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Leadership 2 > Exam 1 > Flashcards

Exam 1 Flashcards

1
Q

vision 2025 pillars

A

Effective: Occupational therapy is evidence based, client centered, and cost-effective.

Leaders: Occupational therapy is influential in changing policies, environments, and complex systems.

Collaborative: Occupational therapy excels in working with clients and within systems to produce effective outcomes.

Accessible: Occupational therapy provides culturally responsive and customized services.

Equity, Inclusion, and Diversity: We are intentionally inclusive and equitable and embrace diversity in all its forms

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2
Q

policy

A

management of affairs based on material interest

goals/procedures that guide decisions

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3
Q

US healthcare system

A 
most expenditures
#45 in life expectancy
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4
Q

six domains of healthcare quality

A

(SEPT-EE)

Safe
Effective
Patient- centered
Timely
Efficient
Equitable
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5
Q

IHI Triple Aim

A

population health
experience of care
per capita cost

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6
Q

how a new law works

A

congress passes bill, president signs as a statute, write regulations, state proposals for implementation, pass state laws/budget, approve or disapprove

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7
Q

affordable care act

A

increase access and quality of health insurance

can remain on parent’s insurance until 26

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8
Q

NIFIB vs. Seleblius

A
  • ruled in favor of the ACA
  • obamacare declared a tax and not a mandate
  • *states can opt out of expanding medicaid
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9
Q

King v. Burwell

A
  • ruled in favor of the ACA

- upheld subsidies declaring them legal

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10
Q

Tax cuts and Jobs act

A
  • reduced the amount of the individual shared responsibility payment to $0 for months
  • healthcare insurance coverage no longer reported on IRS documents
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11
Q

habilitation services

A

help keep, learn, or improve skills and functioning

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12
Q

rehabilitative services

A

get back previously learned skills

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13
Q

scanning the healthcare horizon

A

continued AOTA member, promote value of OT

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14
Q

long term goal of any organization

A

sustainability
survival
revenue - expenses = profit

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15
Q

business aspects of practice

A

who, what, where, when, how, why

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16
Q

traditional business

A
  • ownership by sole proprietor, partnership, corporation, or shareholders
  • may or may not have a board with bylaws
  • typically have a business plan
  • NOTTTTT eligible for tax deductible charitable donations
  • expenses typically tax deductible for owners and staff with limitations
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17
Q

non-profit

A
  • 501 c-3 tax category
  • initial and ongoing application to IRS
  • bylaws and board provide oversight
  • typically have a nonprofit business plan
  • typically 1+ paid staff to run it
  • eligible for tax deductible charitable donations
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18
Q

employees

A
  • W2/W4
  • insurances typically covered by employer
  • structured work schedule, hourly or salary
  • eligible for worker’s comp
  • taxes take out of each paycheck
  • 50+ employees must provide benefits
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19
Q

independent contactor

A
  • 1009 contractor
  • self employed, operates independently under own or company name
  • responsible for own taxes
  • own hours, own insurance
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20
Q

sustainability 4 things

A

clients
staff
location
LIFT

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21
Q

LIFT

A
  • legal regulations
  • insurance/liability
  • financial management
  • taxes
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22
Q

expenses

A 
mortgage/rent
admin/staff
marketing/promotion
utilities/insurance
communications/tech
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23
Q

revenue

A 
insurance
grants
corporate sponsorships
individual donors
state/nat gov
cash/out of pocket
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24
Q

business administration

A
  • process of organizing business personnel and resources to meet goals and objectives
  • human resources, operations management, finances, marketing
  • ability to evaluate and make strategic business decisions in changing environments
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25
Q

business development

A
  • pursuing strategic opportunities for an organization

- cultivating partnerships and identifying are markets for products/services

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26
Q

differences between business admin and development

A

admin - in education, skills to manage the process, evaluate/approve business dev

dev - process, any level of business, growth, sustainable and profitable

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27
Q

8 essential steps in business development

A
  1. plan
  2. management
  3. project
  4. investment
  5. research
  6. strategy
  7. marketing
  8. innovation
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28
Q

