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179 Cards in this Set

  • Front
  • Back
RHQDAPU
- Reporting Hospital Quality Data for Annual Payment Update iniative
- Pay for reporting quality metrics
- Separate incentives for physician reporting
Hospital Transparency
- Metrics of success online for
1. Process of Care (heart attack, pneumonia, surgery, asthma, etc.)
2. Outcomes (death, readmits, etc.)
3. Patent Satisfaction
Pay for Performance (HAC)
-Hospital Acquired Conditions (non-reimbursable as of 2008)
-Examples – foreign objects, falls, UTI, Blood incompatibility
Licensure
- Government authority granting permission to operate as a practictioner of healthcare organization
Accreditation
- Formal process assessing and recognizing a healthcare organization meets applicable standards
- Accredited by a non-government entity (JC)
Certification
Government or non-government organization that evaluates and recognizes an individual or organization as meeting predetermined criteria
Risk Financing
- Risk Retention – assumed by organization through available funds, loss reserves, borrowed fundsy or self insurance
- Risk Transfer – shifting to and assuming by an outside party (commercial insurance)
Risk Management
-Involves clinical and administrative activities to reduce the risk of injury to patients staff and visitors
- Includes all risk factors (operational, financial, human, strategic, legal, technology, hazard)
Insurance Types
1. First Party – coverage on own property or person
2. Third Party – coverage to other than insured (liability insurance)
3. Health and Welfare – for insured employees
4. Financial Guarantees – guarantee that obligations will be fulfilled
Hospital Governing Body
- Ultimate authority and responsibility for the oversight and delivery of healthcare by practioners
Utilization
- Underuse of Services
- Overuse of Services
- Misuse of Services
- Variation
Sentinel Event
- Unexpected occurrence involving death or serious injury
Benchmarking
- Comparative process to collect and measure data to make quality improvements
EBM
- Evidence Based Medicine – use of current evidence to make care of patient decisions
Disease Management
- Coordinated health care interventions and communications for populations with conditions which patient self care efforts are significant
Population Health
- Health outcomes of a group of individuals, including the distribution of outcomes with the group
- Health People 2010 – most accepted model of population health
SBAR Technique
- Situation
- Background
- Assessment
- Recommendation
Performance Excellence
= QualityTheory + Management Theory
- Award = Baldridge
Job Description
- Building block of HR and best way of preventing employee disciplinary action
Job Analysis
- Should precede their recruitment process and utilize objective information from a variety of sources (internal and external)
Critical Incidents Technique
- The record of behaviors of employees that are related to good and bad behaviors
Word of Mouth Recruiting
- Inadvisable when trying to correct an inadvisable class
Selection Tool
- ANY procedure or data collection used to select employees (job interview, application, ability to pick up 50 pounds)
Uniform Guidelines on Employee Selection
- 1978 – designed to help organizations comply with federal laws that impact hiring
NPSG
- National Patient Safety Goals
- Joint Commissions ongoing database of sentinel events
HCAHPS
- Hospital Consumer Assessment of Healthcare Providers and Systems
- National Patient Satisfaction
- Survey around Dimensions of Care (patient needs physical comfort, involvement of family, access to care, etc.)
