Title: Healthcare
1Jamie Phillips, FACHE Vice President,
Operations Nationwide Childrens Hospital
2Highlights
- Healthcare
- 24 questions for 14 of exam
- 8 knowledge areas
3Knowledge 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
4Healthcare
- 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
5Healthcare
- 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
6Healthcare
- 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
7Healthcare
- Traditional healthcare delivery system is a
sickness system - Focused on clinical interventions
- Treated patients after they presented to the
healthcare system
8Healthcare
- 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.
9Healthcare
- 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
10Healthcare
- Understand the continuum of care
- Acute
- Curative care
- Long-term rehabilitative/custodial care
- Palliative care
- Outpatient/ambulatory
- Inpatient/institutional
11Healthcare
- Settings of outpatient care
- home
- physician offices
- clinic-based settings
- outpatient departments of a hospital
- emergency departments of a hospital
12Healthcare
- Implications of types of inpatient care
- Service complexity
- Specialization
- Medical staff membership
- Ownership
- Breadths of ancillary services
- Level of acuity
13Healthcare
- Alternatives site of care
- Satellite facilities
- Joint venture partnerships with physicians
- Freestanding facilities
- Sub acute care
- Post-acute care
14Healthcare
- Horizontal vs. vertical integration
- Vertical expanding services up and down the
continuum of care - Horizontal increasing and integrating points of
care
15Healthcare
- 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?
16Healthcare
- 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.
17Healthcare
- Ready for some test questions?
18Healthcare 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.
19Healthcare 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.
20Healthcare 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.
21Healthcare Test Questions
- Which physician organization is responsible for
accrediting residency training programs? - ACGME
- AAMC
- CAT
- BPQA
22Healthcare 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.
23Healthcare 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.
24Healthcare 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.
25Healthcare 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.
26Healthcare 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.
27Healthcare 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.
28Healthcare 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.
29Healthcare 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.
30Healthcare 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.
31Healthcare Test Questions
- The principle goal of a Health Services
Organizations medical /hospital model is - Security.
- Disease treatment.
- Quality of life.
- Comfort.
32Healthcare Test Questions
- Which of the following regulations exempted
self-funded employer-sponsored health insurance
plans from state insurance regulations? - BBA.
- TEFRA.
- COBRA.
- ERISA.
33Healthcare 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.
34Healthcare 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.
35Healthcare 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 37Highlights
- Management
- 19 questions for 11 of exam
- 6 knowledge areas
- Business
- 20 questions for 12 of exam
- 7 knowledge areas
38Knowledge 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
39Knowledge 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
40Management 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
41Management Business
- The five management functions
- Planning
- Organizing
- Controlling
- Directing
- Staffing
- All are connected by decision making problem
solving
42Management Business
- Managing vs Leading
- Managing
- caretaking
- maintaining status quo
- transactional
- Leading
- visionary
- dynamic
- transformational
43Management 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
44Management Business
- Mintzbergs research managerial roles
- Interpersonal
- Figurehead
- influencer
- Informational
- Monitor
- spokesperson
- Decisional
- Entrepreneur
- negotiator
45Management Business
- Managerial competencies
- Conceptual
- Technical managerial/clinical
- Interpersonal/collaborative
- Political
- Commercial
- Governance
- others
46Management Business
- Managements authority or power
- Legitimate (formal)
- Reward
- Coercive
- Expert
- Referent
- Understand the risks and benefits of each
47Management Business
- Leader traits and skills
- Assertive
- Cooperative
- Decisive
- Dependable
- Intelligent
- Conceptually skilled
- Creative
- Persuasive
48Management Business
- Leadership styles (Likert)
- Autocratic
- Benevolent
- Consultative
- Participative/democratic
49Management Business
- Designing Formal Organizations
- Genesis in the planning function
- Authority and responsibility relationships
- Departmentation
- Coordination and relationships of components
50Management Business
- Levels of Organization
- Health systems composed of health service
organizations - Health service organizations
- Clusters of workgroups (clinical groups)
- Workgroups (departments, teams)
- Individual positions
51Management 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
52Management 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
53Management Business
- Contingency planning
- Anticipating the unknown
- Mitigating the potential negative implications
- Turning the unknowns into economic or competitive
advantages - External disasters
- Internal disasters
54Management 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
55Management Business
- Resolving Disputes
- Alternative dispute resolution (ADR)
- binding finding and nonbinding arbitration
- mediation
- mini-trials
- neutral fact
- Legal action
56Management 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
57Management Business
- Ready for some test questions?
58Management 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.
59Management Business Test Questions
- The concept of demand management consists of
- Concurrent review.
- Risk assessment.
- Disease management.
- Chart review.
60Management 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.
61Management 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.
62Management 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.
63Management 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.
64Management 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.
65Management 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.
66Management 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.
67Management 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.
68Management 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.
69Management 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.
70Management 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.
71Management 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.
72Management 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
73Management 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
74Management 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
75Management 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.