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Healthcare

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Title: Healthcare


1
  • Healthcare

Jamie Phillips, FACHE Vice President,
Operations Nationwide Childrens Hospital
2
Highlights
  • Healthcare
  • 24 questions for 14 of exam
  • 8 knowledge areas

3
Knowledge Areas
  • Healthcare Medical Terminology
  • Healthcare Trends
  • Managed Care Models, Structures Environment
    (Group, Staff, IPA, PPO)
  • The Acute Care Sector
  • The Ambulatory Care Sector
  • Interaction Integration Among Healthcare
    Sectors
  • Ancillary Services (Lab, Radiology, Therapies)
  • Nursing, Physicians Allied Health Professionals
    Roles

4
Healthcare
  • This section will focus on your knowledge of the
  • Key components of healthcare delivery systems
  • Roles and relationships of the principal
    professionals involved in healthcare delivery
  • General education and training requirements for
    major healthcare professions and occupations
  • Primary professional associations with which
    healthcare professionals are affiliated
  • Principle types of healthcare delivery settings
    in which inpatient and ambulatory care is
    delivered
  • Differences in ownership, mission, service
    specialization, and other important features
    among hospitals
  • Vertical and horizontal integration in recent
    years

5
Healthcare
  • This section will focus on your knowledge of the
  • Different types of ambulatory care settings and
    how they differ in structure and operations
  • Varied configurations of physician practice
    arrangements
  • Major types of managed care organizations and the
    products they offer
  • Managed products and contracting arrangements
  • Purchaser and consumer preferences have shaped
    managed care markets and how they may be changing
    over time
  • Managed care organizations may differ in terms of
    ownership and affiliations
  • Consumerism affecting healthcare organizations
    and professionals

6
Healthcare
  • Healthcare straddles science, commerce and many
    other aspects of human behavior and draws on
    several different bodies of knowledge.
  • Clinical
  • Administrative
  • Rapid pace of technological advances
  • Policy changes

7
Healthcare
  • Traditional healthcare delivery system is a
    sickness system
  • Focused on clinical interventions
  • Treated patients after they presented to the
    healthcare system

8
Healthcare
  • As the scarcity of limited resources in
    healthcare has grown, executives are expected to
    become even more directly involved in RESOURCE
    MANAGEMENT and ALLOCATION DECISIONS.

9
Healthcare
  • Efforts are made to re-orient the attention of
    healthcare systems more toward
  • Health
  • Health promotion
  • Disease prevention
  • Customer service
  • Patient involvement in their care and decisions

10
Healthcare
  • Understand the continuum of care
  • Acute
  • Curative care
  • Long-term rehabilitative/custodial care
  • Palliative care
  • Outpatient/ambulatory
  • Inpatient/institutional

11
Healthcare
  • Settings of outpatient care
  • home
  • physician offices
  • clinic-based settings
  • outpatient departments of a hospital
  • emergency departments of a hospital

12
Healthcare
  • Implications of types of inpatient care
  • Service complexity
  • Specialization
  • Medical staff membership
  • Ownership
  • Breadths of ancillary services
  • Level of acuity

13
Healthcare
  • Alternatives site of care
  • Satellite facilities
  • Joint venture partnerships with physicians
  • Freestanding facilities
  • Sub acute care
  • Post-acute care

14
Healthcare
  • Horizontal vs. vertical integration
  • Vertical expanding services up and down the
    continuum of care
  • Horizontal increasing and integrating points of
    care

15
Healthcare
  • Understand the rise and fall of managed care
  • Purpose of managed care
  • Risk based compensation
  • capitation
  • Focus on wellness care management
  • Operational efficiency
  • But why did it not succeed?

16
Healthcare
  • Need more in-depth resources?
  • Delivery Health Care in America, 2nd ed. By Leiyu
    Shi and Douglas A. Singh
  • Essential in Managed Health Care, 4th ed by Peter
    R. Kongstvedt
  • Health and Healthcare in the United States, by
    Michael J. Long, Ph.D.
  • Introduction to Healthcare Delivery
    Organizations Functions and Management, 4th Ed,
    by Robert M. Sloane, FACHE Beverly LeBov Sloane
    and Richard K. Harder
  • Understanding the U.S. Health Services System,
    2nd Ed by Phoebe Lindsey Barton, Ph.D.