branding

A
  • the value, emotion, and reputation a consumer gives any organization, product or service
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29
Q

components of branding

A

promise, trust, engagement, longevity, positioning, projecting, preference

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30
Q

traditional 4 Ps of marketing

A

Place
Promotion
Product
Price

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31
Q

principles-based marketing for OT services

A
  • internal marketing
  • benefits development
  • program/product dev
  • targeting
  • channels
  • differentiation
  • setting
  • positioning
32
Q

medicare part A

A
  • covers care for 65+ with in patient stays

- hospitals, hospice, home health, SNIF

33
Q

medicare part B

A
  • supplemental insurance, which covers out patient, some AE
  • need for skilled care
  • AOTA offers a faulty payment program (QPP) and merit based incentive payment system (MIPS)
  • 8 min rule for CPT codes for OP therapy
34
Q

eligibility for parts A and B

A

65+
OR
- receiving social security disability benefits for 24 months
- dx of ALS or end stage renal disease w/ dialysis or kidney transplant

35
Q

medicare part C

A
  • medicare advantage, extra supplemental insurance

- higher payment rates

36
Q

medicare part D

A
  • covers drugs (not OT)
37
Q

medicaid

A
  • covers aid for disabled and low income individuals
  • early intervention 0-3
  • COBRA safety net insurance
  • funded and regulated by federal and state gov
38
Q

medicaid eligibility

A

disabilities

low income

39
Q

early intervention

A

0-3 with developmental delays or diagnosis

  • federal gov regulation
  • IDEA part C
  • home environment
40
Q

private pay

A

typically follow medicaid and medicare guidelines
networks of preferred providers
(blue cross, aetna, united healthcare)

41
Q

Tricare

A
  • federally funded insurance for active duty service members and families
  • highly regulated policies for provision of services
42
Q

budget

A
  • a plan for income and expenses
43
Q

financial terms

A

income - any financial transaction that comes in from sales of goods/services
revenue - total amount of income from sales
expense - any financial cost of doing business
profit - difference between amount earned and spent

44
Q

can OTs diagnose?

A
  • must use clinical judgement to select tx dx codes that correspond to the client’s condition and intervention
  • support medical necessity
45
Q

ICD-10

A

WORLD
official system of assigning codes to diagnoses and procedures associated with hospital utilization
- alphanumerical list

46
Q

Level I of healthcare common procedure coding system (HCPCS)

A
  • identify medical services and procedures furnished
    by healthcare professionals for billing public or private insurance
  • numeric system (5 digits)
  • some are “untimed codes” at least 1 unit
47
Q

low complexity eval code

A

untimed

  • OT profile and history
  • brief
48
Q

moderate complexity eval code

A

untimed

  • OT profile and history
  • expanded review and additional review of aspects of functional performance
49
Q

high complexity eval code

A

untimed

  • OT profile and history
  • extensive additional review of related functional performance deficits
50
Q

re-eval code

A

untimed

  • assessment of changes in patient functional or medical status
  • update to the initial occupational profile that reflects changes in condition that affect goals
  • revised plan of care
51
Q

Level II of healthcare common procedure coding system (HCPCS)

A
  • coding for orthotics, prosthetics, and DME

- ambulance

52
Q

process of OT documentation

A

Referral –> entering services –> continuing services –> exit services

53
Q

AOTA guidelines for documentation/common types of OT reports (4)

A
  1. screening
  2. evaluation/reevaluation
  3. intervention
  4. outcomes (discharge/discontinuation)
54
Q

