Use LEFT and RIGHT arrow keys to navigate between flashcards;
Use UP and DOWN arrow keys to flip the card;
H to show hint;
A reads text to speech;
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)
|