the standards specified for tages 5 and 2 of meaningful use, including
those devoted to privac- and securit- #Lecture c%
:. 7efine the clinical *ualit- measures #1>Ms% for the meaningful use program
#Lecture c%
5. =e*uirements for meaningful use
2. Implementation of meaningful use
(. 1ore and menu criteria for tages 5 and 2 of meaningful use for eligible
professionals and eligible hospitals
8. tandards for tages 5 and 2 of meaningful use, including those devoted to privac-
and securit-
:. 1linical *ualit- measures #1>Ms% for the meaningful use program
Unit .e-erences
)ecture 10a
5. Elumenthal, 7. #2454%. Launching 0ITE10. New ;ngland /ournal of @edicine,
(<2, (92)(9:.
2. Elumenthal, 7., M Tavenner, M. #2454%. The Qmeaningful useY regulation for
electronic health records. New ;ngland /ournal of @edicine, (<(, :45):48.
0ealth IT 'orkforce 1urriculum Introduction to 0ealthcare and @:
3. MetDger, A. and =hoads, A. #2452%. ummar- of Fe- "rovisions in $inal =ule for
tage 2 0ITE10 Meaningful +se. $alls 1hurch, 3/, 1omputer ciences 1orp.
http ://assets1.csc.com/health9ser$ices/do%nloads/CSC9Ie*9Pro$isions9o-
9/inal9.ule9-or9Stae9!.pd-.
)ectue 10a Charts8 (ables8 /iures
54.5 1hart: @S(govB @edicare and @edicaid ;H, !ncentive 5rogram 0asics. #2452%.
=etrieved 7ecember 2452, from 1enters for Medicare M Medicaid ervices website:
http://%%%.cms.o$/.eulations2and2
Cuidance/)eislation/+H.Incenti$eProrams/3asics.html
54.2 1hart: @S(govB @edicare and @edicaid ;H, !ncentive 5rogram 0asics. #2452%.
54.( 1hart: @S(govB @edicare and @edicaid ;H, !ncentive 5rogram 0asics. #2452%.
)ecture 10a Imaes
lide <: McBuire, E. #2455%. 3ocus on Healthcare 0log. =etrieved 7ecember 2452,
from http://healthcarehis.-iles.%ordpress.com/!011/0!/meanin-ul2use.&p
lide 5:: Health !T(govB ertification 5rograms and 5olicy. #2452%. =etrieved 7ecember
2452, from +.. 7epartment of 0ealth M 0uman ervices website:
http://%%%.healthit.o$/polic*2researchers2implementers/onc2hit2certi-ication2
proram
lide 5<: Health !T(govB ertification 5rograms and 5olicy. #2452%. =etrieved 7ecember
2452, from +.. 7epartment of 0ealth M 0uman ervices website:
http://%%%.healthit.o$/polic*2researchers2implementers/about2
certi-icationBbene-its9o-9certi-ication
lide 5@: @S(govB ;H, !ncentive 5rograms. #2452%. =etrieved 7ecember 2452, from
1enters for Medicare M Medicaid ervices website: http://%%%.cms.o$/.eulations2
and2Cuidance/)eislation/+H.Incenti$eProrams
)ecture 10b
(<2, (92)(9:.
http:// assets1.csc.com/health9ser$ices/do%nloads/CSC9Ie*9Pro$isions9o-
0ealth IT 'orkforce 1urriculum Introduction to 0ealthcare and @<
)ecture 10b Charts8 (ables8 /iures
54.8 1hart: @S(govB Stage #. #2452%. =etrieved 7ecember 2452, from 1enters for
Medicare M Medicaid ervices website: http:// cms.o$/.eulations2and2
Cuidance/)eislation/+H.Incenti$eProrams/Stae9!.html
54.:)54.24 1harts: MetDger, A. and =hoads, A. #2452%. ummar- of Fe- "rovisions in
$inal =ule for tage 2 0ITE10 Meaningful +se. $alls 1hurch, 3/, 1omputer ciences
1orp.
http://assets1.csc.com/health9ser$ices/do%nloads/CSC9Ie*9Pro$isions9o-9/inal
9.ule9-or9Stae9!.pd-. #E- "ermission.%
)ecture 10c
(<2, (92)(9:.
