WGU D545 Healthcare Admin Evolution, Systems and Leadership OA

health care

an act or deed between the healthcare provider and the patient to maintain or improve the patient's healthcare status

biomedical model

a theoretical framework in healthcare that views illness and disease as primarily resulting from biological factors

holistic health

an approach to wellness that simultaneously addresses the physical, mental, emotional, social, and spiritual components of health

holistic medicine

the practice of healthcare professionals using a diverse range of disciplines, religious philosophies, and cultural practices to heal individuals, communities, and the environment

functional organizational structure

The organization is split into departments based on the employees' expertise, such as the manager or chief executive officer, commercial and marketing, finance, accounting, managerial, facilities, etc.

functional organizational structure advantages

-Enhanced coordination & control

-Centralized decision-making

-Enhanced organizational-level perspective

-More efficient use of managerial & technical talent

-Facilitated career paths in specialized areas

functional organizational structure disadvantages

Specialization can lead to departments operating in silos

Potential for decreased communication

Narrow business perspectives

multi-divisional organizational structure

The chief corporation comprises several smaller business units or divisions based on geographic locations, products, or services so that the daily processes or functions occur at the unit or divisional level, allowing the separate units or divisions to operate independently

multi-divisional organizational structure advantages

Ability to hold corporate executives accountable for the results of local operations that are within their control

multi-divisional organizational structure disadvantages

Duplication of functions, such as products and services across divisions, which threatens the quality and costs of healthcare

Increased operational costs due to the inability to achieve economies of scale

Leads to a lack of standardization and inefficiencies

Matrix organizational structure

comprises the functional structure and a temporary project structure, which requires using two managers simultaneously

Matrix organizational structure advantages

Clearly defined project objectives

Seamless integration of project and functional objectives

Efficient use of limited human resources

Fluid streaming of information throughout the project

Prompt diffusion of team members back into the functional organization upon project completion without organizational disruption

Ability of functional management to handle conflicts arising at the project level

Matrix organizational structure disadvantages

Increases the complexity of the organization

Problems derived from having employees answer to too many bosses and having conflicting managerial directives

Difficulty in establishing priorities for functional and project management

Delay in management reactions

accountable care organization (ACO)

a network of doctors, hospitals, and other healthcare providers that voluntarily come together to provide coordinated, high-quality care to their patients

managed care organization (MCO)

a type of healthcare delivery system that aims to manage the cost, quality, and accessibility of healthcare services; MCOs are commonly associated with HMOs, PPOs, and POS plans

delivery

the provision of healthcare services by various providers in exchange for payment for services rendered

health maintenance organization

a type of managed care organization that provides health insurance coverage through a network of healthcare providers who offer services to members for a fixed fee

Integrated Delivery System (IDS)

a network of organizations that provides or arranges to provide an organized variety of services to specific populations and is held accountable for the outcomes and health status of those populations

consumer-driven health plan (CDHP)

(also known as a high-deductible health plan) a type of health insurance plan that encourages individuals to manage their healthcare costs

Fee-for-service (FFS)

a system wherein healthcare is provided as individual units of service, such as magnetic resonance imaging (MRI) or other X-ray, medical examination, flu shot, or other service

preferred provider

a type of organization that provides services based on contracts with groups of physicians and hospitals that are referred to as preferred providers

First contact as the gateway to the healthcare system.

primary care

Occur when needed after the patient has been seen at primary care.

specialty care

In integrated systems such as managed care, Primary care physicians (PCP) serve as

gatekeepers to control cost, usage of services, and allocation of resources.

Treats the person holistically

primary care physicians

Trains in ambulatory care setting to learn how to treat many patient conditions and diseases.

Primary care

public health services

services provided by local health departments, including well-baby care, venereal disease clinics, family planning services, screening and treatment for tuberculosis, and ambulatory mental health services

Which organizational structure used by healthcare facilities incorporates a temporary project structure using a project and a department manager?

matrix

3 multiple choice options

A rural clinic that provides services to families who lack access to adequate healthcare has improved the quality and health status of this population. A recent survey showed the patients are satisfied with the services.

