HCA 1 Flashcards
What does NACHRI stand for?
National Association of Children’s Hospitals and Related Institutions.
What is Minimally Invasive Surgery?
Use of fiber optics, guide images, microwaves and other technologies to do surgery rather than cutting large sections of tissue.
What is an ASC?
Ambulatory Surgery Center, normally costs 50% less than an inpatient hospital procedure because they practice line by line billing.
What does HHS stand for?
Department of Health and Human Services.
What is Laparoscopy?
Laparotomy performed with a laparoscope that makes a small incision to examine the abdominal cavity (esp. ovaries and Fallopian tubes).
What is Endoscopy?
Inspection of body organs or cavities using a lighted scope that may be inserted through an existing opening or through a small incision.
What is Phacoemulsification?
Method to remove cataracts in which an ultrasonic needle probe breaks up the lens, which is then aspirated.
What is Arthroscopy?
A minimally invasive operation to repair a damaged joint.
What is Natural Orifice Surgery?
Abdominal surgery where the entrance wound is through either the stomach or through the vagina.
What is a Single Payer System?
Government run healthcare system. Healthcare system is made up of a) cost, b) access and c) quality.
What is Altruism?
Helping people.
What is a Supply Chain?
Taking raw materials and processing them until they become a useable good.
What is Evidence Based Medicine?
Used EMR’s to compile statistics to determine the ‘best practice.’
What does Compliance refer to?
The % of goods and services used in hospitals that have been negotiated with the GPO’s.
What is Indemnity Insurance?
‘Standard’ type of health insurance individuals can purchase, provides comprehensive major medical benefits and allows insured individuals to choose any physician or hospital when seeking medical care.
What is a PPO?
Preferred Provider Organization. A prepaid health insurance plan in which providers agree to deliver services for discount fees; patients can go to any provider, but using nonparticipating providers results in higher costs to the patient. Part of managed care.
What is an HMO?
Health Maintenance Organization. A prepaid health insurance plan in which patients receive health care from designated providers. Part of managed care.
What are National Insurance Costs?
The average US family pays $14,000 a year for insurance coverage with 3/4 being paid by the employer and 1/4 being paid by the employee.
What is the Patient Protection and Affordable Care Act?
This is the health care reform law. Focuses on reform of the private health insurance market; providing better coverage for those with pre-existing conditions; improving prescription drug coverage in Medicare.
What is the Corporate Structure of Hospitals?
1) Department Heads; 2) Medical Executive Committee; 3) Board.
What is an Accountable Care Organization?
A term used in the Patient Protection and Affordable Care Act to define an ideal healthcare organization able to have very low costs caused by successful capitalization on medical goods and services.
What is Common Law?
A civil law established by following earlier judicial decisions.
What are Statutes?
Laws enacted by a state or federal legislature that in certain cases can overwrite common law.
What is an Executive Order?
A rule issued by the president that has the force of law.
What is Civil Law?
Wrongs against a particular person or organization.
What is a Tort?
Any wrongdoing for which an action for damages may be brought.
What does declining reimbursement refer to?
Less resources to recruit, compensate, and develop workforce.
What does declining supply of workers mean?
Shortage of skilled workers.
What does increasing population need refer to?
Increased volumes of patients and workload for HSO.
What are external pressures on HSO’s?
HR must ensure high performance in HSO.
What is the National Labor Relations Act?
1935 law that provides bargaining units and collective bargaining in hospitals and health service organizations.
What is the Fair Labor Standards Act?
1938 law regulating minimum wage, overtime pay, and minimum worker ages.
What is the Equal Pay Act?
1963 law prohibits discrepancies in pay between men and women.
What is the Civil Rights Act?
1964 law that prohibits discrimination based on gender, race, or religion.
What is the Age Discrimination in Employment Act?
1967 law that prohibits discrimination of employees 40 years and up.
What is the Occupational Safety and Health Act?
1970 law that requires employers to maintain a safe workplace and adhere to standards specific to healthcare employers.
What is the Rehabilitation Act?
1973 law that protects rights of handicapped.
What is the Employee Retirement Income Security Act?
1973 that grants protection to employees for retirement benefits to which they are entitled.
What is the Pregnancy Discrimination Act?
1978 law stating that pregnancy is considered a medical condition and prohibits exclusion of pregnancy in benefits and leave policies.
What is COBRA?
Consolidated Omnibus Budget Reconciliation Act: 1986 law that gives benefits like health coverage for a limited time due to various circumstances like termination, layoff, death, reduction of hours per week, and divorce.
What is the Immigration Reform and Control Act?
1986 law that establishes penalties for employees who knowingly hire illegal aliens.