http://assets1.csc.com/health9ser$ices/do%nloads/CSC9Ie*9Pro$isions9o-
)ecture 10c Charts8 (ables8 /iures
54.25 P 54.2@ 1harts: MetDger, A. and =hoads, A. #2452%. ummar- of Fe- "rovisions
in $inal =ule for tage 2 0ITE10 Meaningful +se. $alls 1hurch, 3/, 1omputer
ciences 1orp.
http://assets1.csc.com/health9ser$ices/do%nloads/CSC9Ie*9Pro$isions9o-9/inal
9.ule9-or9Stae9!.pd-. #E- "ermission%
0ealth IT 'orkforce 1urriculum Introduction to 0ealthcare and @@
Component 'cron*m Clossar*
/1$ P /dministration for 1hildren and $amilies
/7/ P /merican 7ental /ssociation
/7L P activit- of dail- living
/0=> P /genc- for 0ealthcare =esearch and >ualit-
/I7 ) /c*uired immune deficienc- s-ndrome
/M/ P The /merican Medical /ssociation
/o/ P /dministration on /ging
/T7= P /genc- for To!ic ubstances and 7isease =egistr-
11+ P critical care unit
17)54)"1 ) The International 1lassification of 7iseases, 54th =evision, "rocedure
1oding
171 P 1enters for 7isease 1ontrol and "revention
1701 ) 1onsumer 7riven 0ealth 1are "lans
17 P 1linical 7ecision upport
17T ) 1ode on 7ental "rocedures and 6omenclature
1M P 1enters for Medicare and Medicaid ervices
1"I P 1onsumer "rice Inde!
1"T ) 1urrent "rocedure Terminolog-
1T P 1omputeriDed Tomograph-
76= P do)not)resuscitate order
7=B ) 7iagnosis =elated Broups
EEM P Evidence Eased Medicine
E7 ) Emergenc- 7epartment
E7I ) Electronic data interchange
EMT P emergenc- medical technician
EMT/L/ P Emergenc- Medical Treatment and /ctive Labor /ct
E", ) E!clusive "rovider ,rganiDation
E= P emergenc- room
$7/ P $ood and 7rug /dministration
$$ ) $ee)for)service
B7" P gross domestic product
01, P 0ealth 1are ,rganiDation
01"1 ) 0ealth 1are 1ommon "rocedure 1oding -stem
00 P 7epartment of 0ealth and 0uman ervices
0I"// P 0ealth Insurance "ortabilit- and /ccountabilit- /ct
0IT P 0ealth Information Technolog-
0ITE10 /ct ) The 0ealth Information Technolog- for Economic and 1linical 0ealth /ct
0I3 ) 0uman immunodeficienc- virus
0M, ) 0ealth Maintenance ,rganiDation
0=/ P 0ealth =esources and ervices /dministration
I17)54)1M ) The International 1lassification of 7iseases, 54th =evision, 1linical
Modification,
I17);)1M ) The International 1lassification of 7iseases, 6inth =evision, 1linical
Modification
I1+ P intensive care unit
I0 P Indian 0ealth ervice
I"/ P independent practice association
A1 P Aoint 1ommission
ATT P Aoint Theater Trauma -stem
L"6 P licensed practical nurse
L=6 ) Lab =esponse 6etwork
M1, ) Managed care organiDation
M0 P Militar- 0ealth -stem
M=I P Magnetic =esonance Imaging
M=/ ) methicillin)resistant taph-lococcus aureus
6ational 7rug 1odes #671
6/T, P 6orth /tlantic Treat- ,rganiDation
6I0 P 6ational Institutes of 0ealth
6, P 6ot ,therwise pecified
,IB P ,ffice of Inspector Beneral
,= P operating room
"/ P ph-sician assistant
"M"M ) per member per month
", ) "oint of ervice "lan
"", ) "referred "rovider ,rganiDation
"T7 P post)traumatic stress disorder
=E=3 ) =esource Eased =elative 3alue cale
=6 P registered nurse
/M0/ P ubstance /buse and Mental 0ealth ervices /dministration
TEI P traumatic brain injur-
3/ P 7epartment of 3eterans /ffairs
0ealth IT 'orkforce 1urriculum Introduction to 0ealthcare and @;
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