hospital administration Flashcards
Understand advocacy organizations for not for profit and for profit hospitals
advocacy groups provide legal and political representation.
Their goals is to influence nation’s healthcare on behalf of healthcare workers and patients.
AHA-American Hopital Association, advocacy for not-for-profit org
FAH-Federation of american hospitals advocacy for-profit
AMA- advocacy group for doctors
For-profit and not-for profit groups have to have their own advocacy groups because the mission of for profit institutions is to create profit and increase the worth of their shares while the mission of not-for-profit institutions is mission dricen rather than profit-driven. their primary focuses are different than one another.
Medicare Part A
hospital insurance- inpatient care, skilled nursing, hospice care, home health services
Medicare Part B
medical insurance, outpatient, dr vistits, lab services
Medicare Part D
Prescription Drug Coverage-covers cost of prescription drugs,
Who is covered by Medicare?
people 65 and up or people iwth certain disabilities, those on SChIP
What is “managed care” with an example
guaranteed coverage for a fixed annual premium, the cost of treatment is monitored by a managing company. Managed care organizations include HMOs and the more common PPOs
What authority does the governing board have over the hospital?
- Formulates policy
- Directs the hospital administrator to carry out the policy.
- Monitors how the policy is carried out and its outcomes
What responsibility does the board give to the medical staff?
Patient Care
What responsibility does the board give to the CEO?
Day-to-day management of facility
Fill staff positions
Medical Staff reviews applications for physicians to practice for what two things?
A) They make sure the doctor is credentialed (eligibility has been ascertained by medical staff and board)
B) Give medical staff priveleges which clearly states which procedures that doctor can perform in that facility
The board is charged with establishing the _, , and with hiring and supervising the _.
mission, goal, objective
CEO
Diagram the typical org of the medical staff in a provider org
board
admin
info services, therapeutic services, diagnostic services, support services
Six Healthcare Laws
HIPPA- health insurance portability and accountability act 1996
EMTALA 1986
Anti-kickback laws 1972
False Claims act 1986
Physician Self-Referral 1988
Patient Protection and Affordable Care Act- 2010
HIPPA
Protect the privacy of medical information in the age of the internet
EMTALA
a) provide a medical screening exam to determine the acuity of any patient who shows up
b) patient has to be treated and if they can not they have to be stabilized and transfered to a facility that can treat them
c) no one can be turned away regardless of their ability to pay or insurance status
Anti-kickback laws
Pharmaceutical companies and equipment companies would pay physicians for using their products, this law made that practice illegal
False Claims Act
You can not knowingly attempt to get payment from CMS under false circumstances, It is illegal for any healthcare provider to bill CMS for services that a)are not bona fide services b) are provided to a non-Medicare patient c) greater than those that were actually deliverd
Physician Self-referral
“stark legislation” prevent physicians referring a patient to a medical facility in which they have a financial interest in some form or another.
Patient Protection and Affordable Care Act
Reforms pricate health insurance industry and public health insurance programs, giving coverage for those with pre-existing condition and expanding coverage to over 30 million Americans, while mandating an increase in total national medical expenditures.
explain
Voluntary process, Medical license sets a minimum competency requirement. Board certification demonstrates a physician’s expertise in a particular specialty. Drs must pass a test and go before the board which is made up of other board certified physicians.
Each specific college administers its own board certification exam.
A _ _committed against a _ or _ excluding breach of contract.
civil, wrong
person or property
IRB
Institutional Review Board- determines what studies, procedures can be done at a teaching hospital, reviews and monitors biomedical research involving human subjects they approve, or disapprove research
ACHE
American College of Healthcare Executives-professional society for healthcare executives
HFMA
Healthcare financial management association
D.O.
Doctor of Osteopathy
MGMA
medical group management association, professional organization
HMO
health maintenance organization
PPO
preferred provider organiation
laparoscopy
surgical procedure in which a fiber-optic instrument is inserted into the abdominal wall to view organs or perform a surgical procedure
CRNA
certified registered nurse anesthetist
ADL’s
activites of daily living, dressing, eating, transferring, bathing oneself
OID
office of inspector general
ABMS
American board of medical specialties (oversees, processes physician board certification)
compliance
the size of discount given to each facility participating in the GPO
Example of Vertically Integrated Healthcare System
vertical integration=ownership of facilities+physicians+health insurance under a single corporate structure
IHC health insurance (select health)+contracts with drs+provider organizations
What single feature distinguishes an integrated network from a multiple hospital system?
