Financial Decision Making Flashcards
Performance improvement
A method to improve organizational performance and individual performance
Data driven and emphasizes human performance factors
What is the point of discussing Management Decision Making?
direct organizational activities
to produce the best outcomes for ongoing activities
Decision-Making Methods
Project management
Operational planning
Business planning
Root Cause Analysis
technique used with performance improvement that ID’s the conditions that initiate and undesired state
What caused the problem?
What is the emphasis on with root cause analysis?
cause
fishbone diagram
Quality Improvement (QI)
Another group of data-driven methodologies to define and close the gap between the current state and expected performance outcomes
What is the emphasis on with quality improvement?
process
Tools for current operations performance analysis include
business intelligence system
decision support system
Business intelligence systems
Applications and technologies for gathering, storing, analyzing, and providing access to data
Decision support systems
Integrated computer support systems to manage organizations and aid in making rational decisions
Total Quality Management
a management technique devoted to exceeding customers expectations
Business Intelligence:
Applications and technology for gathering, storing, analyzing, and providing access to data to help make better business decisions
Data mining:
A class of database application that look for hidden patterns in data to predict future behaviors
Decision Support System:
DSS are computer applications that aid users in judgement and choice activities
American Hospital Association Quality Center recommends that management should know the answer to these 4 questions
- What is the rate of process variability?
- What is the rate of waste?
- What are the types of defects or errors?
- What is the overall rate of organizational variability?
Malcolm Bridge National Quality Criteria
Outcome driven performance management system with basis in data, analysis and knowledge
Six Sigma
Management system utilized with the goal of reducing errors up to 2+ standard deviations
Developed by Motorola in the 1980’s adopted in the US by GE in 1995
What does Six Sigma seeK?
improve the quality of process outputs by identifying and removing the cause of defects (errors) and minimizing variability in manufacturing and business processes
Key Principles of Lean Six Sigma
- Focus on the customer
- ID and understand how the work gets done (value stream)
- Manage, improve, and smooth the process flow
- Remove non-value added steps and waste
- Manage by fact and reduce variation
- Involve and equip the people in the process
- Undertake improvement activity in a systematic way
How does Six Sigma work practically?
Define Measure Analyze Improve Control
Define
problem to be solved, define everyone’s roles, define what you are doing and what is the goal
Measure
Clarify by seeing how the work gets done and measure how well it is done
Analyze
find out why things are working as well as they could. Manage by fact, get to the root cause
Improve
Find a way to address root cause, come up with ideas and select the best one. Then test it out.
Control
Achieve the goal you wanted and ensure the process continues and is carried out consistently
What is value?
what a customer is willing to pay for out of their pocket
International Organization of Standardization (ISO 9000)
Plan-do-check-act cycle
A plan-do-check-act cycle (PDCA) can be used:
Plan (assess ideas)
Do (pilot phase)
Check (examine pilot results to determine what went right and wrong)
Act (implementation)
Oversight:
Care involving agencies and private groups to prevent waste and fraud protect civil liberties accumulate info useful to lawmakers education of public ensure compliance with laws evaluate performance
What has oversight been tied to?
provider’s ability to participate under private and governmental insurance programs
Pay for performance
P4P
tie payment rates to oversight which is basically the idea behind Accountable Organizations (ACOs) in ACA
Administration for Children and Families Act (ACF)
head start
low income family support or childcare
Prevention of child abuse and domestic violence
Administration on Agining (AoA)
Meals on Wheels
Community service for elderly and their caregivers
What does Medicare provide insurance to?
those age 65 or older
those under age 65 with certain disabilities
everyone with end-stage renal disease requiring dialysis or a kidney transplant
Medicaid
Health insurance program for certain low-income people
Funded and administered jointly by a state-federal government partnership
What must a Medicaid program cover?
Inpatient and outpatient hospital services Laboratory and x-ray services Skilled nursing and home health services Doctors’ services Family planning Periodic health checkups Diagnosis and treatment for children
Agency for Healthcare Research and Quality (AHRQ)
Supports research to improved health care and reduce cost, improve safety and reduce errors
Center for Disease Control and Prevention (CDC)
Disease outbreaks, bioterrorism, disease prevention, immunizations, workplace safety, environmental disease prevention, international disease prevention
Food and Drug Administration (FDA)
drugs, medical and biological products
Health Resources and Services Administration (HRSA)
Health care access to poor and uninsured where health care is scarce
National Institutes of Health (NIH)
medical research organization
expand knowledge base to enhance national economic well being
Substance Abuse and Mental Health Service Administration
Provides grant to state for substance abuse and mental health services
Provide programs to increase the use of proven prevention and treatment methods
DOJ
mission to enforce the law and interest of the USA
State/Local Government Regulation
adult day care ambulance HIPPA Individual and Business background checks hospital regulation plan reviews of health care facilities
Occupational Safety and Health Administration (OSHA)
federal administration but works with state and local government
Inspect, investigators, engineers, physicians, educators, standard writers who look at the safety and health of America workers for workplace safety.
Which division of DOJ focus on antitrust regulation in healthcare?
Antitrust division of DOJ and Federal Trade Commission FTC
Non Governmental Oversight
Joint Commission
CARF
Hospital and Rehab Facilities
Joint Commission
Evaluates and accredits more than 15,000 health care organization in US
Corporate (Regulatory) Compliance
Noncompliance with Medicare/Medicaid coverage and reimbursement guidelines represents substantial risk to the health care provider.
Sanctions:
Recouping improper payments
Imprisonment for owners and managers
Exclusion from future participation in these programs
Corporate Compliance Program (CCP)
Organizations establish a CCP to lessen risks of intentional or unintentional regulatory noncompliance
Elements of a health services business CCP are
Organization structure for the program
Operational mechanisms to implement the program
Infrastructure to assure corporate compliance officer’s power to implement CCP program
Measures to prevent violations
Measures to respond to violations
CCP measures to prevent violations include
Organization-wide training on compliance standards, policies, and procedures
Continual efforts to recognize and respond to regulatory developments
Mechanisms to measure the effectiveness of the compliance program and adherence to related policies and procedures
Mechanisms to respond to identified compliance program weaknesses
CCP measures to respond to violations include
Monitoring
Responding to suspected compliance violations
Reporting suspected compliance violations
Protecting employees who report compliance violations
Policies to govern the reporting to the government of probable compliance violations
CMS
Medicare
Medicaid
SCHIP
Divisions fo HHS
Administration for Children and Adults
Administration on Aging
Agency for Healthcare Research and Quality
CDC
CMS
FDA
Health Resources and Service Administration
Indian Health Services
NIH
Substance Abuse and Mental Health Services Administration
US Public Health Service Commissioned Corp
