Final Review! Flashcards
What is the revenue cycle? What is revenue?
The revenue cycle is the process in which a company from a service gains revenue. Revenue is money derived from a company’s core business.
What’s the average number of days of revenue in accounts receivable for US hospitals?
46 days
What’s a benchmark?
A benchmark is national average or standard against which a company can measure itself.
Who is the audience for the primary performance indicators?
The board
Who is the audience for secondary perormance indicators
The staff
What’s the formula for profitability?
net income/net revenue = profit margin
What’s the formula for productivity?
Units of service/FTE (full time equivilants)
FTE = 2080 hours (40 a week x 52 weeks)
How do you figure out net income?
Gross Revenue
* Deductions from Gross Revenue
1. Bad Debt
2. Charity Care
3. Contractual Allowance
Net Revenue = Gross Revenue - Deductions
Expenses
* SWB (most of the expenses)
* Supplies, depreciation, etc.
Net income = Net Revenue - Expenses
In healthcare, what does “ambulatory” mean?
Outpatient
When, by whom and in what state was the first ASC begun?
1970 by some anesthesiologists in Arizona.
What’s the nosocomial rate in hospitals as opposed to ACSs?
4% in hospitals, .5% in ASCs
What are the 6 types of scope-based tech that are used in surgical procedures?
Arthroscopy Endoscopy Laparoscopy Laryngoscopy Colonoscopy Sigmoidoscopy
What’s a CASC admin?
A certified administrator of surgery centers
Who owns the highest percentage of freestanding ASCs?
Physicians…duh.
ASCs are not allowed to markup _____?
Inplants
How many inpatient beds do ASCs have?
None!
About how many acute care hospitals are there in the US?
About 5,500
What is acute care?
Medical care for the ill or injured. Short term care.
What advocacy organizations represent:
Non-for-profit hospitals?
For-profit hospitals?
AHA (American Hospital Association)
FAH (Federation of American Hospitals)
What does triage mean?
Triage means to separate cases into the 3/4 levels of care/acuity: Primary Secondary Tertiary Quaternary
What are the levels of care and where do they most commonly occur?
Primary = diagnosing and planning for treatment (physicians office, ER)
low acuity
Secondary = Anything for which you are admitted into a hospital. Admitted surgery with a medium acuity.
Tertiary = Level of care that requires at least one-on-one nursing. Generally takes place in an ICU. High acuity.
Quaternary = Experimental procedures and research not yet approved by FDA. Must be approved by IRB. Considered a kind of off-shoot of tertiary care
What does CMS stand for?
Centers for Medicare and Medicaid Services
What are the 4 parts to the Medicare program?
Part A - Inpatient Services
Part B - Outpatient and Physician Services
Part C - Medicare advantage. Contract with 3rd party insurance. A+B
Part D - Drugs!
A critical access hospital may not have more than ___ inpatient beds.
25
Disproportionate Share Hospitals care for more than the national average of _____ patients.
CMS
What is the OAA and when was it enacted?
The Older Americans Act in 1965.
Identify the 4 levels of long term care (from least to most intense)
Home Care
Assisted Living
Nursing Home
Skilled Nursing Facility (SNF)
What is an ADL and what 5 are there?
Activities of Daily Living
Ambulating Toileting Bathing Eating Medicating
What’s the biggest source of payment for LTC?
Private pay
What percentage of LTC is paid by Medicare?
0%!
What’s the biggest operational challenge in LTC?
HR, for sure. There’s large turnover and issues of pay and benefits.
Why do we treat rehab facilities as different from LTC?
Rehab is more about the acute care side of LTC. They have their own conditions of participation and are focused specifically on rehab.
Think PT, OT, ST and RT
What are the 5 things physicians value?
Quality Care Time (money) Efficiency Autonomy Control
What percent of group practices are HOGs?
70%. Doh!
What are the 8 managerial challenges of medical group practice?
Business operations Quality management Financial management Human Resources Risk Management Information Management Organizational Governance Patient Care
ABMS
American Board of Medical Specialties
ACHE
American College of Healthcare Executives
ACOG
American College of Obstetricians and Gynecologists
AHA
American Hospital Association
ALOS
Average Length of Stay
AMA
American Medical Association
ANA
American Nurses Association
ASCA
Ambulatory Surgical Center Association
CRNA
Certified Registered Nurse Anesthetist
DHHS
Department of Health and Human Services
DME
Durable Medical Equipment
DO
Doctor of Osteopathy
DPM
Doctor of Podiatric Medicine
FDA
Food and Drug Administration
HFMA
Hospital Financial Management Association
HIPAA
Health Insurance Portability and Accountability Act
HMO
Health Maintenance Organization
HOPD
Hospital Outpatient Department
HSCA
Healthcare Supply Chain Association
IRB
Institutional Review Board
ISO
International Organization of Standards
NICU
Neo-natal Intensive Care Unity
OPPS
Outpatient Prospective Payment System
PACU
Post anesthetic payment system
PCP
Primary Care Physician
PIP
Periodic Interim Payment
What’s the definition of hospice and palliative care?
Hospice is pain management at the end of life.
Palliative care is addressing emotional, social, and spiritual care, for both those dying and those that are just recovering in an acute care setting.