The ownership of their own health insurance
revenue
the amount of money that is brought into a company by its business activities. Revenue is also known as sales,
Gross Revenue
total amount of sales recognized for a reporting period prior to any deductions
Net Revenue
the total amount of cash that remains from the original amount of revenue after accounting for all expenses and additional income.
Depreciation
decrease in the value of a currency relative to other currencies or reduction in the value of an asset with the passage of time or wear and tear
capital
wealth in the form of money or other assets owned by a person or organization or available.
“To Expense”
the treatment of an expenditure as an operating cost rather than a capital investment.
what does accreditation look at?
Infection Control Medication Management Quality Assurance Patients’ Rights Prevention of Medical Errors Verifying that medical professionals are qualified and competent
Primary Care encompasses what?
Primary Care
ER
OBGYN
Pediatrician
Secondary Care encompasses what?
internal medicine
surgery
gastroenterology
cardiology
Tertiary Care encompasses what?
ICUS
NICU
Shock/Trauma
who needs to be licensed?
Every hospital and health care facility
who needs to be certified?
any entity to provide care for medicare or medicaid membershas to be certified by CMS
who gets accredited?
voluntary and demonstrates the quality of care they provide
It is a valuable marketing tool because the public is able to know that if a hospital is accredited, it must provide quality care. Therefore, those patients are more likely to choose that hospital over one that is not accredited.
The Joint Commission & ISO9000.
How does a dr get board certified?
1) awarded prior to the completion of a multi year residency
2) pass the board certification exam
HCA
Hospital Corporation of America- the nation’s leading provider of healthcare services, composed of locally managed facilities
what motivates hospitals to form networks?
Provide economies of scale, influence the way laws are written and enforced, enhanced purchasing power
Disproportionate Share
compensate hospitals for the higher operating costs they incur in treating a large share of low-income patients
Future of Hospitals looks like
Increasing demand for services • Continued cost pressures • Increasing number of uninsured • Declining payment/support from states • Increasing "price-sensitive" customers Financial Performance • Continued "bifurcation" very likely= the division of something into two branches or parts. Future structural/organizational changes
What does fiduciary mean?
“Trust” .” It pertains to our study of the healthcare industry because trust is something that must be present on a hospital governing board. Sometimes board members are even referred to as “trustees.” It is important that they are honest in their dealings and that they have the hospital’s quality service of the community as their number one priority. They should diligently do all that they can to help improve the hospital so that it can function efficiently and serve the public as successfully as possible.
AUPHA
The American University Programs of Healthcare Administration and is for Students and faculty apart of a university healthcare administration program
Role of the Board of Trustees?
The hospital board of trustees works with hospital leadership on issues that the hospital is facing. They collaborate to create new policies that will benefit the hospital. They also are responsible for recruiting new board members from the community that can replace them when the time comes. They should prioritize the issues the hospital is confronting and work together to formulate good solutions that will help the hospital better serve the community. It is also their responsibility to make sure the hospital is fulfilling its mission.
“5” level components of healthcare industry
Patients, Providers and Payers (remember the 3 P’s) and the ‘lower’ components are the Group Purchasing Organizations and Suppliers / Manufacturers.
Acute Care
hospitals, ambulatory surgery center, ER, healthcare facilities
The purpose of these acute care facilities is to provide services to and treat people who are either ill or injured. The goal is to cure or at least ameliorate their illness and allow them to return to normal daily functioning that they had before becoming ill.
ABMS
The American Board of Medical Specialties is for clinicians
HHS
US Hepot of Health and Human Services
Long-Term Care
home-health, nursing homes, assisted living facilities. elderly old people who cannot carry out these activities
HCA
Hospital Corporation of America
Why would a board NOT be fiduciary?
A board may not be a fiduciary board at a Not for Profit facility. Not-for-Profit facilities always have the responsibility of doing the greater good for the public. One responsibility that can never be removed from a non-fiduciary board is coordinating with physicians and administrators to make sure the community is receiving quality care
essential message that Tom Peters was trying to convey in his PowerPoint presentation about the industry?
there is a lot of work to be done in the healthcare industry so that everyone can have access to affordable healthcare and not have to go without and that the healthcare industry needs to make ‘safety’ a top priority
