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225 Cards in this Set

  • Front
  • Back
What are the two types of hospitals?
Profit & Not-for-profit
A "for profit" hospital is a ___ enterprise; it pays ____; and has what 2 usual forms?
1) business
2) taxes
3) Invester Owned & Physician Owned
What does a not for profit hospital do with their profit?
It is retained.
Does a not for profit hospital pay taxes?
No.
What must a not-for-profit hospital do with the extra money?
Show community benefit (charity/other)
What are the 3 usual forms of a not for profit hospital?
1) Sectarian
2) Community
3) Governmental
What are the two classification nomenclatures for hospital ownership?
1) Private
2) Public
Is a private hospital a 'for profit' or a 'not for profit' hospital?
ALL for profit
What are the two forms of a private hospital?
Sectarian NFP & Non-sectarian NFP
What's considered "short stay"? Long stay?"
1) short = 30 days or less
2) long = more than 30 days
What are the 2 reasons someone would be in a long-stay hospital?
1) nursing home
2) Special purpose (rehab, chemical dependency, psych, ventilator...)
What's a teaching hospital?
A general, acute, short stay, tertiary hospital PLUS a training program (affiliated with medical school) and a Research program
What's an Academic Medical Center?
Teaching hospital + DUAL ROLE FOR PHYSICIANS
What is the dual role of physicians for the AMC?
Chief of service (clinical/hospital) & Department Chair (academic/medical school)
LICENSURE is a ___ function, it ____ individuals to engage in a health occupation AFTER determining a ____ level of ____.
1) governmental
2) allows
3) minimum
4) competence
License's are usually a ____ administered exam for individuals that have completed specified ____.
1) state
2) training
Licensure is required if you are going to be a ______ or a ______ for example.
Physician or Psychologist
REGISTRATION is a _____ or ____ of qualified individuals. Listing may be required by the ____ to engage in a particular health ______, thus giving registration the effect of "-____"
1) roster
2) list
3) state
4) occupation
5) Licensure
Registration may be developed by what 3 ways?
1) Governmental body
2) Government-sanctioned non-governmental body
3) independent non-governmental body
What is an example of someone who would need to be registered?
Registered Nurse (RN)
CERTIFICATION is recognition by a _____ body that an individual has met certain ____ to engage in a health ____.
1) non-governmental
2) qualifications
3) occupation`
Certification may be required by the ____, thus giving it the effect of ________.
1) state
2) licensure
What is an example of someone who would need to have a certification?
a Certified Nurse Aid (CNA)
Is Licensure/Registration/Certification required for managers?
No.
Why isn't L/R/C required for managers?
they are not direct caregivers
Managers are only responsible for ____ and ____; what is the exception?
1) business
2) operations
3) nursing home administrators
Managers have effective ____ ____ by profession; what two organizations portray this?
1) self-policing
2) American College of Healthcare Executives & Medical Group Management Association
What are LIP's?
Licensed Independent Practitioners
LIP's include?
Physicians, PA's, and Advanced Nurse Practitioners
LIP's have ____, _____ access to consumers for health services.
1) direct
2) independent
LIP's may ____, ____ & ____ persons directly as well as direct the ____ by non-LIP's.
1) diagnose
2) prescribe
3) treat
4)treatment
Who are Non-LIP's?
Nurses
Technicians
Therapists
Non-LIP's must have?
A diagnosis and an order from an LIP.
Non-LIP's are dependent on LIP's for?
referral
Physician training includes?
- 4 years undergrad
- 4 years med school
- 3 years residency
What's the advanced physician training?
-fellowships & 2nd residency
- (also continuing ed)
What's the minimum level of training for an unrestricted license?
4 years med, 1 year residency equivalent
A Physician must apply for ____ in the medical staff and request specific practice ____.
1) membership
2) privleges
With the assistance of hospital staff, the ____ staff determines qualifications and recommends practice _____.
1) medical
2) privleges
PA qualifications?
- 4 years undergrad
- 2 years PA school
The 2 years of PA school consist of?
- 1 year med
- 1 year clinical rotations
Whats the qualifications of a nurse practitioner?
- 4 years undergrad
- 1.5-3 years masters in a nursing school
Does a PA have physician supervision? What about an NP?
- PA = yes
- NP = no
Does an NP have prescriptive authority? What about a PA?
