Exam 3 Flashcards
Industry Sector Chart
Industry Structure
EBITDA
Earnings Before Interest Tax Depreciation and Amortization
P4P
Pay for Performance
Doctors are incentivized to encourage their patients to be more active. Didn’t work because patients didn’t have any incentive
IRB
Define and give a situation where it has been used
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.
HIGPA
What was it and what is it now?
Healthcare Industry Group Purchasing Association
What is the Rule of Thirds?
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
Indemnity Plans
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.
Retail Health Clinics
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.
Four most common surgeries performed in ASC’s
Orthopedics
Pain and neurology
Gastro intestinal
Opthomology
HIGPA changed HSCA
Single Payer System
Nationalized health care
Quality of care would probably decrease because of lack of competition and there would also be more patients
What is Vertical Integration and give an example of it.
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.
Horizontal integration
The formation of multi-hospital systems from hospitals that were previously free-standing. (one type of facility)
Needs an example…
Generations
Greatest Generation
Baby Boomers
Generation X-ers
Millennials (Generation Y)
Generation Z
HIPAA
FCA
HCQIA
EMTALA
Stark
PPACA
- HIPAA – Health Insurance Portability and Accountability Act of 1996
- False Claims Act Senate Bill 2041
- Healthcare Quality Improvement Act (HCQIA)-1986
- EMTALA – Emergency Medical Treatment and Active Labor Act 19865.
- Stark Legislation – preventing physicianself-referral.
- Patient Protection and Affordable Care Act (PPACA)-March 23, 2010
CMS and who qualifies
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
Four technologies that ASC’s have/use
Arthroscope
Laproscope
Endoscope
Pill Cam
Two reasons why natural orifice surgery isn’t mainstream yet and how long have they been in practice?
Not sure..
The cost of the new technologies and it hasn’t been tested on enough subjects
15-20 years
Common organizational categories in a hospital
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
Job requirements
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
GPO’s and three things that they do for hospital members
Group Purchasing Order
Pool purchasing dollars to exert leverage over suppliers
Lower unit costs for members
Negotiate & manage contracts
What was the Anti-kickback law?
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)
PPACA
Two ways people on the governing board are put into office
Appointed and elected
HSCA
Healthcare Supply Chain Association
What are Disproportionate Share Payments?
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.
AUPHA
Association of University Programs in Health Administration