What is the Worker Adjustment and Retraining Notification Act?
1986 law that requires employers who will make a mass layoff or plant closing to give 60 days advance notice to affected employees.
What is the Americans with Disabilities Act?
1990 law that gives people with disabilities access to public services and requires employers to provide reasonable accommodation for applicants and employees.
What is the Family Medical and Leave Act?
1993 law that permits employees in organizations to take up to 12 weeks of unpaid leave each year for family or medical reasons.
What is the Health Insurance Portability and Accountability Act?
2003 law that guarantees employees protection from outside access to personal health info and limits employers’ ability to use employee health info under health insurance plans.
What are conceptual skills?
Ability to critically analyze and solve complex problems.
What are technical skills?
Expertise or ability to perform a specific work task.
What are interpersonal/human relation skills?
Enables a manager to communicate with and work well with other individuals.
What is a functional organizational structure?
Most common organizational structure; pyramid shaped; used in larger organizations; deep vertical structures; strict chain of command ensures that communication and assignment and evaluation of tasks are carried out; used most frequently in HSO’s.
What is the matrix management method?
Administrative structure; dual authority system where individuals are assigned to complete specific work tasks; advantages are improved coordination and communication, also increases flexibility of organization to carry out work.
What is product/service line management?
Organized around selected services to control service delivery; Advantages are resource control, accountability, enhanced clinical quality of service.
What does environment for HSO’s refer to?
Entities and influences outside of the organization’s boundaries.
What are open systems?
Organizations which are affected by, and also affect, their environment.
What are exchange relationships?
Transaction between 2+ organizations where something of value is exchanged and both gain value.
What is the input/output management model?
Management acquires inputs, uses inputs to provide services, and creates outputs.
Who are managers?
Persons appointed to positions of authority who enable others to do their work effectively, who have responsibility for resource utilization, and who are accountable for work results.
What are line managers?
Those that supervise other employees.
What are staff managers?
Those that carry out work and advise their bosses.
What are the 6 management functions?
1) Planning; 2) Organizing; 3) Staffing; 4) Controlling; 5) Decision-Making; 6) Directing.
What is organizing?
Establishing authority and responsibility management.
What is staffing?
Acquiring and retaining human resources.
What is directing?
Initiating action in the organization by leading, motivating, and communicating.
What is controlling?
Monitoring, adjusting, and improving aggregate performance.
What is decision making?
Evaluating alternatives and making choices.
What are managerial tasks?
Include core tasks, routine add-ons, and specialty add-ons.
What are the domains of management?
1) Self; 2) Team/Work Unit; 3) Organization.
What is organizational culture?
Ingrained patterns of shared beliefs, values and behaviors, with associated symbols and rituals, that are acquired over time by members.
What is direct care?
Deals directly with the patients such as a hospital, nursing home, physician practice, and assisted living facilities.
What is indirect care?
Supports the care of individuals through products and services made available to direct care settings. Ex) Consulting firms, associations, pharmaceutical companies, and medical suppliers.
What percentage of expenditures in healthcare goes to pay the workforce?
70%.
What are contracts?
The most basic/important item in business relationships.
What is a restrictive covenant?
Worst provision for the employee in a contract.
What is an at will contract with or without restrictive covenant?
What is the best deal for employer in a contract?
What is a contract with money/stability and free agency?
What is the best deal for you in a contract?
What are patients and skills?
As a physician what are your bargaining tools in a contract?
What is a covenant?
Restriction on free agency.
What is an integration clause?
Tells us what the whole deal is.
What is an ADR provision?
How we’re going to resolve disputes.
What are the maximum notice possible and severance?
What provisions are best for you in a termination without cause?
What are the 2 key principles in hiring?
Fairness and consistency.
What is a business plan?
Good place to start on how to set up your practice: 1) Executive summary; 2) Mission statement; 3) Ownership/management; 4) Market analysis; 5) Financing; 6) Projected patient base/referral sources; 7) Services; 8) Location; 9) Assets; 10) Operational plan; 11) Human Resources; 12) Marketing.
What must reimbursements for physician services be?
These must be credentialed!
What is joint several liability?
Risk is that if one person screws up, all in the partnership are liable.
What is LLP?
Limited liability partnership: Risk is that liability is limited individually.
What is an LLC?
S-corporation.
What is accessibility?
What is the most important factor in choosing a location for your practice?
What is the statute of frauds?
What says that leases/realty agreements must be in writing?
What is the sales maximum to be eligible for an SBA loan?
15M.
What are adverse occurrences?
What on your record is very bad for credentialing criteria?
