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Issues in Healthcare > Lecture 8/Chapter 8 > Flashcards

Lecture 8/Chapter 8 Flashcards

1
Q

inpatient

A

-requires an overnight stay in a health care facility

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2
Q

hospital

A
  • an institution with at least 6 beds
  • function is to deliver patient services that include diagnostic and treatment
  • evolved from institution of refuge for homeless and poor
  • ultramodern facilities providing advanced services
  • must be licensed
  • have an organized physician staff
  • provide continuous nursing services supervised by RNs
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3
Q

hospital characteristics

A
  • a governing body is legally responsible for hospital conduct -> board of directors
  • a CEO is responsible for operations
  • medical records on each patient
  • pharmacy services supervised by a registered pharmacist
  • food services to meet nutritional needs
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4
Q

construction and operation of a hospital are governed by:

A
  • federal laws
  • state health regulations
  • city ordinances
  • *joint commission standards -> makes recommendations if the hospital meets certain standards or performance, cleanliness -> carries huge wait for medicare and medicaid reimbursement
  • fire codes
  • sanitation standards
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5
Q

inpatient costs

A
  • hospitals consume the biggest share of national health spending
  • were the first to be targeted with prospective payment systems (PPS)
  • subsequently, outpatient services mushroomed
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6
Q

social welfare

A

-almshouses and pesthouses

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7
Q

care for the sick

A

-public and voluntary (charitable) institutions

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8
Q

evolution of five dominant functions in hospital transformation

A
  • social welfare
  • care for the sick
  • medical practice
  • medical training and research
  • consolidated systems
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9
Q

medical practice

A
  • medical science and technology
  • hospital administration, organization, efficiency
  • the joint commission
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10
Q

medical training and research

A

-collaboration between hospitals and universitites

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11
Q

consolidated systems

A
  • organizational integration
  • service diversification
  • hospital/heatlhcare systems*
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12
Q

expansion phase: development of professional nursing

A
  • florence nightingale transofmred nursing

- efficiency of treatmnet; hygeine

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13
Q

expansion phase: growth of health insurance

A
  • great depression closed many hospitals
  • insurance allowed people to pay for health care
  • increased the demand for health care
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14
Q

expansion phase: role of government

A
  • *hospital survey and construction act (hill burton act, 1946):
  • federal grants to build nonprofit community hospitals
  • charitable care was a condition
  • biggest factor to increase nations bed supply
  • by 1980, goal of 4.5 beds per 1,000 population reached
  • *public health insurance (medicare and medicaid)
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15
Q

downsizing phase: mid 1980s onward

A
  • average hospital has become smaller
  • shift from inpatient to outpatient
  • changes in reimbursement- from cost-plus to PSS and decrease in inpatient utilization
  • impact of managed care
  • hospital closures- since 2000 many government run hospitals closed
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16
Q

downsizing phase: impact of managed care

A
  • emphasis on cost containment

- efficient utilization of resources (care in alternative settings)

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17
Q

downsizing phase: hospital closures

A
  • economic constraints
  • many rural and urban hospitals had to close
  • other hospitals closed wings or used them for alternative purposes
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18
Q

utilization measures and operational concepts: discharges

A
  • discharges per 1,000 population
  • an indicator of access and utilization
  • number of overnight patients a hospital serves in a given time period
  • includes newborns and deaths
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19
Q

hospital transformation in the US

A

five functions in the evolution of hospitals:

    1. primitive institutions of social welfare
    1. distinct institutions of care for the sick
    1. organized institutions of medical practice
    1. advanced medical training and research
    1. consolidated systems of health services delivery
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20
Q

utilization measures and operational concepts: inpatient day (patient day)

A

-a night spent by a patient

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21
Q

average length of stay (ALOS)

