Healthcare Admin Test 1

NACHRI

The non-profit advocacy group for pediatric hospitals in the US. National Association of Children's Hospitals and Related Institutions.

minimally invasive surgery

Use of fiber optics, guide images, microwaves and other technologies to do surgery rather than cutting large sections of tissue.

ASC

Ambulatory Surgery Center, normally costs 50% less than an inpatient hospital procedure because they practice line by line billing.

HHS

Department of Health and Human Services.

laparoscopy

Laparotomy performed with a laparoscope that makes a small incision to examine the abdominal cavity (esp. ovaries and Fallopian tubes).

endoscopy

Inspection of body organs or cavities using a lighted scope that may be inserted through an existing opening or through a small incision.

phacoemulsification

Method to remove cataracts in which an ultrasonic needle probe breaks up the lens, which is then aspirated.

arthroscopy

A minimally invasive operation to repair a damaged joint.

natural orifice surgery

Abdominal surgery where the entrance wound is through either the stomach or through the vagina.

single payer system

Government run healthcare system. Healthcare system is made up of a) cost, b) access and c) quality.

altruism

Helping people.

supply chain

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

evidence based medicine

Used EMR's to compile statistics to determine the "best practice."

compliance

The % of goods and services used in hospitals that have been negotiated with the GPO's.

indemnity insurance

"Standard' type of health insurance individuals can purchase, provides comprehensive major medical benefits and allows insured individuals to choose any physician or hospital when seeking medical care.

PPO

Preferred Provider Organization. A prepaid health insurance plan in which providers agree to deliver services for discount fees; patients can go to any provider, but using nonparticipating providers results in higher costs to the patient. Part of managed care.

HMO

Health Maintenance Organization. A prepaid health insurance plan in which patients receive health care from designated providers. Part of managed care.

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

This is the health care reform law. Focuses on reform of the private health insurance market; providing better coverage for those with pre-existing conditions; improving prescription drug coverage in Medicare.

corporate structure of hospitals

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

accountable care organization

A term used in the Patient Protection and Affordable Care Act to define an ideal healthcare organization able to have very low costs caused by successful capitalization on medical goods and 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 law that provides bargaining units and collective bargaining in hospitals and health service organizations.

Fair Labor Standards Act

1938 law regulating minimum wage, overtime pay, and minimum worker ages.

Equal Pay Act

1963 law prohibits discrepancies in pay between men and women.

Civil Rights Act

1964 law that prohibits discrimination based on gender, race, or religion.

Age Discrimination in Employment Act

1967 law that prohibits discrimination of employees 40 years and up.

Occupational Safety and Health Act

1970 law that requires employers to maintain a safe workplace and adhere to standards specific to healthcare employers.

Rehabilitation Act

1973 law that protects rights of handicapped.

Employee Retirement Income Security Act

1973 that grants protection to employees for retirement benefits to which they are entitled.

Pregnancy Discrimination Act

1978 law stating that pregnancy is considered a medical condition and prohibits exclusion of pregnancy in benefits and leave policies.

COBRA

Consolidated Omnibus Budget Reconciliation Act: 1986 law that gives benefits like health coverage for a limited time due to various circumstances like termination, layoff, death, reduction of hours per week, and divorce.

Immigration Reform and Control Act

1986 law that establishes penalties for employees who knowingly hire illegal aliens.

Worker Adjustment and Retraining Notification Act

1986 law that requires employers who will make a mass layoff or plant closing to give 60 days advance notice to affected employees.

Americans with Disabilities Act

1990 law that gives people with disabilities access to public services and requires employers to provide reasonable accommodation for applicants and employees.

Family Medical and Leave Act

1993 law that permits employees in organizations to take up to 12 weeks of unpaid leave each year for family or medical reasons.

Health Insurance Portability and Accountability Act

2003 law that guarantees employees protection from outside access to personal health info and limits employers' ability to use employee health info under health insurance plans

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 organizational structure; pyramid shaped; used in larger organizations; deep vertical structures; strict chain of command ensures that communication and assignment and evaluation of tasks are carried out; used most frequently in HSO's.

matrix management method

Administrative structure; dual authority system where individuals are assigned to complete specific work tasks; advantages are improved coordination and communication, also increases flexibility of organization to carry out work.

product/service line management

Organized around selected services to control service delivery; Advantages are resource control, accountability, enhanced clinical quality of 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 acquires inputs, uses inputs to provide services, and creates outputs.

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.

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?

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.

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?

business plan

Good place to start on how to set up your practice: 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

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.

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?

15M

What is the sales maximum to be eligible for an SBA loan?

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.

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.

key LEAN principles

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.

less waiting time for patients

What is the most important possible LEAN benefit?

profitability

What is the biggest risk in a practice?