- NP = independent limited prescriptive authority

- PA = no independent prescriptive authority
Does a PA have independent billing? What about an NP?
PA = no ind. billing
NP = ind. billing
Does a PA have hospital privleges? What about an NP?
PA = yes
NP = no
What's the qualifications of an RN?
- 4 year BSN + 2 year Diploma
-
Does an RN have to take a state board examination? What about a specialty certificate?
yes to both
What are the qualifications for an LVN?
High school + 1 year program
Does an LVN have to take a state board examination?
yes
Pharmacists have a ____ but ____ role.
1) narrow
2) expanding
Pharmacists have a __ yr pharmacy program and a ___ ___ examination.
1) 6
2) state board
Dieticians also have a ___ but ___ role. They are in a "____" undergrad program and require either ____,____ or ____.
1) narrow
2) expanding
3) 4+1
4) examination, licensure, or certification.
What's the qualifications for a lab tech?
- 4yr undergrad + exam=ASCP
- 2yr certification by AMT
What kind of work does a lab tech do?
- phlebotomist
- chemistry
- hematology
- blood banking, etc.
What're the qualifications for an imaging technologist?
- 2yr program + exam = RT
(flat film, tomography, fluero)
Imaging tech's can get specialized in?
CAT, MRI, PET, etc...
Acute care hospitals probably help the least in terms of health status, yet they get the most attention. Why?
1) Dramatic (saving lives..)
2) Hospitals are the focus of 'miracles in technology'
3) They're the most expensive
4) Media attention
What're the desirable effects of this attention from the hospital's point of view?
Desirable effect:
high prestige & status
miracles JUSTIFY high cost
managers have large voice
Undesirable effects?
1) great pressure on managers
2) minor problems get publicity
3) public expectations exceed ability to deliver
4) cost pressure & failure
What's the desirable effects from the CONSUMER's perspective?
1) attention makes consumers aware of new technology
2) makes consumers confident in the hospital
3) convenient to have many services in 1 place
Undesirable?
1) high overhead = high cost
2) large org's dehumanize the experience & causes poor response
3) There's a "technology imperative" that leads to unnecessary/inappropriate testing
PH services generally operate at a ____ - ____ level, rather than an __ level. It's partly this focus on ___ of people, that gives PH it's ___ to accomplish what ___ medical care cannot.
1) community-wide
2) individual
3) gropus
4) power
5) individualized
PH incorporates a "public ___ focus" at ___,___, ___ and even ___ levels that health care systmes do not.
1) policy
2) local
3) state
4) national
5) international
What are the 3 main determinants of health?
1) social environment
2) physical environment
3) genetic endowment
What are a few examples of environmental det of health?
physical
social
economic
What are a few examples of lifestyle det of health?
individual choices such as:
1) smoking, diet, exercise, stress etc.
What are 4 det of health?
environments
lifestyles
heredity
health services
Of the 4 det of health, which is the most impt?
environment
Which is the least impt?
medical care services
What can we do the least about?
environment
what can we do the most about?
medical care services?
The precede-proceed planning model has the advantage of?
considering all 4 determinants of health
The PP model also directs attention to?
a number of factors that PH professionals are addressing
"Health Services" are perhaps the ___ important determinant, but unquestionably the most ____.
1) least
2) expensive
Some health services leaders are paying more attention to?
PH and other determinants (good!)
Health ___ and policy ___ is central to the health system. One def suggests that policy is?
1) policy
2) process
3) " the authorative allocation of values in a society"
What's the 5 step policy process?
1) policy initiation
2) legislative process
3) implementation and regulatory processes
4) judicial process
5) private stakeholder influence
PRIVATE SECTOR:
1) Government sector is only one source of ___ ___
2) The private (___ ___ sector) has taken on a great deal of responsibility for ____ as a source of ____.
1) health policy
2) "for-profit", health, profit
The voluntar sector has taken on responsibilty for?
health as a part of its service missions and service to members
What's a health services organization (HSO)?
organizations that provide health or healtcare services.
HSO's work in order to?
-maintain/improve health
- prevent health decrements
- cure,heal, etc.
The spectrum of HSO's include?
- prevention
- promotion
- acute
- chronic
- palliative (where are the widgets?)
Also?
-physical
- mental
-spiritual
HSO's provide services from the ____ to the ___.
