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