Exam 3

Question 1

Industry Sector Chart

Answer 1

Question 2

Industry Structure

Answer 2

Question 3

EBITDA

Answer 3

Earnings Before Interest Tax Depreciation and Amortization

Question 4

P4P

Answer 4

Pay for Performance

Doctors are incentivized to encourage their patients to be more active. Didn’t work because patients didn’t have any incentive

Question 5

IRB

Define and give a situation where it has been used

Answer 5

Institutional Review Board
A committee established to review and approve research involving human subjects. The purpose of the IRB is to ensure that all human subject research be conducted in accordance with all federal, institutional, and ethical guidelines.

Question 6

HIGPA

What was it and what is it now?

Answer 6

Healthcare Industry Group Purchasing Association

Question 7

What is the Rule of Thirds?

Answer 7

1/3 of ASC’s will make money

1/3 of ASC’s will lose money

1/3 of ASC’s will neither gain or lose money

Question 8

Indemnity Plans

Answer 8

Indemnity plans are designed to provide coverage for unexpected medical bills arising mainly through accident or illness, whereas managed care plans are based upon the principle of supporting care that is designed to prevent illness from developing in the first instance, or upon detecting and treating it, at an early stage, when treatment is often relatively simple and costs are low.

Question 9

Retail Health Clinics

Answer 9

Convenience clinics that generally give same day services and work on an outpatient basis. They can be accredited and are increasing in popularity by about 1.5% per year.

Question 10

Four most common surgeries performed in ASC’s

Answer 10

Orthopedics

Pain and neurology

Gastro intestinal

Opthomology

HIGPA changed HSCA

Question 11

Single Payer System

Answer 11

Nationalized health care

Quality of care would probably decrease because of lack of competition and there would also be more patients

Question 12

What is Vertical Integration and give an example of it.

Answer 12

Ownership of facilities + physicians + health insurance, under a single corporate structure.

Kaiser Permanente is a good example as it is a one stop shop type of place.

Question 13

Horizontal integration

Answer 13

The formation of multi-hospital systems from hospitals that were previously free-standing. (one type of facility)

Needs an example…

Question 14

Generations

Answer 14

Greatest Generation
Baby Boomers
Generation X-ers
Millennials (Generation Y)

Generation Z

Question 15

HIPAA

FCA

HCQIA

EMTALA

Stark

PPACA

Answer 15

1. HIPAA – Health Insurance Portability and Accountability Act of 1996
2. False Claims Act Senate Bill 2041
3. Healthcare Quality Improvement Act (HCQIA)-1986
4. EMTALA – Emergency Medical Treatment and Active Labor Act 19865.
5. Stark Legislation – preventing physicianself-referral.
6. Patient Protection and Affordable Care Act (PPACA)-March 23, 2010

Question 16

CMS and who qualifies

Answer 16

Centers for Medicare and Medicaid Services

Medicare: You are eligible if you are over the age of 65, disabled, or if you have kidney failure

Medicaid: - Limited-income families with children

• Children under age 6 whose family income is at or below 133%
• Pregnant women whose family income is below 133% FPL
• Infants born to Medicaid-eligible women
• SSI recipients in most states
• Aged, blind, disabled (state specific)
• Adoption or foster care assistance recipients
• Special Protected Groups
• All children under 19 in families at or below the FPL
• Certain Medicare beneficiaries

Question 17

Four technologies that ASC’s have/use

Answer 17

Arthroscope

Laproscope

Endoscope

Pill Cam

Question 18

Two reasons why natural orifice surgery isn’t mainstream yet and how long have they been in practice?

Answer 18

Not sure..

The cost of the new technologies and it hasn’t been tested on enough subjects

15-20 years

Question 19

Common organizational categories in a hospital

Answer 19

Administrative Services: Manage and oversee the “operation” of departments, Oversee budgeting and finance, Implement hospital policies and procedures as established by the Governing Board, and Perform public relations duties

Information Services: Document and process information

Therapeutic Services: All of the different therapies and the pharmacy

Diagnostic Services: To determine cause(s) of illness or injury

Support Services: Provide Support to the Entire Hospital

Question 20

Job requirements

Answer 20

For upper lever management you need to have a masters and generally at least 10 years of experience.

To be a manager you are generally required to have at least a bachelors and 1-5 years of experience

Question 21

GPO’s and three things that they do for hospital members

Answer 21

Group Purchasing Order

Pool purchasing dollars to exert leverage over suppliers

Lower unit costs for members

Negotiate & manage contracts

Question 22

What was the Anti-kickback law?

Answer 22

A law that says a company can’t offer a financial incentive (junket or other financial compensation) to a provider for use of their services or products (ONLY CMS)

Question 23

PPACA

Question 24

Two ways people on the governing board are put into office

Answer 24

Appointed and elected

Question 25

HSCA

Answer 25

Healthcare Supply Chain Association

Question 26

What are Disproportionate Share Payments?

Answer 26

The original rationale for the Medicare Disproportionate Share (DSH) payment adjustment was to compensate hospitals for the higher operating costs they incur in treating a large share of low-income patients. Low-income Medicare patients tend to be sicker and more costly to treat than other Medicare patients with the same diagnosis. Higher costs also result from the need for additional staffing and services, such as translators and social workers, to care for low-income patients.

Question 27

AUPHA

Answer 27

Association of University Programs in Health Administration