1) cradle
2) grave
An HSO is an organizational entity that provides ___ or ___ health services.
1 or more
An HSO is a _____ _____!!
SERVICE BUSINESS
Why is it a service business? The organized provision of services is an ___ activity; there is ___ ___ from consumers, and ___ __ payors.
1) economic
2) direct payment
4) third party
The private health spending for the US is what % of GDP?
1) 16%
What's a health system (HS)?
an organized collection of 2 or more HSO's.
What's horizontal integration?
- 2 or more HSO's of the SAME service type (hospital or nursing home chains)
What's vertical integration?
two or more HSO's of DIFFERENT service type (rehab hospital, home health, etc.)
What's integrated delivery system? (IDS)
adds the payor component (e.g., HMO like Scott & White)
There are MANY types of health system ___. There is no ___ model, and is an on-going ____.
1) models
2) best
3) experiment
At the end of the day, from the smallest HSO to the largest HS, these are still _____ _____!
service businesses!
All health services need to be ___ and ____.
led & managed
What are the portions of the 3 legged stool?
MGMT
PSO
GB
All three legs must be of similar __ and __ to provide a stable platform for high quality health services.
1) length
2) strength
Which is the weakest link of the 3 legged stool most of the time?
GB
The medical staff is an ____ ______.
Independent organization
What's the #1 responsibility of the GB?
hire and retain the CEO
The GB also approves ___ practice ___. as well as sets ____, and -____ the performance of the ___.
1) PSO
2) privileges
3) policies
4) evaluates
5) HSO ($, quality, services)
GB also approve/update/revise a long range ____ ____.
Strategic plan ( capital investment e.g., buildings & equipment)
At the end of the day, the GB is responsible for the ___ ___ delivered in its ____.
health services; HSO
Quality is largely delegated to the ____. FIscal and operational matters are largely delegated to the ___.
1) PSO
2) CEO
Define: Fiduciary
A person, to whom property or power is entrusted for the benefit of another; - of based on, or in the nature of trust.
nonprofit boards have a ___ responsibility to see that the community receives the best possible care.
fiduciary
Board members individually and collectively have a fiduciary responsibility to?
the stakeholders for the HSO and its provision of healthcare services to the community.
The #1 responsibility of the PSO is?
The quality of services delivered in the HSO.
The PSO is ____-_____. They adopt their own ___-____; such as _____, ____, etc
1) self-governing
2) by-laws
3) creditialing, appointment ...
PSO's develop and enforce ____ and ____ for clinical services.
rules; regulations
PSO's participate with ___ & ____ in planning and policy process. (VERY GOOD)
GB; MGMT
The PSO integrates and participates in what two structures?
GB & MGMT
What's the #1 responsibility of the MGMT?
Communicate! (within and across the HSO structure)
Also to communicate within and among ___ & _____ structure; as well as externally to ____ and _____ and the ____ process.
1) staff & organizational
2) community & stakeholders
3) policy
The #2 job of the MGMT is?
Implement policy (RUN the business- operations, solve problems...)
MGMT must also scan the ____! Monitor and assess the larger ____ in which the HSO is a participant.
1) horizon
2) environment
With the PSO, MGMT must also insure?
quality
SO in summary, what do these three do?
GB?
PSO?
MGMT?
GB: hire & retain CEO
PSO: ensure quality
MGMT: communicate
Why are hospitals so expensive to build?
they have unique infrastructure system requirements
Where must the hospitals get their water?
A municipal water system approved by the dept of health
Besides the main water supply, what is required?
An alternate water supply
Where do they get their sewer?
Must be connected to municipal sewerage system approved by the dept. of health
For trash, what goes in the red bag?
anything having to do with touching the human body
Hospital gas lines must have?
An emergency shut-off
Hospital electricity must have an?
emergency generator: exercise logs & diesel fuel
What are UPS's?
Uniterrupted power supplies that can detect in a few millisecond that power is out and signals to the generator to turn it back on.
Hospital informations systems include?
1) Management Information Systems (MIS)-finance
2) Clinical Information & Support systems- lab, pharm
3) Electronic Medical Record
HVAC has other rules such as having general ____ requirements, ____ pressure rooms, patient room ___-___, for example
1) space
2) negative
3) air-flow
Alexander's Thesis:
Healthcare is an ____ ___. The problem is that we CAN do ____ than we seem willing to pay for.