Which type of healthcare organization is described in this scenario?

accountable care organization (ACO)

3 multiple choice options

Which type of healthcare financing includes savings options such as a health savings account or a health reimbursement account?

consumer-driven health plan

3 multiple choice options

health insurance marketplace

system established to facilitate the purchase of health insurance in organized markets (also referred to as health insurance exchanges)

consumerism

the trend of patients increasingly acting as consumers who make informed choices about their healthcare services based on quality, cost, and other factors

Radio Frequency Identification (RFID)

a technology used in healthcare to track and manage medical equipment, pharmaceuticals, and sometimes patient information, using radio waves for automatic identification and tracking

Information Technology (IT)

the use of digital technologies, like EHRs and telemedicine, for managing patient information, delivering healthcare services, and supporting decision-making processes

Affordable Care Act (ACA)

Enacted in 2010, the ACA aimed to increase the quality and affordability of health insurance. It expanded Medicaid, created health insurance marketplaces, and implemented regulations prohibiting insurers from denying coverage due to pre-existing conditions

Food and Drug Administration Safety and Innovation Act (FDASIA)

Enacted in 2012, FDASIA aimed to enhance the regulation of medical products by the FDA. It included provisions to expedite the review of new drugs and medical devices, improve drug safety monitoring, and strengthen the FDA's authority to regulate drug-compounding pharmacies.

Health Information Technology for Economic and Clinical Health Act (HITECH Act)

Enacted in 2009, the HITECH Act promotes the adoption and meaningful use of electronic health records (EHRs) and strengthens HIPAA privacy and security provisions related to electronic health information

Consolidated Omnibus Budget Reconciliation Act (COBRA)

enacted in 1985, requires employers with 20 or more employees to offer temporary continuation of health coverage to eligible employees and their dependents after certain qualifying events, such as job loss or reduced hours.

Emergency Medical Treatment and Labor Act (EMTALA)

enacted in 1986, requires hospitals that participate in Medicare to provide emergency medical treatment to individuals regardless of their ability to pay or insurance status

False Claims Act (FCA)

a federal law that prohibits knowingly submitting false or fraudulent claims for payment to the government, including claims submitted to Medicare, Medicaid, and other federal healthcare programs, whether directly or indirectly

Federal Anti-Kickback Statute (AKS)

a federal criminal law that prohibits exchanging anything of value in return for referrals or recommendations for items or services covered by federal healthcare programs, such as Medicare or Medicaid.

Stark Law

also known as the Physician Self-Referral Law, prohibits physicians from referring Medicare or Medicaid patients to entities with which they have a financial relationship for certain designated health services.

The Joint Commission on Accreditation of Healthcare Organizations (JCAHO)

now known simply as The Joint Commission, is a nonprofit organization that accredits and certifies healthcare organizations and programs in the United States

Centers for Medicare and Medicaid Services (CMS)

a federal agency within the U.S. Department of Health and Human Services that administers Medicare and Medicaid programs

Agency for Healthcare Research and Quality (AHRQ)

a federal agency within the U.S. Department of Health and Human Services that conducts research and provides evidence-based information to improve healthcare quality, safety, efficiency, and effectiveness

National Committee for Quality Assurance (NCQA)

a private, nonprofit organization that accredits and certifies healthcare organizations and programs in the United States, focusing on quality measurement and improvement in healthcare delivery

Accreditation Commission for Healthcare (ACHC)

nonprofit organization that accredits healthcare organizations and programs across various sectors, including home health, hospice, pharmacy, and behavioral health.

ACOs must enroll a minimum of 5000 Medicare fee-for-service patients and and maintain that level of enrollment as a condition of

membership in a Shared Savings Plan

ACOs must complete an annual _________

certification process

True or False. The fact that laws and policies are regulated at different levels of government can create conflicts regarding jurisdiction and control

true

1 multiple choice option

clinical information system (CIS)

a system that collects, stores, manipulates, and ensures the availability of patient information to medical personnel and the healthcare delivery process

nursing information system (NIS)

a system that supports nursing by managing and improving charting, staff scheduling, and integrating clinical information

pharmacy information system (PIS)

a system that maintains drug supply and organization in a pharmacy or hospital setting

laboratory information system (LIS)

a system used in a laboratory to manage patients' tests and results

clinical decision support system (CDSS)

a system that provides clinicians with evidence-based recommendations, guidelines, alerts, and reminders at the point of care to assist in clinical decision-making

health information exchange (HIE)

a system that enables the electronic sharing of patient health information among healthcare organizations, such as hospitals, clinics, pharmacies, and laboratories

picture archiving and communication system (PACS)

a system that manages digital images, allowing for immediate visualization of X-rays, MRIs, ultrasounds, and CT scans on shared networks

financial information system (FIS)

a system used at the administrative level, in conjunction with the CDSS, to enhance financial planning and decision-making and improve outcomes for the organization

revenue cycle management (RCM)

a system that automates and streamlines the financial processes associated with healthcare billing, coding, claims processing, and reimbursement

telemedicine

a healthcare professional's use of telecommunications technology to diagnose patient conditions and provide patient care from a distance

telehealth

goes beyond telemedicine in that it encompasses education, research, administrative, and clinical applications using various types of healthcare professionals

descriptive analytics

a type of data analytics that focuses on interpreting historical data to identify patterns, trends, and insights

diagnostic analytics

an extension of descriptive analytics used to understand the reasons behind past performance

operational analytics

a type of analytics that focuses on improving current business processes by extracting valuable insights from data generated by everyday business activities

predictive analytics

a type of advanced analytics that uses historical data, statistical algorithms, and machine learning techniques to identify the likelihood of future outcomes based on historical data

prescriptive analytics

an advanced form of data analytics that analyzes past and current data and recommends actions you can take to affect desired outcomes in the future

personal health record (PHR)

an electronic portal for patient information that can be accessed and maintained by the patient

includes electronic copies of information that patients have received from their providers and may include data they enter themselves.