Joint Commission
-2002 – Shared Visions – new pathways (from preparing to continuous compliance)
- 2004 – Revised standards observing Patient Care (Tracer Methodology)
LASA
- Look alike, sound alike
- Patient safety goal for pharmaceuticals
Leapfrog Group
- Consulting group with online Leapfrog safe practices score
- Evidence-based hospital referral – volumes of procedures are related to outcomes (more procedures = better outcomes)
CMS
- Center for Medicare and Medicaid Services
- Required by providers to get reimbursements
- JACHO only accreditation deemed by CMS appropriate
Civil Rights Act
- Does not include age and sexual orientation
ADEA
- Age Discrimination in Employment Act
NLRA
- National Labor Relations Act
- Includes Taft-Hartley Amendments
- Required to bargain in good faith
- Can’t protest while under collective bargaining agreement
- Can’t be fired for starting or joining a union
- Created 8 set bargaining units
ADA
- Americans with Disablities Act
- With Reasonable accommodation
- Focused on the applicants ability to do the job
Nursing Ratios
Workload – Patients per nurse
Staffing – Number of nurses deployed or staffing level
Concepts of Health
1. World Health Organization – state of complete physical, mental, and social we-being and not merely the absence of disease in infirmity
2. Blum’s Model – 4 inputs – environment, lifestyle, heredity, and medical care
3. Medical Model – absence of illness or disease
4. Holistic Model – spiritual, as well as physical and mental, are necessary
ADL
- Activities of Daily Living (6)
- Eating, breathing, dressing, toilet, continence, getting of bed/chair
RVU
- Relative Value Units
- Hospital Payment
RBRVS
- Resource Based Relation Value Scale
- Physician payment
IPOC
- Interdisciplinary Plan of Care
- Physician plan of patient care
- Nurse unofficial lead
Morbidity Metric
- Sickness
Mortality Metric
- Death metric
Job Enlargement
- Motivational strategy that focuses on expanding scope
Intrinsic
- Stuff that makes you feel good
Extrinsic
- Compensation and Benefits
Healthcare Compensation Challenge
- Balancing internal equity and external competitiveness
Medicare
- Part A – Hospital Expenses
- Part B – Medical and Physician office visits
- Part D – Prescriptions
Medicaid
-State
-Childrens Health Insurance Plan
-Low Income
TriCare/CHAMPUS
-Department of Defense
CHAMPVA
-Department of Veterans Affairs
-153 Medical Centers
Agency normally responsible for regulation of the financial solvency and subscriber regulations of HMOs
State Insurance Agency
Established part D of Medicare and HSAs
Medicare Prescription Drug Improvement and Modernization Act
Primary Prevention
action to reduce odds that a disease will develop (smoking cessation)
Secondary Prevention
Early diagnosis (mammo, colonoscopy)
Ambulatory Care
any medical care delivered on an outpatient basis
Federally Qualified Health Centers
Targets medically underserved
-Ambulatory primary care centers
Acute Care
- Hospitals
- General and Specialty
- Profit vs. Non-profit (501c3)
Statutory (county) or other nonprofit hospital
Safety Net Hospital
Hospital desigation based on low income population and Medicaid utilization
Disproportionate Share Hospital (DSH)
US Indian Health Hospitals
operated by Department of HHS (6+53 outpatient centers)
Critical Access Hospitals
-Established by BBA of 1997
-Rural
- 24 hour ED
-<25 beds
-Located>35 miles to nearest hospital
-Medicare pays 101%
Licensure and Accreditation
- held to their standards if you receive federal funding
- CMS (or JC or HFAP)
Being approved as an accreditor for federal reimbursement
Deemed
HFAP
-Healthcare Facilities Accreditation program
- for osteopathic hospitals
Healthcare Systems Ownership
Joint Venture, Mergers/Acquisition, Consolidations
Healthcare Systems (No) Ownership
Alliances and Networks
Enviornment of Care Management
- Facilities and Equipment maintenance
- Facility Site Master Plan
- Safety, Hazardoius, Disaster, etc. plans
Supply Chain
- Manufacturing, distribution, transportation, and storage
- Purchase - value analysis and evaluation
- End user training
ACGME
Physician accreditation approving residency
ABMS
Physician accreditation approving specialty
Physcian Credentialing
Burden of proof on the applicant
Physician Trends
- More physicians interested in work/life balance (part time)
- Population aging creates a gap in physicians to serve
- Physician workforce aging and retirement growth
NPDB
-National Practioner Data Bank
- organization to inform when the board terminates the priveleges of a physician
Florence Nightingale
first hospital administrator and founder of modern nursing
Professional autonomy over practice, nursing control of practice endvironment, effective communication between nurses, physicians, and administrators
Magnet Designation
Professional Organizations
Associations for Management, Physicians, and Nurses (ACHE)
Trade Organizations
- Healthcare Organizations and Education accreditors
- CAHME - Hospital Administration
Quantative versus Qualitative Methods when Forecasting
Quantitative always beats qualitative. Only use qualitative with a lack of quantitative data.
Managerial epidemiology
Measures of health status (incident rates, prevalence rates)
Descriptive Statistics
Method used to describe observation or demographics (Excel measurements - mean, mode, median, counts)
Inferential Statistics
Using observations to make predictions
Median
the number above and below which 50% of the scores fall
Mode
the most common or frequent score
Control Chart
shows mean and the fluctuation or variation of data (lab work, etc.)