1) economic business
3) more
What are the four options for healthcare in the SICKO movie?
1) socialized medicine (govt-run)
2) national health insurance (medicare)
3) Single Payor System (all you can get is medicare)
4) Nationaled Healthcare (all drs work for the govt.
Of the four determinants of health, which is the most important? Which do we spend the most money on?
Environment; the "sickness service business"
What WAS the core structure of old hospitals which is still today?
OR, Lab & Imaging
Financing prior to 1900's for hospitals was "___ ___ ___ __". In 1935 the govt stepped in with ___ ___ for the aged & disabled.
1) pay as you go
2) social security
With post WWII emergence of Medicine, came the widespread growth of?
insurance by employers! (france/britain said no, US said yes!)
In all other parts of the world, healthcare is seen as a?
public health issue, and thus a govt responsibility
Cost spiral is driven by?
1) increasingly effective medical technology
2) need vs. demand
3) increasing govt regulation
4) medicare
What is a system?
an integrated whole, whose essential properties arise from the relatinoships between its parts.
What's "Systems thinking"?
The understanding of a phenomenon within the context of a larger whole.
Systems thinking is "_____", which is the opposite of _____ thinking.
1) contextual
2) analytical
Analysis means?
taking something apart in order to understand it.
Systems thinking means?
putting it into the context of a larger shole (opposite of analysis).
Systems thinking is thinking in terms of ___, ______ and ___.
1) connectedness
2) relationships
3) context
The essential properties of a system are properties of the ____, which none of the ___ have.
1) whole
2) parts
The properties of the system arise from?
the interactions and realtionships among the parts.
"The ___ is great than the ___ of its ____".
whole; sum; parts
Is individual health a systems issue?
Yes.
The major determinants of health not only make up a ____, but are themselves ____ with _____.
system; systems; subsystems
____ or ____ health is a systems issue; such as ____, ____ networks etc.
Public; Population; communities; social
The mechanistic view states a hospital is a _____ of departments, that have _____ with each other and the ___, but the relationships are _____.
collection; relatinoships;patients;secondary
The system view states a hospital is a set of _____, a ___, creating high quality patient care, and the ____ are secondary.
relationships; web; departments
What's the "basic system components"?
input, process, output, feedback, boundary etc.
What's INPUT?
everything that enters the process
Input is sometimes thought of as ___________.
"throughput"
For healthcare systems, inputs almost always include ____/______.
patients/clients
What's OUTPUT?
what comes out of the Process
Typically, the output characterizes the ____ of the system.
purpose
What's FEEDBACK?
serves to regulate/alter/adjust the process based on the output.
The BOUNDARY is a function of the ____ or the ____/____ of the system, but it may not be a true ____ of the system.
observer; description/label; part
Are boundaries real?
NO- they're artificial becuase all systems are part of a larger system
Is there such thing as a closed system?
NO!
So, again, what are the 5 basic system components?
1) Input
2) Process
3) Output
4) Feedback
5) Boundary
What can you never do when intervening in a system?
only one thing.
There are no such things as "____ ____" or "____ ____" when intervening in a system.
1) "side effects"
2) "unintended consequences"
All system changes are subject to __________ effects as they reverberate throughout the system.
cascading
What's the Law of Leverage?
small changes have large results (electrical blackout example)
and
large changes can have small results
dampen ____ disruptions and amplify ____ positives.
1) external
2) internal
The results of system changes have _____ in various _____.
outcomes; dimensions
Some results happen ___, some take longer. Some effect ____, some affect ____.
quickly; individuals; groups
Short term and long term outcomes may be diamterically _________.
opposed
The results of system changes may differ for the ____ and the ____.
individual; group
The results of system changes may occur in _____ _____.
distand locales
Systems naturally seek a stae of ____.
equilibrium (homeostasis)
It's almost always a mistake to attempt to _____ any one ____! Rather, the target variable should be _____ as one of several important interrelated ____.
maximize; optimized; variables
What's medicare/medicaid?
national health care coverage programs
Who's it for?
elderly, disabled, low income...etc
'Care & 'Caid began in?
1960's
MEDICARE:
What is it?
Federal program for the elderly.
MEDICARE:
What are the two parts?