What do audits and penalties cover?
In your insurance, what does regulatory liability cover the costs of?
What is D&O insurance?
Protects directors and officers in corporations.
Can unemployment or worker’s comp be waived?
No.
What is most important in regards to suppliers and equipment?
Quality.
How many years must patient records be kept?
7.
What are the 4 philosophies of risk management?
1) Avoidance; 2) Reduction of effect–or risks; 3) Transfer; 4) Acceptance.
What is lean?
Main goal = reducing waste reduces risk to practice. Achieve high quality, defect-free medicine.
What is the worst waste in healthcare?
Patient’s death.
What are the key LEAN principles?
The patient comes first. Care must be of the highest quality. Promote efficiency. ID/remove practice/treatment defects. Maximize business safety. Organize all elements of practice. Eliminate all waste.
What is the most important possible LEAN benefit?
Less waiting time for patients.
What is the biggest risk in a practice?
Profitability.
What is Heijunka?
Leveled production, no bottlenecks or waste.
What is Jidoka?
The safety element/be watchful for all defects.
What is the 5 S theory?
Sort, Simplify, Sweep, Standardize, Self-discipline/sustain.
How many million people are uninsured?
46.
What is process engineering?
Focus on design, operations, control and optimization of processes through the aid of systemic efforts.
What is world class leadership?
What is MOST critical to LEAN?
What is everyone’s job in a practice?
Safety.
Who does arbitration favor?
Employer.
How many million people are underinsured?
25.
What is the Affordable Health Choices Act?
Same as house bill but more emphasis on prevention and wellness.
What is The Care Triad?
Quality, Cost, Access.
How many thousands of patients die each year from medical errors?
98.
What is the Hill Burton Act?
Instigated after WWII: most community hospitals est. as a result of this act, provided funds for community hospitals.
Who are top managers?
(#1) CEO, Chief Executive officer, COO, owners, VP’s of finance, marketing.
Who are middle managers?
(#2) Largest category–they lead and follow at the same time, comprised mostly of dept. heads.
Who are first line managers?
(#3) Supervisors who organize how will things get done, using resources.
What are the responsibilities of a CEO?
Responsibilities include: planning rather than executing, relations with governing board, external relations, leadership, ceremonial functions.
What are the responsibilities of a COO?
Responsibilities include: mostly internal and execution, delivers short-term expectations for cost, demand, quality, patient satisfaction, employee satisfaction; link between strategy/performance; can be chief medical officers or chief nursing officers.
What are the responsibilities of a CFO?
(Chief Financial Officer) Responsibilities include: finance, accounting, protections of assets, reimbursement job.
What are the responsibilities of a CIO?
(Chief Information Officer) Responsibilities include: information services and planning, medical records, technology, computers, electronic records.
What are the responsibilities of a CMO?
(Chief Medical Officer) Responsibilities include: medical staff relations, medical education, physician recruitment, top manager that takes care of all staff issues.
What are the responsibilities of a CNO?
(Chief Nursing Officer) Responsibilities include: nursing, staff planning, recruitment, inpatient care, top nurse plans.
What is proactive coordinating?
Activities that anticipate and prevent problems.
What is reactive coordinating?
Activities aimed at fixing structural and functional arrangements.
What are measurement and control systems?
Collect data and reward specific behaviors is a way to determine performance.
What is Theory X?
Belief that the average employee hates work, avoids work and tries to get by with doing as little as possible.
What is Theory Y?
Belief that most employees consider work natural and that most are eager to do the right thing, seek responsibility under the proper conditions, exercise self-control and do not need to be constantly reminded to do their work.
What is formal authority theory?
Originates at the top of the organizational hierarchy and is delegated downward from superiors to subordinates.
What is acceptance authority theory?
Addresses the role of subordinates in managerial authority in bottom up-approach.
What does DMAIR stand for?
Design.
What is Theory Y?
Belief that most employees consider work natural and are eager to do the right thing, seek responsibility under proper conditions, exercise self-control, and do not need constant reminders.
What is acceptance authority theory?
Addresses the role of subordinates in managerial authority in a bottom-up approach.
What does DMAIR stand for?
Design, Measure, Assess, Improve, Redesign.
What is the Fair Labor Standards Act of 1938?
Establishes minimum wage, overtime pay, and record keeping.
What does OSHA stand for?
Occupational Safety and Health Administration—focused on workplace safety.
What is the Employee Polygraph Protection Act?
Prohibits the use of polygraphs by most private employers.
What does HIPAA stand for?
Health Insurance Portability and Accountability Act—governs health insurance coverage.
What is the Nursing Relief for Disadvantaged Areas Act?