17
Healthcare
  • Ready for some test questions?

18
Healthcare Test Questions
  • An efficient Formulary and Therapeutics Committee
    in many hospitals evaluates all of the following
    except?
  • Symptoms of adverse reactions.
  • Patients current medication effectiveness.
  • Contraindications.
  • Specific drugs in terms of appropriateness to
    caseload.

19
Healthcare Test Questions
  • Which of the following would represent the most
    common cause of adverse drug events?
  • Lack of standardization.
  • Lack of knowledge of drug.
  • Preparation errors.
  • Transcription errors.

20
Healthcare Test Questions
  • Participating providers in the federal Medicare
    program must
  • Be accredited by the Joint Commission.
  • Serve Medicaid beneficiaries.
  • Meet the Conditions of Participation.
  • Be in compliance with state Certificate of Need
    laws.

21
Healthcare Test Questions
  • Which physician organization is responsible for
    accrediting residency training programs?
  • ACGME
  • AAMC
  • CAT
  • BPQA

22
Healthcare Test Questions
  • According to CMS Conditions of Participation,
    under what circumstances, if any, is it
    permissible to deny a patient access to his/her
    medical record?
  • The information requested consists of
    psychotherapy notes.
  • The request comes from the patients personal
    representative instead of directly from the
    patient (if allowed under state law).
  • The provider organization will incur significant
    costs in copying or forwarding the requested
    records.
  • It is never permissible to deny a patient access
    to his/her records.

23
Healthcare Test Questions
  • Communication Health Intranet Networks (CHINs)
    were developed for what purpose?
  • To provide a platform for an electronic medical
    record.
  • To provide a way to disseminate community level
    health data.
  • To provide an inexpensive way of sharing health
    information.
  • To provide a community-based hub for sharing
    health information.

24
Healthcare Test Questions
  • In planning for future community health services,
    it is important to understand population health
    needs. Which ethnic category tends to
    proportionately use physician services the most?
  • African American.
  • Asian.
  • Latino.
  • White.

25
Healthcare Test Questions
  • Which of the following limitations would cause a
    hospital OB unit to see no change in volume over
    a four year period?
  • Organizational.
  • Market.
  • Financial.
  • Clinical.

26
Healthcare Test Questions
  • The overall goal of the HIPAA Act of 1996 is
  • To insure the privacy and confidentiality of
    patient medical records.
  • To standardize the sharing of clinical and
    administrative information.
  • To strengthen healthcare data security standards
    and practices.
  • Improve portability and continuity of health
    insurance, and to combat fraud.

27
Healthcare Test Questions
  • The four important aspects of clinical support
    services are technical quality, patient
    satisfaction, continuity of integration and
  • Cost-benefit analysis.
  • Outcome.
  • Appropriateness.
  • Health promotion.

28
Healthcare Test Questions
  • Medicare Conditions of Participation for
    hospitals require that a prescribing practitioner
    authenticate a verbal order within ____, if not
    defined by the state.
  • 24 hours.
  • 48 hours.
  • 7 days.
  • 30 days.

29
Healthcare Test Questions
  • What is true about the relationship between acute
    care hospitals and long-term care organizations?
  • Hospitals and patients frequently have difficulty
    arranging for nursing home care services.
  • Hospitals generally do not want to refer patients
    to nursing homes since part of the patient care
    revenue must be shared.
  • Nursing homes generally do not want to refer
    patients to hospitals since this interferes with
    state or federal length of stay requirements.
  • Nursing homes are generally thought to be
    superior to hospitals at chronic disease
    management.

30
Healthcare Test Questions
  • Under HIPAA, Congress required the Secretary of
    HHS to adopt standards to
  • Create Pay-for-Performance Standards for CMS.
  • Provide for standard data elements and code sets.
  • Require electronic health records by 2010.
  • Publish clinical outcome results on Medicare
    patients.

31
Healthcare Test Questions
  • The principle goal of a Health Services
    Organizations medical /hospital model is
  • Security.
  • Disease treatment.
  • Quality of life.
  • Comfort.