1) A = hospital
2) B= physician
MEDICARE:
Paid from ?
Federal "trust" funds (payroll taxes)
MEDICARE:
Administered by?
Centers for Medicare and Medicaid Services (CMS)
Where is the CMS run from?
The departmend of health and human services of the executive branch.
What's the eligibility requirements fo Medicare?
1) 65+
2) under 65 if disabled
3) people with end-stage renal disease
What are the benefits to part A of medicare (hospital insurance)?
1) inpatient hospital
2) skilled nurising facility services (SNF)
3) Home Health (folloing snf)
4) hospice care
Wha'ts SNF?
the kind of care that requires 24/7 care by an RN.
What's the benefits to Part B of medicare (supplementary medical insurance)?
1) physician and outpatient
2) home health (not part A)
3) cancer screening (mammograms)
4) lab procedures, med equipment
What's part D of medicare?
pharmacy benefit
What's the cost of Part A?
1) automatic at age 65
2) no payment required
3) hospital deductible of $912 EVERY TIME YOU GO
What's the cost of Part B?
1) monthly premiums ~$80/mo
2) annual deductible of $110
3) 80/20 copay
4) prescription drug coverage (sort of)
Why is supplemental insurance good too?
pays deductibles! (hospital ones too)
What's Medicaid?
federal program for low income individuals - home and long-term care
Medicaid is a ____-____ program
federal;state
Each state sets ____ Standards for medicaid;
eligibility
Of the medicaid $$ spent in TX, ____ % goes to supporting beneficiaries in ____ ____.
60%; nursing homes
Why is that % bad for our health service?
- not enough $$ to hire quality people, so nursing homes have bad service
What's the eligibility for medicaid?
1) people meeting low income req's
2) most pregnant women
3) elderly people ("dual eligibilities"
4) people with disabilities
What are some benefits from medicaid?
1) inpatient & outpatient hospital services
2) lab & xray
3) nursing facility & home health
What is EPSDT?
a subst of medicaid
What's EPSDT stand for?
Early Primary Screening & Diagnostic Treatment
What's PPS?
Prospective Payment System
What's DRG?
Diagnosis Related Groups
SDA?
standard dollar amount
Wha'ts APG's?
ambulatory payment groups
Wha'ts the math equation for the way medicaid decides to reimburse the hospital?
Payment = DRG Weight X SDA
What's payment rate per discharge determined by?
the reported principal and secondary diagnosis and surgical procedurs
Each DRG is assigned a relative ____, reflective of ____ _____.
weight; resource consumption
Physcians are reimbursed by medicaid via a "___ ___", called?
fee schedule; CPT-4
With regard to physician reimbursement for medicaid, what's RBRVS?
resource based relative value scale
Payment to physicians has become a key ____ point for all other ___ ____ reimbursement systems.
reference; fee schedule
How are nursing homes, out patient and emergency services reimbursed for care & caid?
a fixed payment on a per diem basis (complicated)
Wha'ts RUG?
resource utilization groups (for nursing homes)
SUMMARY OF PAYMENT:
Medicare reimbursement to provers often is ____ true cost of operation.
1) below
'Care & 'Caid have a budget deficit, therefore they pay their drs ___ ____, which means more people won't be ___.
1) drs less
2) treated
CARE/CAID Regulation:
Hospitals must have a ____; can't admit their patients unless you play their ____.
1) license
2) game
State focus is on ___ ___ ___ and PH issues.
life safety codes
These regulations are only at the ___ leve, there is no __ regulation here, unless they get ____ by federal programs.
state; federal; paid
What are the Conditions of Participation (COP) to get paid by 'care and 'caid?
must meet regulatory requirements
Meeting those regulatory requirements is called?
meeting the "conditions of participation"
These standards/requirements are much more ___ than the ___ requirements; they have regular _____/_____.
extensive; state; surveys/inspections
Wha'ts "deemed status"?
policy decision by medicare that JCAHO accreditation is an acceptable proff of meeting all the conditions of participation (COP).
Thus, JCAHO accredited providers have " ____ ____" in the care/caid programs.
deemed status
JCAHO req's are different than the _____ COP regulations
formal
Is JCAHO cheap?
no!
What's JCAHO stand for?
Joint Commission on Accreditation of Healthcare Organizations
What's JCAHO called now?
The Joint Commision (TJC)