Permits temporary employment of illegal aliens/foreign Registered Nurses.
What does laissez faire mean?
People are left to do their work with minimal supervision; most useful in an organization of professionals.
What is motivation?
Process affecting the inner needs or drives that arouse, move, energize, direct, channel, and sustain human behavior.
What is morale?
State of mind and emotion affecting attitudes, feelings, and sentiments of individuals and groups towards their work, environment, administration, and colleagues.
What is controlling in management?
Process that checks performance against standards to ensure consistency with plans and achievement of goals.
What is the feedback model?
Information on system performance is obtained by the supervisor or sensor who monitors the system by comparing actual results with desired performance.
What is a rolling budget?
Manager prepares a 12-month budget and projects the next month’s budget for the following year after the first month ends.
What is a flexible budget?
Prepared with a range of activity levels to allow adjustments throughout the year for changes in activity levels.
What is a traditional budget?
Involves projections for the following year based on current expenditures and the previous annual budget.
What is an incremental budget?
Couples with rolling or flexible budget; the base is treated as already authorized and requires no review.
What is zero-based budgeting?
Ignores previous years’ budgets; every activity submitted for funding must be justified from the ground up.
What is the respondent superior doctrine?
The employer is legally responsible for the negligent acts of the employee, even if the facility itself committed no wrong.
What are ethics theories?
Offer a means to explain and justify actions and serve as guides for making moral decisions.
What is the National Committee on Vital and Health Statistics?
Government agency that has led the development of basic data sets for health records and computer databases.
What is the purpose of the minimum data set?
To recommend common data elements to be collected in health records.
What is aggregate data?
Data collected on large populations of individuals and stored in databases.
What is the Uniform Hospital Discharge Data Set?
The inpatient data set required for Medicare reporting, incorporated into federal law.
What are performance improvement programs?
Designed to collect data for quality improvement, including HEDIS and the Joint Commission’s ORYX program.
What is the National Health Information Network?
A network of networks.
What is the Health Insurance Portability and Accountability Act of 1996?
Federal law directing the development of healthcare standards for electronic data interchange and data security.
What is state regulation in healthcare?
Most healthcare information standards have been implemented by state regulations.
What is a data dictionary?
A critical early step in designing an EHR, defining the characteristics of each data element.
What does UHDDS stand for?
According to UHDDS, ethnicity should be recorded as either Hispanic, non-Hispanic, or unknown.
What is the reason for encounter in outpatient data collection?
Focuses on the principal diagnosis.
What is MDS Version 2.0?
In long-term care, the resident’s care plan is based on data collected in the MDS.
What does OASIS stand for?
Reimbursement for home health services is dependent on data collected from OASIS.
What is HEDIS?
A comparison of the performance of health plans.
What does XML stand for?
A standard that allows data to be transferred across the Internet.
What is the harmonization of standards from multiple sources?
The Office of the National Coordinator of Health Information Technology is responsible for this.
What does the prefix ‘later’ mean?
Side.
What does the prefix ‘akylo’ mean?
Bent.
What does the prefix ‘iso’ mean?
Equal.
What does the prefix ‘ado’ mean?
Toward or near.
What does the prefix ‘contra’ mean?
Opposite.
What does the prefix ‘brady’ mean?
Slow.
What does the prefix ‘tachy’ mean?
Fast.
What does the prefix ‘cyan’ mean?
Blue.
What does the prefix ‘leuk’ mean?
White, white blood cell.
What does the prefix ‘erythr’ mean?
Red, red blood cell.
What does the prefix ‘aden’ mean?
Gland.
What does the prefix ‘cephal’ mean?
Head.
What does the prefix ‘enter’ mean?
Intestines.
What does the prefix ‘cyt’ mean?
Cell.
What does the prefix ‘gingiv’ mean?
Gum.
What does the prefix ‘hemat’ mean?
Blood.
What does the prefix ‘hepat’ mean?
Liver.
What does the prefix ‘rhin’ mean?
Nose.
What does the suffix ‘algia’ mean?
Pain.
What does the suffix ‘cele’ mean?
Hernia, rupture.
What does the suffix ‘malacia’ mean?
Softening.
What does the suffix ‘emesis’ mean?
Vomiting.
What does the suffix ‘phagia’ mean?
Swallowing.
What does the suffix ‘plasia’ mean?
Development, formation.
What does the suffix ‘stalsis’ mean?
Contraction.
What does the suffix ‘stenosis’ mean?
Tightening, stricture.
What does the suffix ‘megaly’ mean?
Enlargement.
What does the suffix ‘sclerosis’ mean?
Hardening.