32
Healthcare Test Questions
  • Which of the following regulations exempted
    self-funded employer-sponsored health insurance
    plans from state insurance regulations?
  • BBA.
  • TEFRA.
  • COBRA.
  • ERISA.

33
Healthcare Test Questions
  • The single most important way patients can help
    prevent medical errors from affecting them is
    to
  • Interact with their caregivers.
  • Research medical error rates among organizations.
  • Read and understand consent forms.
  • Chose large, reputable healthcare providers.

34
Healthcare Test Questions
  • In a hospital setting, a critical pathway is beet
    described as
  • A document that focuses on efficiency and
    describes a standard set of activities to be
    performed for a defined category of patients.
  • A set of guidelines that focus on identifying
    those decision points which should lead to the
    consistent provision of appropriate clinical
    practice.
  • Any attempt to standardize clinical activities
    based upon diagnostic categories and projected
    outcomes.
  • Decision tree that focuses on physician decision
    making.

35
Healthcare Test Questions
  • Under a capitated payment system, the risk
    sharing arrangements involve which parties?
  • Insurers and patients.
  • Physicians and purchasers.
  • Hospitals and patients.
  • Hospitals and patients.

36
  • Management
  • Business

37
Highlights
  • Management
  • 19 questions for 11 of exam
  • 6 knowledge areas
  • Business
  • 20 questions for 12 of exam
  • 7 knowledge areas

38
Knowledge Areas - Management
  • Implementation Planning (e.g., operational plan,
    management plan)
  • Contingency Planning (e.g., emergency
    preparedness)
  • Organizational (systems) Theory Structuring
    (e.g., span of control, chain of command,
    interrelationships of organizational units)
  • Management Functions (e.g., planning, organizing,
    directing, controlling)
  • Leadership Styles/Techniques
  • Mediation, Negotiation, Dispute Resolution
    Techniques

39
Knowledge Areas - Business
  • Basic Statistical Analysis
  • Strategic Planning Principles
  • Basic Business Controls (e.g., legal and
    financial implications)
  • Marketing Principles Tools (e.g., market
    analysis, market research, sales, advertising)
  • Techniques for Business Plan Development
    Implementation
  • Principles of Public and Community Relations
  • The Functions of Organizational Policies
    Procedures

40
Management Business
  • Management or managing is a process comprising
    interrelated social and technical functions and
    activities.
  • Establishing organizational objectives
  • Providing organizational context within which
    direct and support work can be performed
    effectively
  • Preparing an organization to deal with the treats
    and opportunities in its external environment

41
Management Business
  • The five management functions
  • Planning
  • Organizing
  • Controlling
  • Directing
  • Staffing
  • All are connected by decision making problem
    solving

42
Management Business
  • Managing vs Leading
  • Managing
  • caretaking
  • maintaining status quo
  • transactional
  • Leading
  • visionary
  • dynamic
  • transformational

43
Management Business
  • Managerial skills
  • technical
  • conceptual
  • interpersonal
  • Senior managers make greater use of conceptual
    skills
  • Middle/entry level managers tend to have a more
    even mix of the three

44
Management Business
  • Mintzbergs research managerial roles
  • Interpersonal
  • Figurehead
  • influencer
  • Informational
  • Monitor
  • spokesperson
  • Decisional
  • Entrepreneur
  • negotiator

45
Management Business
  • Managerial competencies
  • Conceptual
  • Technical managerial/clinical
  • Interpersonal/collaborative
  • Political
  • Commercial
  • Governance
  • others

46
Management Business
  • Managements authority or power
  • Legitimate (formal)
  • Reward
  • Coercive
  • Expert
  • Referent
  • Understand the risks and benefits of each

47
Management Business
  • Leader traits and skills
  • Assertive
  • Cooperative
  • Decisive
  • Dependable
  • Intelligent
  • Conceptually skilled
  • Creative
  • Persuasive

48
Management Business
  • Leadership styles (Likert)
  • Autocratic
  • Benevolent
  • Consultative
  • Participative/democratic

49
Management Business
  • Designing Formal Organizations
  • Genesis in the planning function
  • Authority and responsibility relationships
  • Departmentation
  • Coordination and relationships of components