A
  • days of care/discharges
  • an indicator of severity of illness and resource use
  • highest in federal hospitals, followed by stated and local government hospitals
  • private nonprofit and for profit hospitals had the same ALOS in 2010
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22
Q

capacity

A
  • size is determined by number of beds set up and staffed
  • 84% of community hospitals in US have fewer than 300 beds
  • average size of community hospital is 161 beds
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23
Q

average daily census

A
  • average number of beds occupied per day
  • days of care/number of days
  • if it is low they dont get approved for a lot of beds
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24
Q

occupancy rate**

A
  • percent of capacity occupied
  • calculation: average daily census / number of available beds (capacity) x 100
  • a measure of performance
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25
Q

higher utilization among

A
  • the elderly
  • children under 1
  • women
  • people of lower socio-economic status (bc they dont have primary care)
  • medicare and medicaid beneficiaries
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26
Q

expansion phase

A
  • development of professional nursing
  • growth of private health insurance
  • role of government- hill burton act and public health insurance
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27
Q

key utilization measure and operational concepts

A

discharges

  • inpatient days
  • average length of stay- hospital access and utilization -> comparative data
  • capacity
  • average daily census
  • occupancy rate
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28
Q

factors that affect hospital employment

A
  • Hospitals accounted for largest number of jobs in the health care industry in 2013.
  • Workforce represented roughly 39% of total health care employment.
  • More than 6 million people are employed by U.S. hospitals.
  • Changes in reimbursement policy can affect employment.
  • Cannot outsource health care jobs because they generally require personal interaction.
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29
Q

hospital employment

A
  • 4% of all service jobs
  • employment has continued to grow
  • 2005- 4,350,000
  • 2009- 4,680,000
  • SBUH- 5,100 employees- largest single site employer in suffolk county
  • north short-LIJ system- 31,000 employees -> 31 hospitals and 5,678 beds
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30
Q

hospital costs

A
  • inpatient hospital services are the largest share of total US health care expenditures
  • medicare and medicaid payments
  • rise in bad debts
  • international cost comparison
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31
Q

types of hospitals

A 
Classification by ownership:
-public hospitals
-private nonprofit hospitals
-private for-profit hospitals
Classification by public access
Classification by multiunit affiliation
Classification by type of service:
-general hospitals
-specialty hospitals
-physician-owned specialty hospitals
-psychiatric hospitals
-rehabilitation hospitals
-childrens hospitals 
Classification by length of stay:
-short stay hospitals
-long term care hospitals
Classification by location
-swing bed hospitals
-critical access hospitals
-other rural designations
Classification by size
-other types of hospitals:
-teaching hospitals
-church affiliated hospitals
-osteopathic hospitals
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32
Q

public hospitals

A
  • first appear when almhouses and pesthouses evolved into hospitals
  • owned by federal, state, or local government
  • federal hospitals are open to special groups only (NA, military, veterans)
  • VA runs the largest hospital system (federal)
  • states run mainly psychiatric hospitals
  • local hospitals (county or city owned) serve a high proportion of disadvantaged groups
  • overall high utilization*
  • average length of stay (ALOS) highest in federal hospitals -> veteran population is aging
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33
Q

private nonprofit hospitals

A
  • owned and operated by community associations or other nongovernment organizations
  • their mission is to benefit the community
  • largest group of hospitals*
  • does NOT mean that they do not make money !!!
  • ex. northshore
  • they do not give profits to shareholder
  • reinvests money into organization to make it better
34
Q

private for profit hospitals

A
  • operated for the financial benefit of owners or stockholders
  • have gained market share, mainly as physician owned specialty hospitals have grown in number
  • lower occupancy rates than nonprofits
35
Q

expectation for nonprofit hospitals

A
  • internal revenue code, section 501
  • grants tax-exempt status to nonprofit organizations
  • institutions are exempt from federal, state, and local taxes
  • nonprofit organizations provide some defined public good and do not distribute any profits to any individuals
36
Q

community hospitals

A
  • nonfederal
  • short stay
  • serve the general public
  • can be proprietary, voluntary or government owned (only state or local)
  • can be a general or specialty hospital
  • 87% of US hospitals are community hospitals
37
Q

