Ultimate FBLA Healthcare Administration Guide

NACHRI

- association

- National Association of Children's Hospitals and Related Institutions

- improves child's health services in: quality, cost, and delivery of care in their hospitals

- tries to ensure children's access to medical services

Minimally Invasive Surgery

- uses of techniques

- tries to operate with less damage to the body

- (less pain) (cuts small piece of tissue/body)

ASC

- ambulatory surgery centers

- focuses on providing same-day procedures (surgery, diagnostics)

- provides cost-effective services (50% cheaper than inpatient)

- uses billing of hospital+physician

HHS (dept. of health and human services)

protects/enhances health of ppl and advances, provides services

Laparoscopy

-surgical diagnostic procedure

- examines organs inside the abdomen

- minimally invasive procedure

- uses laparascope

- ((ovaries), (fallopian tubes))

Endoscopy

- non surgical procedure

- examines a person's digestive tract

- uses endoscope

- in existing hole

Phacoemulsification

- surgery to restore vision in patient's eye bc of cataracts, which clouds their lens (behind the iris)

Arthroscopy

- minimally invasive surgery

- diagnoses and treats joint problems

Natural Orifice Surgery

- surgery where the entrance is an internal incision behind the uterus or in the stomach wall to access the abdominal cavity

- uses endoscope

Single Payer System

- medicare for all

- gov run healthcare system

- gov pays cost of healtcare needs

- healthcare system is made up of: cost, access, quality

((((((billing))))):

1. gov > hospital & cost of care

2. hospital > doctor

Altruism

Helping people.

Supply Chain

Taking raw materials and processing them until they become a useable good.

Evidence Based Medicine

Uses EMR of patient to compile statistics to determine the "best practice"/ best treatment.

Compliance

The % of goods and services used in hospitals that have been negotiated with the GPO's. - gpo (group purchasing organization, helps healthcare providers)

Indemnity Insurance

- type of health insurance

- provides medical benefits such as the costs of medical expensives

- pays a portion of total costs

- choose any medical person or place

PPO

- preferred provider organization

- premiums and copays cost more

- can choose any physician they want

HMO

- health maintenance organizations

- certain doctors and hospitals

- reduced costs

- coverage restrictions (tests, visits)

National Insurance Costs

The average US family pays $14,000 a year for insurance coverage with 3/4 being paid by the employer and 1/4 being plaid by the employee.

Patient Protection and Affordable Care Act

- healthcare reform law

- costs less (expands so Medicaid covers poor ppl)

- provides better coverage for pre-existing conditions

- improves prescription drug coverage in medicare

Corporate Structure of Hospitals

1)Department Heads; 2) Medical Executive Committee; 3) Board.

Accountable Care Organization

- in patient protection and affordable care act

- defined as an ideal healthcare organization

- has low costs bc of successful capitalization on medical goods/services

Common Law

A civil law established by following earlier judicial decisions.

Statutes

Laws enacted by a state or federal legislature that in certain cases can overwrite common law.

Executive Order

A rule issued by the president that has the force of law.

Civil Law

Wrongs against a particular person or organization.

Tort

Any wrongdoing for which an action for damages may be brought.

declining reimbursement

Less resources to recruit, compensate, and develop workforce.

declining supply of workers

Shortage of skilled workers.

increasing population need

Increased volumes of patients and workload for HSO.

external pressure on HSO's

HR must ensure high performance in HSO.

National Labor Relations Act

- 1935

- to protect the rights of employees/employers

- allows hospital/health care provders to use bargaining units (job represented by labor union)

- allows employees to organize in trade unions (# shares for trading) and engage in collective bargaining and strikes

Fair Labor Standards Act

- 1938

- regulates minimum wage, overtime pay, minimum worker ages

Equal Pay Act

- 1963

- = pay between men/women

Civil Rights Act

- 1964

- prohibits discrimination

Age Discrimination in Employment Act

- 1967

- prohibits discrimination

- employees 40+

Occupational Safety and Health Act

- 1970

- establishes: safer workplace conditions & adhere to certain standards to healthcare employers

Rehabilitation Act

- 1973

- protects handicapped

Employee Retirement Income Security Act

- 1973

- protects employees for retirement benefits

- establishes minimum standards for pension plans

Pregnancy Discrimination Act

- 1978

- pregnancy is medical condition

- prohibits exclusion in benefits and leave policy for pregnants

COBRA; consolidated omnibus budget reconciliation act

- 1986

- gives benefits (health coverage for limited time due to circumstances)

Immigration Reform and Control Act

- 1986

- penalties for employees hire illegal aliens

Worker Adjustment and Retraining Notification Act

- 1986

- mass layoff/plant closing needs 60 days advance to notice affected employees

Americans with Disabilities Act

- 1990

- disabilities ppl access to public services

- requires employers to provide accomodation for applicants and employees

Family Medical and Leave Act

- 1993

- employees in organizations: up to 12 wks/yr of unpaid leave bc of fam or medical