50
Management Business
  • Levels of Organization
  • Health systems composed of health service
    organizations
  • Health service organizations
  • Clusters of workgroups (clinical groups)
  • Workgroups (departments, teams)
  • Individual positions

51
Management Business
  • Organization within an organization
  • Formal structure and formal organization
  • Informal organization dynamic behavior and
    activity patterns
  • Combination of both the formal and the informal
    are the actual organization

52
Management Business
  • Strategic Planning Operational Planning
  • Strategic planning addresses the longer-term
    direction and goals selected by the governance
    and management
  • Operational planning focuses on the direction and
    activities of individual units and departments of
    the organization. The operational plan must be
    coordinated with and is subordinate to the
    strategic plan

53
Management Business
  • Contingency planning
  • Anticipating the unknown
  • Mitigating the potential negative implications
  • Turning the unknowns into economic or competitive
    advantages
  • External disasters
  • Internal disasters

54
Management Business
  • Managers as Negotiators
  • Know the art of negotiating
  • Conflict in negotiations
  • how resources are to be divided
  • resolving psychological dynamics and satisfying
    the personal motivation of those involved

55
Management Business
  • Resolving Disputes
  • Alternative dispute resolution (ADR)
  • binding finding and nonbinding arbitration
  • mediation
  • mini-trials
  • neutral fact
  • Legal action

56
Management Business
  • Need more in-depth resources?
  • Haimanns Healthcare Management, 7th ed by Rose
    T. Dunn, FACHE
  • Healthcare Strategic Planning Approaches for
    the 21st Century by Alan M. Zuckerman, FACHE,
    FAAHC
  • Health Service Management Readings and
    Commentary, 7th Ed., by Anthony R. Kovner, Ph.D.
    and Duncan Neuhaser, Ph.D.
  • The Leaders Change Handbook, by Jay A. Conger,
    Gretchen M. Spreitzer, and Edward E. Lawler III
  • Leadership for the Future Core Competencies in
    Healthcare, by Austin Ross, LFACHE Frederic J.
    Wenzel and Joseph W. Mitlyng
  • Managing Health Services Organizations and
    Systems by Beafort B. Longest, Jr., Jonathon S.
    Rakich, and Kurt J. Darr, J.D., Sc.D, FACHE
  • Mastering the Negotiation Process A Practical
    Guide for the Healthcare Executive, by
    Christopher L. Laubach
  • The Well-Managed Healthcare Organization, 5th
    Ed, by John R. Griffith FACHE and Kenneth R.
    White, Ph.D., FACHE

57
Management Business
  • Ready for some test questions?

58
Management Business Test Questions
  • Hospitals pursuing strategic alliances are faced
    with issues of vertical integration. One example
    of vertical integration is
  • Acquiring a long-term care facility.
  • Creating a super physician-hospital
    organization.
  • Developing a system of local hospitals.
  • Outsourcing laboratory services.

59
Management Business Test Questions
  • The concept of demand management consists of
  • Concurrent review.
  • Risk assessment.
  • Disease management.
  • Chart review.

60
Management Business Test Questions
  • You are planning to conduct an assessment of the
    utilization patterns in your organizations
    emergency department over the past three years.
    Which of the following techniques would be most
    appropriate? (186)
  • Strategic Planning.
  • Trend Analysis.
  • Situational Analysis.
  • Survey Research.

61
Management Business Test Questions
  • Which of the following is not an example of a
    marketing function?
  • Promoting the organization.
  • Convincing patients to select the organization.
  • Managing external relationships.
  • Reviewing organizational costs.

62
Management Business Test Questions
  • The arrival of women for obstetrical deliveries
    or patient flow in an emergency department can
    best be analyzed through the use of which
    technique?
  • Pert Charting.
  • Stochastic Modeling.
  • Gant Charting.
  • Monte Carlo Simulation.

63
Management Business Test Questions
  • All of the following are essential components of
    strategic planning except
  • The corporate mission statement.
  • Timetables for activity completion.
  • Competitive analysis.
  • Assessment of the external environment.

