Abbreviation	Meaning
AHA	American Hospital Association
app	application; an “app” is a piece of software that can run on the Internet, on a computer, or on a phone or other electronic device
CCM	certified case manager
CEO	chief executive officer
CFO	chief financial officer
COO	chief operating officer
DRG	diagnosis-related groups
ECF	extended care facility
HIMS	health information management system
HMO	health maintenance organization
ICD	International Statistical Classification of Diseases and Related Health Problems
LTC	long-term care
PPO	preferred provider organization
SNF	skilled nursing facility
TJC	The Joint Commission (formerly the Joint Commission on Accreditation of Healthcare Organizations [JCAHO])
WHO	World Health Organization

EXERCISE 1

Write the abbreviation for each term listed.

1. American Hospital Association

2. application

3. certified case manager

4. chief executive officer

5. chief financial officer

6. chief operating officer

7. diagnosis-related groups

8. extended care facility

9. health information management system

10. health maintenance organization

11. International Statistical Classification of Diseases and Related Health Problems

12. long-term care

13. preferred provider organization

14. skilled nursing facility

15. The Joint Commission

16. World Health Organization

EXERCISE 2

Write the meaning of each abbreviation listed.

Challenges Facing the U.S. Health Care System Today

1. More than 50 million people were uninsured in 2010, almost one in six U.S. residents, the Census Bureau reported (published 9/13/2011). Millions of Americans lost their jobs and their health benefits during the recession and often had no way to regain affordable health coverage.

2. There is a disparity in care provided to insured people compared with the uninsured or underinsured, many of whom belong to racial and ethnic minorities.

3. The staggering cost of advanced technology. Medical technology discoveries have been a major contributor to rising health care cost, but imposing controls could impede medical innovation.

4. Increasing insurance costs and out-of-pocket costs continue to soar. Customers of health insurance are now assuming a greater share of premiums and are paying higher deductibles, higher copayments, and a higher percentage of coinsurance.

5. Many doctors and health care facilities are refusing or limiting the number of Medicare patients they treat. The doctors’ reasons are that reimbursement rates are too low and the paperwork is too much of a hassle. There is the real possibility of a far worse health crisis than we see today.

6. Medicaid cuts are expected to cause about 17,000 adults to lose state health coverage and 30,000 more to pay higher premiums. In April, 2012, the federal government approved state Medicaid cuts. The approved cuts save $28 million, in state money officials said. Other proposed cuts await federal approval.

7. Medical errors are one of the nation’s leading causes of death and injury. A 1999 report by the Institute of Medicine of the National Academies (IOM), To Err is Human, estimated that as many as 44,000 to 98,000 people die in U.S. hospitals each year as a result of medical errors. This means that more people die from medical errors than from motor vehicle accidents, breast cancer, or acquired immunodeficiency syndrome (AIDS). The reaction to this IOM report was swift and positive. Congress launched a series of hearings on patient safety and in 2000 $50 million was appropriated to the Agency for Healthcare Research and Quality to support a variety of efforts targeted to reducing medical errors.

The Affordable Care Act

The Affordable Care Act, signed into law in 2010, puts in place comprehensive health insurance reform that will roll out over 4 years and beyond; most changes will have taken place by 2014, and other changes have already taken place. Key provisions of the Affordable Care Act are provided in Box 2-1, Key Provisions of the Affordable Care Act.

BOX 2-1 KEY PROVISIONS OF THE AFFORDABLE CARE ACT

2010

• Adults with preexisting conditions who have been uninsured for at least 6 months became eligible to join a temporary high-risk pool.

• Insurers are prohibited from imposing lifetime dollar limits on essential benefits, such as hospital stays, in new policies issued.

• All new plans must cover certain preventive services such as mammograms and colonoscopies without charging a deductible, copay, or coinsurance.

• Dependents (children) are permitted to remain on their parents’ insurance plan until their 26th birthday.

• Enhanced methods of Medicare fraud detection are implemented.

2011

• The Centers for Medicare and Medicaid Services is responsible for developing the Center for Medicare and Medicaid Innovation and overseeing the testing of innovative payment and delivery models.

2012

• Employers must disclose the value of the benefits they provided beginning in 2012 for each employee’s health insurance coverage on the employees’ annual Form W-2’s.

• Health plans are required to begin adopting and implementing rules for the secure, confidential, electronic exchange of health information (electronic medical record [EMR]).