Health Insurance Portability and Accountability Act

- 2003

- protects employees from access to personal health info

- limits employers' ability to use their health info under insurance plan

- protects patient's health info

- 1996

- (to secretary of hhs)

- develop healthcare standards governing electronic data interchange and security

conceptual skills

Ability to critically analyze and solve complex problems.

technical skills

Expertise or ability to perform a specific work task.

interpersonal/human relation skills

Enables a manager to communicate with and work well with other individuals.

functional organizational structure

- most common organization pyramid structure

- used in larger organizations/hso's

- from pres to service (single authority)

- strict chain of command (skills)

- ensures communication/assignment/evalutation of tasks

matrix management method

- administrative structure

- dual authority system

- individuals: complete specific work tasks to boss and for manager(s)

- advantages: improved coordination/communications/ flexibility of organization to work

product/service line management

- organized around selected services

- controls service delivery

- advantages: resource control/accountabilty/enhanced clinical quality service

environment for HSO's

Entities and influences outside of the organization's boundaries.

open systems

Organizations which are affected by, and also affect, their environment.

exchange relationships

Transaction between 2+ organizations where something of value is exchanged and both gain value.

input/output management model

Management uses inputs (labor, materials, info, lands) to provide services, and creates outputs (goods and services).

managers

Persons appointed to positions of authority who enable others to do their work effectively, who have responsibility for resource utilization, and who are accountable for work results.

line managers

Those that supervise other employees.

staff managers

Those that carry out work and advise their bosses.

6 management functions

1) Planning; 2) Organizing; 3) Staffing; 4) Controlling; 5) Decision-Making; 6) Directing

organizing

Establishing authority and responsibility management.

staffing

Acquiring and retaining human resources.

directing

Initiating action in the organization by leading, motivating, and communicating.

controlling

Monitoring, adjusting, and improving aggregate performance. The process that checks performance against standards--ensures that performance is consistent with plans and that the organizational and departmental goals and objectives are achieved.

decision making

Evaluating alternatives and making choices.

managerial tasks

Include core tasks, routine add-ons, and specialty add-ons.

domains of management

1) Self; 2)Team/Work Unit; 3)Organization

organizational culture

Ingrained patterns of shared beliefs, values and behaviors, with associated symbols and rituals, that are acquired over time by members.

direct care

Deals directly with the patients such as a hospital, nursing home, physician practice, and assisted living facilities.

indirect care

Supports the care of individuals through products and services made available to direct care settings. Ex) Consulting firms, associations, pharmaceutical companies, and medical suppliers.

70%

Percentage of expenditures in healthcare that go to pay the workforce.

contracts

The most basic/important item in business relationships.

restrictive covenant

Worst provision for the employee in a contract.

at will contract w/ or w/o restrictive covenant

What is the best deal for employer in a contract? (exchange a current performance for future assets )

contract with money/stability and free agency

What is the best deal for you in a contract?

patients and skills

As a physician what are your bargaining tools in a contract?

covenant

Restriction on free agency.

integration clause

Tells us what the whole deal is.

ADR provision

How we're going to resolve disputes. (Generally through arbitration (settling of a dispute through an impartial (unbiased) third party))

maximum notice possible and severance

What provisions are best for you in a termination without cause?

fairness and consistency

What are the 2 key principles in hiring?

1) Executive summary; 2) Mission statement; 3) Ownership/management; 4) Market analysis; 5) Financing; 6) Projected patient base/referral sources; 7) Services; 8) Location; 9) Assets; 10) Operational plan; 11) Human Resources; 12) Marketing

business plan

reimbursements for physician services

These must be credentialed!

joint several liability

Risk is that if one person screws up, all in the partnership are liable.

LLP-limited liability partnership

Risk is that liability is limited individually.

LLC

S-corporation (both have limited liability protection but S-corporations are more limited to being in the US and having only 100 share holders (owners) or less )

accessibility

What is the most important factor in choosing a location for your practice?

statute of frauds

What says that leases/realty agreements must be in writing?

adverse occurrences

What on your record is very bad for credentialing criteria?

audits and penalties

In your insurance, what does regulatory liability cover the costs of?

D&O insurance

Protects directors and officers in corporations. Directors and Officers Liability Insurance

no

Can unemployment or worker's comp be waived?

quality

In regards to suppliers and equipment what is most important?

7

How many years must patient records be kept?

risk management

4 philosophies: 1) Avoidance; 2) Reduction of effect--or risks; 3) Transfer; 4) Acceptance.

lean

Main goal = reducing waste reduces risk to practice. Achieve high quality, defect-free medicine.

patient's death

The worst waste in healthcare.

The patient comes first. Care must be of the highest quality. Promote efficiency. ID/remove practice/treatment defects. Maximize business safety. Organize all elements of practice. Eliminate all waste.

key LEAN principles

less waiting time for patients

What is the most important possible LEAN benefit?

profitability

What is the biggest risk in a practice?

Heijunka

Leveled production, no bottlenecks or waste.