Strategic Planning
#1 Function of Management
Defining organizational objectives
Implement strategies
Mission Statement
- purpose
- established and only changed by the governing board
Values
- extension of mission statement that talk to behaviors
Environmental Assesment
- corporate activity that id's changes in the environment (with respect to customers, competitors, and associations)
- useful for formulating vision
Achieving and maintaining competitive advantage
- Porter
- Cost, Differentiation, Focus
Master Facility Plan
- plan to address physical capacity, correct code, and improve functional configuration
- includes accreditation requirements, growth plans, and physical facilites assessment
Business Plan
- plan for particular project or initiative
Business Contracts
- Can be verbal, written, or implied
- Includes nature of agreement and deliverables
- Board approves physician contracts, real estate, mergers/acquisitions, joint ventures, and deals with large sums of $$
Tort
Civil wrong that results in injury (not based on a contract)
Defamation
wrongful injury to a person's rep
Libel
Defamation made in writing
Slander
Defamation made orally
Demand
What a purchaser is willing to or has paid to satisfy a need or want
4 Ps of Marketing
Product, Place, Price, Promotion
The 5 I's of Services Marketing
Intangibility, Inconsistency, Inseperability, Inventory, Interaction with customers
Market Share
- Capture divided by Prevalence
- Plus Inmigration, minus Outmigration
Crisis Communication Plan
PR led when sentinel events, internal and external critical incidents occur
Policy around safety and security
Material Safety Data Sheet
Patient Management Protocols
- Also called clinical pathways
- normal steps to treat a related group of patients
Considered in strategic, marketing and business planning dealing with racial and ethnic health disparities
Socioeconomic Environment
Performance Improvement Teams
developed when opportunities for improvement (OPI) go beyond a single unit or department
Has 24/7 responsibility from patient to CEO
Line Management
Input Measures
Based on demand, cost, resources, or HR
Output Measures
Quantitative ratios based on productivity, quality, and patient sat
Output Process Measures (3x)
Malcolm Baldridge
National Quality Forum
Joint Commission Patient Safety Goals
Most Patient Sat Complaints come from....
Service Quality
When not to add a service...
- Insufficient volume to maintain quality
- Insufficient demand to maintain cost
What is always first and last when accomplishing organizational change?
Identifying is always first evaluating last
Formal and Informal Organizations within the HCO are...
the actual organization
Mintzberg Managerial Roles
- Interpersonal
- Informational
- Decisional
Performance Improvement Teams
developed when opportunities for improvement (OPI) go beyond a single unit or department
Has 24/7 responsibility from patient to CEO
Line Management
Input Measures
Based on demand, cost, resources, or HR
Output Measures
Quantitative ratios based on productivity, quality, and patient sat
Output Process Measures (3x)
Malcolm Baldridge
National Quality Forum
Joint Commission Patient Safety Goals
Most Patient Sat Complaints come from....
Service Quality
When not to add a service...
- Insufficient volume to maintain quality
- Insufficient demand to maintain cost
What is always first and last when accomplishing organizational change?
Identifying is always first evaluating last
Formal and Informal Organizations within the HCO are...
the actual organization
Mintzberg Managerial Roles
- Interpersonal
- Informational
- Decisional
Herzberg's Motivation and Hygiene Factors
Factors that money only motivates so much and that non-monetary factors such as work climate, involvement, recognition, and being kept informed are necessary
Laissez-faire Management Style
highest subordinate freedom and lowest personal authority
Functional Authority
related expertise in a particular field
Bureaucratic Theory
Hierarchical Fashion and Technical Competency
Financial Regulatory Hierarchy
1. SEC
2. FASB - Financial Accounting Standards Board
3. AICPA - American Institute of Certified Public Accountants
4. HFMA - Healthcare Financial Management Association
Auditors Opinions
- Unqualified opinion - in line with GAAP
- Qualified Opinion - minor issues with GAAP
- Adverse opinion - major issues with GAAP
Cash Accounting
are recognized when financial transaction takes place
Accrual accounting
- are recognized when the event takes place
- hospital accounting (and GE)
Statement of Operations
- also known as an income statement or P&L statement
- Shows Revenue - Operating Expenses
Balance Sheet
- shows Assets and Liabilities
- E = A - L
Liquidity Ratio
- shows HCOs ability to pay short term debt
- Current Ratio = Current Assets/Current Liabilities (2x normal)