AOTA perform screening, eval, and assessment documentation

A
  • medical and therapy history
  • occupational profile
  • analysis of occupational performance
  • intervention/plan of care
55
Q

screening

A
  • initial brief assessment to determine client’s need for OT evaluation or referral to another service (e.g.- PT, SLP, psych, etc.)
    •Includes professional judgment on appropriateness of need for a complete OT evaluation
    •Not considered an OT evaluation
56
Q

evaluation

A

Show the patient’s functional limitations at baseline and relate to the patient’s functional goals
•Documents referral source and data gathered through the evaluation process in accordance with payer, facility, state, and/or federal guidelines
•Four primary elements: Medical and therapy history, Occupational profile, Analysis of occupational performance, Intervention Plan/Plan of Care

57
Q

Selecting Assessment Tools and Methods

A

•CMS requires practitioners to include in their documentation of evaluation:
•Results of a specified performance measure tool or an explanation of certain factors that describe the patient’s status in relation to goals to be achieved.
***•Clinical observation is an important assessment tool.

58
Q

re-evaluation report

A

-similar to evaluation in terms of analysis of occupational performance
•Typically conducted when required by insurance or if a patient has a significant change in status

59
Q

intervention plan

A

documents occupation-based goals, intervention approaches, discontinuation criteria, and discharge

60
Q

contact/treatment note

A

record types of interventions used and client response/progress•Frequently uses “SOAP” Note format •Treatment activities should always be tied back to functional goals from most recent assessments

61
Q

progress report

A

Summarizes intervention process and documents client progress toward goals
•Typically conducted after ≤10 visits; may be monthly or quarterly in some settings
•Initial assessments re-administered to measure progress toward goals
•Goals modified/updated to reflect patient progress or if all goals met with no additional goals

62
Q

transition plan

A
  • discharge report
  • summary, recommendations
  • consider continuum of care*
63
Q

strategies for documentation

A
  • if it is not documented, it did not happen
  • appropriate abbreviations
  • insurance limitations
  • do not delete errors (cross it out, initial and date it)
64
Q

DME codes

A

orthotics and prosthetics

durable medical equipment

65
Q

ACA impacts on OT

A
  • Increase in the number of potential clients as formerly uninsured persons gain access to health insurance coverage for OT.
  • In participating states, increased access to OT services–which in most cases will have to be covered as essential health benefits.
  • Provide habilitative services, which will have to be covered to some degree for most of the newly insured population
66
Q

business development what, how, and why

A

What: Create and implement innovative OT ideas that affect service provision, policy change, product design, educational curriculum, access to services, financial outcomes, and patient outcomes

How: Activities extend across different departments including sales, marketing, project management, product management, and vendor management. Networking, negotiations, partnerships, and cost-savings efforts are also involved. Business administration skills are used to manage and combine all of the interdisciplinary management aspects to drive business towards a common goal.

Why: The ideas, initiatives, and activities aimed towards making a business better. Includes increasing revenue, growth in terms of business expansion, increasing profitability by building strategic partnerships, and making strategic business decision

67
Q

exiting OT services reasons

A

meet all goals
geographical move
progress plateaus
facility change

68
Q

internal marketing

A

Training and support of organization employees to ensure achievement of marketing goals

69
Q

benefits development

A

Distinguishing between features and benefitsis a key component in marketing and advertising activities

70
Q

program/product development

A

Programs and products are developed and reevaluated on a cyclical basis, usually part of a continuous quality improvement program.

71
Q

targeting

A

the portion of the marketplace that the marketer wishes to influence

72
Q

channels

A

sets of people and institutions that perform the functions necessary to move a product or service from a producer/provider to an end-user—the consumer.

73
Q

differentiation

A

Differentiation distinguishes one’s company or organization’s competitive advantage over another. Demonstrating higher technical quality, improved outcomes, increased accessibility, innovation, service, lower cost, or better value are all ways to achieve differentiation.

74
Q

selling

A

The ultimate goal of marketing is to make a sale.Occupational therapy practitioners often have a problem with the ideaof selling their services, but to promote the benefits of the profession,we must maintain a stance of providing positive outcomes for ourclients at a fair market value

75
Q

positioning

A

designing a company’s image so that the target market understands and appreciates what the firm stands for, in relationship to its competitors

Leadership 2 (2 decks)

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