PHR personal health record

electronic medical record (EMR)

real-time digital versions of paper charts

contains the results of encounters between a healthcare professional and a patient during patient care episodes.

electronic medical record (EMR)

electronic health record (EHR)

differs from the EMR in that the EHR contains patient information from all healthcare clinicians who have provided care to the patient, whereas the EMR contains the patient's information from one facility

integrates a person's multiple, physician-generated EMRs and their patient-generated and maintained PHR.

electronic health record (EHR)

registry

a systematic collection of data about patients who share a particular condition, treatment, or healthcare-related characteristic

covered entity

organizations or individuals that must comply with HIPAA regulations, primarily handling protected health information

diffusion of innovation theory (DOI)

innovation as a different, unfamiliar, or new idea, process, product, technique, technology, or service that appeals to others, including healthcare consumers

research and development (R&D)

the activities companies take on to innovate and introduce new products and services

Which type of analytic system is used to determine a hospital's current admissions rate?

operational analytics

3 multiple choice options

How does the electronic medical record (EMR) impact the quality of a patient's care?

It enables a healthcare provider to track data over time.

3 multiple choice options

How does the nursing information system (NIS) impact healthcare?

Reduces duplication in documentation

3 multiple choice options

What is one disadvantage of multi-divisional organizational structures?

Duplication of functions

3 multiple choice options

What does a healthcare organization consider when undergoing strategy planning for a new healthcare location?

Market forces

3 multiple choice options

Which aspect of the Emergency Medical Treatment and Labor Act (EMTALA) of 1986 expanded emergency room care availability?

The inability to refuse care based on the ability of the patient to pay

3 multiple choice options

How has the 21st Century Cures Act of 2016 assisted the Food and Drug Administration in its mission to improve drug quality and safety?

Incorporating patient perspectives helped enhance the decision-making process.

3 multiple choice options

How has the smallpox epidemic of the 18th century impacted healthcare?

The creation of the smallpox vaccine expanded the field of immunology.

3 multiple choice options

What led to the creation of departments of health in the United States?

Epidemics and sanitation concerns

3 multiple choice options

How has the spread of the human immunodeficiency virus (HIV) in 1985 caused regulators to modify healthcare institution operations?

The Centers for Disease Control and Prevention instituted blood donation screening for HIV.

3 multiple choice options

How did the Clinical Laboratory Improvement Amendments (CLIA) of 1988 regulate laboratories to improve healthcare delivery?

By standardizing testing procedures across organizations

3 multiple choice options

How have regulators partnered with stakeholders in establishing governance of health savings accounts (HSAs)?

By partnering with the Internal Revenue Service to tax exempt qualified purchases

3 multiple choice options

Which actions did healthcare regulators take in 2001 as a response to the threat of terrorism?

Created the Office of Public Health Emergency Preparedness

3 multiple choice options

How does the Food and Drug Administration impact drug availability in the U.S.?

By classifying drugs by risk

How can e-prescriptions assist in reducing adverse patient impact liability?

Providing a record of past and present medication usage, which helps track substance abuse

Which outcome should be predicted by a widespread use of electronic recordkeeping within a healthcare organization?

Fewer medication prescription errors

3 multiple choice options

How do information systems help improve the quality of healthcare delivery?

By enabling the collection and analysis of health data

How can descriptive analytics be used to improve future patient outcomes?

By comparing program implementation past data to current needs

Which outcome can be concluded about predictive analytics and the future of quality healthcare access?

Healthcare access will improve since practitioners will be informed about patients' likely anticipated needs in advance.

3 multiple choice options

organizational effectiveness

the productivity of an organization, such as meeting its objectives with available resources (time, money, effort, people, and materials)

organizational culture

shared values, beliefs, attitudes, and practices that characterize an organization

competing values framework (CVF)

used for assessing organizational effectiveness and culture, focusing on adaptability, flexibility, stability, and control

external environment

outside influences like competitors and legal, political, sociocultural, economic, and technological factors such as state and federal laws and issues affecting population health, wellness, and safety, and the presence or absence of public or private insurance coverage

internal environment

factors within the organization (employees, patients, protocols)