- Average collection period (50 days normal)
Profitability Ratios
- Operating Margin
- Excess Margin (includes investment margin)
Capital Structure
Long-term debt / capitalization
Asset Efficiency Ratios
- Age of Plant ratio
- Inventory turnover ratio
Managerial Accounting
- used for internal users
- current or perspecitve/future data to make decisions on sub-unit
Contribution Margin
Rev - VC
Strategic Plan
10 year look a the future by the board and the C team
Strategic Financial Plan
5 year look that forces management to id resources
Operating Plan
process of translating the strategic plan into next year's objectives
Budget
converting the operating plan in $$ terms
Capital Budgeting
- Id'ing and prioritizing replacement and new venture capital equipment
-Financial Analysis including NPV and IRR
Gross Patient Revenue versus net patient revenue
Gross is the charges times volume, where net takes into account what the HCO
The Power of Clinical and Financial Metrics (Berger)
- Labor compensation as a percetn of net revenue
- Overtime as a %
- Total paid hours adjusted to patient day
- Total labor compensation adjusted to patient day
- Average hourly rate
Internal Finance and Auditing Controls
- CEO sets culture
- 3 parts of statement of auditing standards (SAS)
1. control environment
2. accounting system
3. control procedures
Accounts Receivable
function of both the production cycle (pre care to recording charges) and the payment cycle (billing to collection resolution)
Duty of Care
BOD obligation to exercise good faith to become informed in making decisions and overseeing management
Duty of Loyalty
BOD obligation to conduct in the best interest of the HCO
- including disclosing conflicts of interest
Duty of Disclosure
informing fellow directors and management of info pertinent to making decisions
Business Judgment Rule
protects the board members from personal liability if the decision which they approved is a mistake
- presumes good faith and in best interest for the HCO
Confidentiality Rule
- keep info confidential that was not intended to go public
Managerial Functions of the BOD
1. Hire/Fire the CEO
2. Establish the Mission, Vission, and Values
3. Approve long range plans and budget
4. Ensure quality care
5. Monitor performance versus plans
BOD Committees
Executive
Strategic
Finance
Quality
Audit
Governance
Executive Committee
made up of Board Officers, and can make decision alone (negative)
Finance versus Auditing Committees
seperate due to Sarbanes Oxley
BOD Member Appointment
appointed by the Chairman with concurrence of the Executive Committee
Medical Staff Appointment to the BOD
Elected by the Medical Staff
Utilitarianism
Measuring the end result produced by a certain action
Deontology
moral philosophy based on duty (right or wrong actions, regardless of result)
Act that guarantees confidentialty to patient data
HIPAA
Need for a BAA
1. Not an employee
2. Not already covered
3. Can not do their job without access to personal health info (PHI)
Protections against Mental Health Records
Protected and dependant upon who writes it (psychiatrist, psychologist, counselor, etc.)
HIPAA Penalties
Honest Mistake - $100/incident not to exceed $25K
Knowingly - up to $50K / 1 yr
False Pretenses - up to $100K / 5 yr
Intention to sell - $50K each up to $1.5M / 10 yr
ARRA
- American Recovery and Reinvestment Act
- expands protection of PHI effective Feb 17, 2010
PHI Breach
unauthorized acquisition, access use, or disclosure of PHI
- within good faith and employment or inadvertent is ok
- must notify within 60 days of breach
Intellectual Property
-rights attached to inventions, patents, trademarks, and copyrights
Peer Review
- review of practices
- highly confidential and subject to state and federal penalties
Corporate Compliance Plan
- policies and procedures detailing employee behavior
Exclusion
- Mandatory exclusion for conviction of fraud
- Permanent exclusion for 2 or more previous convictions
- Permissive exclusion - obstruction of justice
Stark Law
- targeted physician financial gain from overutilization of imaging equipment
Stark is a law of exception...
One exception is all you need, and you're not creating a kickback
Under Arrangements
-ability to bill for non-billable services
-common for both in and out-patient care
Stark and Kickbacks
- Stark is civil and Kickbacks are criminal
Physician Recruitment
- a hospital may induce a physicain to relocate
- physician can not be required to make referrals to the hospital
- hospital can make payments to a group, as long as it's passed through
Physician Retention
Can make payment to keep physician (current - offered) as long as they have a written offer >25 miles away
EMTALA
- Emergency Medical Treatment and Active Labor Act
- can't turn away an ED patient, have to stabalize