2014

• Insurers are prohibited from discriminating against or charging higher rates for any individual based on preexisting medical conditions.

• An annual penalty of $95, or up to 1% of income, whichever is greater, is imposed on individuals who do not secure insurance; this will rise to $695, or 2.5% of income, by 2016. This is an individual limit; families have a limit of $2085. Exemptions to the fine in cases of financial hardship or religious beliefs are permitted.

• Insurers are prohibited from establishing annual spending caps.

• A new health insurance marketplace will offer a choice of health plans that meet certain benefits and cost standards.

• Chain restaurants and food vendors with 20 or more locations are required to display the caloric content of their foods on menus, drive-through menus, and vending machines. Additional information, such as saturated fat, carbohydrate, and sodium content, must also be made available on request.

For more information, go to www.healthcare.gov/law/provisions/index.html.

Many Americans have voiced concerns regarding the Affordable Care Act, and several states are challenging the constitutionality of the “individual mandate.” In June of 2012, the U.S. Supreme Court ruled that the individual mandate was constitutional as a tax. The individual mandate requires that virtually all legal residents of the United States obtain minimum essential health insurance coverage for each month, starting in 2014, or pay a penalty that will be included with the individual’s federal tax return. It is important to stay current with changes made, as the changes may have an impact on health care providers as well as everyone receiving health care. (See Box 2-2, Concerns Voiced by States and Individuals Regarding the Affordable Health Care Act.)

BOX 2-2 CONCERNS VOICED BY STATES AND INDIVIDUALS REGARDING THE AFFORDABLE HEALTH CARE ACT

• The mandate that individuals purchase coverage or face penalties is contrary to the Tenth Amendment of the United States Constitution. The individual mandate was upheld by the U.S. Supreme Court in June of 2012.

• Government is too big; health care makes up one fifth of the U.S. economy.

• Higher costs than predicted will be incurred (e.g., taxes will be raised).

• Individuals will have to give up high-quality health care to pay for this legislation.

• There will be rationing of health care, and panels will turn down needed procedures for cheaper options.

• Electronic medical record (EMR) systems have a high cost, ranging from 20 million to 100 million dollars.

Implementing A National Interconnected Electronic Medical Record System

A national electronic medical record (EMR) system will allow the federal government to track the course and impact of a pandemic in real time. A spokesperson from the Center for Health Transformation reported that a national EMR system would provide local, state, and federal governments with the necessary data to direct therapies, medical personnel, and supplies during an emergency. Studies conducted by the Leapfrog Group have shown that computer physician order entry (CPOE) with clinical decision support system (CDSS), if implemented in all urban hospitals in the United States, could prevent as many as 907,600 serious medication errors each year. Studies have also shown that the EMR and CPOE reduce length of stay and reduce retesting and turnaround times for laboratory, pharmacy, and radiology requests while delivering cost savings.

Hospitals and practices that are not using “meaningful use” EMR by the federally set goal of 2014 will be penalized by a cut in the percentage of their Medicare payments starting in 2015. Once the provisions of the law are fully phased in, the penalties could amount to a loss of $3.2 million annually in Medicare funding for the average 500-bed hospital.

Advancing Electronic Medical Record Technologies

Confidentiality and Security

Health care is in the midst of an information technology (IT) revolution. One cannot have confidentiality without information security. There is a balancing act between ease of access for prompt medical care and the maintenance of confidentiality. The American Health Insurance Portability and Accountability Act of 1996 (HIPAA) (detailed in Chapter 6) protects private individual health information from being disclosed to anyone without the consent of the individual. The Health Information Technology for Economic and Clinical Health (HITECH) Act (detailed in Chapter 6), enacted as part of the American Recovery and Reinvestment Act, was signed into law in 2009, to promote the adoption and meaningful use of health IT. Subtitle D of the HITECH Act addresses the privacy and security concerns associated with the electronic transmission of health information, in part, through several provisions that strengthen the civil and criminal enforcement of the HIPAA rules.

See Chapter 6 for complete information on HIPAA and the HITECH Act.

Health care providers must make sure their EMR system is HIPAA compliant and that the EMR systems installed take care of all the privacy and information security issues. Physicians and nurses have unlimited access to the patient’s electronic chart, and other health care providers may have limited access to it, in accordance with their area of expertise. A patient’s chart may be opened and viewed or used by more than one person at a time. If someone who is viewing the record steps away from the computer, it will turn off automatically, and when the person returns and signs onto the computer again with his or her code, the screen will be at the same place.