64
Management Business Test Questions
  • Operational planning can be correctly defined
    as
  • A function of establishing the annual budget by
    accumulating departmental information.
  • The process by which short range objectives and
    actions are established and implemented in
    accordance with the strategic plan.
  • An annual process of developing, evaluating and
    implementing goals based on community needs.
  • Determining the major types of services offered
    based on profit margins.

65
Management Business Test Questions
  • Which of the following statements best defines
    increased productivity?
  • An increase in productivity occurs when the
    number of units of service rendered in a given
    year increases over the number rendered in the
    previous year.
  • An increase in productivity occurs when an
    increase occurs in the volume or number of units
    of service rendered.
  • An increase in productivity occurs when a
    reduction occurs in the ratio of hours worked to
    the number of units of service rendered.
  • An increase in productivity occurs when an
    increase occurs in the revenue from a given
    number of full-time equivalent employees.

66
Management Business Test Questions
  • Materials management can best be defined as a
    system of effective
  • Purchasing of materials at the lowest possible
    cost.
  • Distribution of materials on a scheduled basis.
  • Allocation of materials.
  • Control of inventories.

67
Management Business Test Questions
  • Before submission of the annual business plan to
    the governing authority, the plan should be
    developed by
  • Recommendations from the finance committee, on
    the basis of its estimate of income for the
    budget year.
  • The heads of the profit centers, considering each
    centers anticipated revenues and expenses, with
    the CEO collating.
  • Key executives, after receiving recommendations
    from the head of operating divisions.
  • The heads of the operating divisions, with the
    CEO collating.

68
Management Business Test Questions
  • From a marketing viewpoint, the development of
    the standards of practice, clinical pathways,
    clinical guidelines and protocols can all be
    viewed as efforts to deal with which unique
    aspect of delivering services
  • Inseparability.
  • Intangibility.
  • Heterogeneity.
  • Perishability.

69
Management Business Test Questions
  • The master site plan (or master facility plan)
    for a healthcare organization
  • Describes future facility needs (either
    renovation or new construction) necessary to meet
    strategic and operational needs.
  • Provides detailed design documents for all
    construction programs along with specific costs
    for each project.
  • Must be prepared by an outside planning or
    architectural firm to ensure sufficient
    objectivity.
  • Is necessary to ensure that the organization
    complies with certificate of need and other
    regulatory requirements.

70
Management Business Test Questions
  • A master patient index (MPI) can best be
    described as
  • A relational database containing all
    identification numbers assigned to patients.
  • A system for converting social security numbers
    to medical record numbers.
  • A system for converting medical record numbers to
    patient account numbers.
  • A longitudinal record of all patient encounters
    for a fixed period of time.

71
Management Business Test Questions
  • A bar chart format, with the items rank ordered
    on a dependent variable, such as cost, profit, or
    satisfaction that examines the components of a
    problem in terms of their contribution to it is
    known as
  • A run chart.
  • A frequency table.
  • Pareto analysis.
  • Deming cycle.

72
Management Business Test Questions
  • The best way to reduce/contain the costs of
    distributing supplies throughout an organization
    is to
  • Purchase the most modern supply distribution
    system for your organization
  • Minimize the number of times an item is handled
    from the time it is received by the organization
    to the time it is used
  • Utilize a computerized materials management
    system that allows the organization to minimize
    inventory levels
  • Negotiate a contract with an outside vendor who
    specializes in supply distribution to provide
    these services

73
Management Business Test Questions
  • To guard against the loss of assets, an
    administrator should do which of the following?
  • Encourage off-site storage of equipment
  • Allow service directors to determine the
    frequency of asset inventories
  • Implement detailed procedures, risk control and
    annual outside audits

74
Management Business Test Questions
  • Medicare DRG payment is highly dependent upon a
    hospitals case mix index. This index represents
    the average relative weight for all Medicare
    patients treated in a
  • Specific nursing unit or specialty area
  • Specific period
  • Common geographic market
  • Specific facility

75
Management Business Test Questions
  • What is the first effect of demographic trends on
    a health service organizations strategic
    planning process?
  • Appraising financing sources and payment levels
    for programs.
  • Establishing future staff by type and estimating
    staffing levels.
  • Determining the locations of delivery units for
    the next period.
  • Determining the range and types of services to be
    offered.
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