Acute Care Facilities Flashcards
Number of Registered Hospitals
5,600+
Vertical vs. Horizontal Integration
Vertical - Hospitals (facilities), INSURANCE, and Physicians - Multi-hospital expansion can happen Horizontal - Hospitals and Physicians - Multi-hospital expansion can happen
Levels of Care
Primary - Doctors office and ER’s
Secondary - Everything between
Tertiary - Highly specialized, one on one care
- (i.e. Intensive Care Unit)
Quaternary - Teaching facilities
Community Hospital
Open to the general public and Non-federal
For Profit vs. Not For Profit
For Profit (1/3)
- Pay dividends to stockholders
-The board declares a dividend by separating dividends from RE
Not for Profit (2/3)
- CB (Community Benefits)
- Tax exemption
- Uncompensated care
□ Charity Care
□ Difference between Medicaid and Billed charges
- Retail PriceSpecialty Hospital
Any facility that is restricted in admissions
ALOS
Average Length Of Stay
- 5.2 days is the national average
C Suite
CEO COO CFO (can either report to the CEO or the COO) CNO and other Asst. Clinical and service department
Job of CEO
Take care of the Board, Community, and Medical Staff
Parts of Reimbursement
CMS 50%
Private/Commercial Insurance 40%
Out of Pocket 10%
Prospective vs. Retrospective
Prospective - there are predetermined rates that have already been set such as in CMS
Retrospective - The facility basically gives the insurance company the bill with a list of the charges and it’s either paid in full, part, or none at all
CPB and Process of it
Cost Plus Basis
- Find % of your Expense that was from Medicare
- This includes both operating and Capital expenses
- File a Cost Report
- Receive Prospective Interim Payments
- You are prepaid each quarter based on the passed year’s report
CBO
Congressional Budget Office
- The committee that determines the funds that you get is the Ways and Means Committee
CAH
Critical Access Hospital
- Certified to receive Cost Plus Basis Medicare payments
- All costs are covered plus at least 1%
- Must have less than 25 beds and must be rural
- Must be located at least 35 miles from any other hospitals
- Can have Swing Beds
- You can use the beds for either short or long term care without penalty
Disproportionate Share Hospital
- Can qualify for Cost Plus Basis
2. It must treat a higher % of CMS than the national average
Recuse
To remove yourself from the group due to possible conflict of interest
Fiduciary
A fiduciary is responsible for managing the assets of another person, or of a group of people
Goal of Board of Directors
- Declare the mission and vision of the facility
- Declare Policies and Procedures
- i.e. only qualified physicians can be members of the medical staff
Bylaws
A rule made by a company or society to control the actions of its members
OIG
The Office of Inspector General
- There to assure that all laws are fallowed
- One there for every cabinet position in the government
Governance
Governance
- Episodic
- Can only transact business when in session
- Must have a Quorum
- A majority or uneven number of people in the group so that they can rule in one direction or another
Management
- Ongoing or continual
2. Day to day activities
Executive Committee
Chair - Vice chair - CEO
CQI
Continual Quality Improvement. Looks at Quality of Care. Is lead by President of Medical Staff
What does the board want to know?
- If you were profitable
- Volume of patient services
- Total inpatient days
- Total outpatient visits
- Compare budget to actual to variance
- Productivity
- Productivity = Units of Service ÷ FTE’s ???
Income Statement Facts
Net Income = Retained Earnings
- RE aren’t liquid
Net income ÷ Net Revenue = Profit Margin
Balance sheet Fact
Tells you the net worth of your company
Operating Line of Credit
- Established with local bank
- You can flex into and out of for short term needs
- Must be paid off as quickly as possible
Average % profitability
-.7%
Advocacy Groups
For profit - Federation of American Hospitals (FAH)
Not for Profit - American Hospital Association (AHA)
Acute Care Definition
The treatment of injury and/or Illness
Acute vs. Critical Care
- Acute is primary/ secondary
2. Critical care occurs with anything above secondary care
Triage
The assignment of degrees of urgency to an illness or wound that determines the order to treat patients
How does the state grade facilities?
It uses Conditions of Participation to grade or grade a Facility
Deemed Status
If they have already been approved by the JC then the CMS doesn’t need grade them to
CMS
Centers For Medicare and Medicaid Services
Who Medicare covers and the Parts
65+ and disabled A - Reimburses acute care hospital inpatients B - Physicians and or outpatient C - Medicare supplemental D - Drugs
AHCA
American Health Care Association
AUPHA
Association for University Programs in Health Administration
ACHE
American College of Healthcare Executives