noncommunity hospitals

A
  • federal hospitals
  • hospital units of institutions (prisons, colleges)
  • long term stay
38
Q

multiunit affiliation hospitals

A
  • 2 or more hospitals (owned/leased/managed)
  • 2011- 61% of hospitals were affiliated with a multihospital system (52% in 2005)
  • nonprofit chains dominate
  • advantages:
  • economies of scale
  • wide spectrum of care; variety of markets
  • access to capital
  • ease of contracting with managed care
  • access to management resources and expertise
39
Q

nonprofit organization

A
  • provide some defined public good

- do not distribute any profits to any individual

40
Q

nonprofit institutions face new ACA demands

A
    1. establish written financial assistance and emergency care policies
    1. limit charges for those eligible for assistance under hospitals financial assistance policy
    1. limit billing and collection actions against those within the guidelines of financial assistance
    1. conduct a community health needs assessment
41
Q

some management concepts

A
  • hospitals organizational structure differs from other large business organizations
  • hospital governance:
  • board of trustees
  • chief executive officer
  • medical staff
42
Q

short stay hospitals

A
  • high level care until they can move you
  • ALOS of 25 days or less
  • treat acute conditions
43
Q

swing bed hospital

A
  • rural areas

- flexibility to shift -> more flexibility with types of bed used

44
Q

urban hospitals

A
  • located in a metropolitan statistical area (MSA)

- have higher costs: high salaries, competition, broader and complex services

45
Q

rural hospitals

A
  • not in a MSA

- 40% of all community hospitals

46
Q

balanced budget act 1997

A
  • managing the money
  • to save small rural hospitals from closure
  • maximum 23 acute care or swing beds
  • emergency services must be available
  • must meet a distance test
  • can have 10-bed psychiatric unit, a 10-bed rehabilitation unit, and a SNF
  • cost-plus reimbursement, not to exceed 101% of cost
47
Q

community hospitals by size: most popular

A
  • 25-99 beds

- 43.1%

48
Q

teaching hospitals

A
  • medical training and research
  • additional reimbursement from medicare
  • broad and complex scope of services (often have tertiary care services)
  • many located in economically depressed areas -> they dont have choice of where they go for care
  • provide disproportionate share of uncompensated care
  • COTH members provide nearly half of charity care nationwide
49
Q

church affiliated hospital

A
  • charity based
  • first established by catholic sisterhoods
  • mostly community general hospitals
  • owned or influenced by church groups
  • do not discriminate in giving care
  • spiritual and dietary emphases are often present
50
Q

osteopathic hospitals

A
  • till about 1970, osteopaths operated their own hospitals
  • subsequent acceptance by allopathic practitioners
  • separate osteopathic hospitals are no longer needed -> they are also more costly and less productive
  • many have closed
51
Q

licensure, certification, and accrediation

A
  • state government oversee the licensure of health care facilities
  • certification allows a hospital to participate in medicare and medicaid programs
  • accreditation is designed to ensure facilities meet certain basic standards
52
Q

magnet recognition program

A
  • designation conferred by the american nurses credentialing center
  • affiliate of the american nurses association
  • evaluates nursing staff
  • recognizes-
  • quality patient care
  • nursing excellence
  • innovation in professional nursing practice in hospitals
53
Q

management concepts

A
  • hospital governance: a tripartite structure
  • board of trustees- governing body, board of directors
  • CEO- administrator / president
  • medical staff- chief of staff heads the medical staff
54
Q

licensure*

A

-a hospital must be licensed to operate
-state government oversees with own set of standards
-emphasizes physical plant compliance with:
-building codes
-fire safety
-

55
Q

certification

A
  • not mandatory (required only if hospital wants to participate in medicare and medicaid- most do)
  • a federal function
  • hospitals must comply with the conditions of participation -> federal standards for health, safety, and quality
  • currently revised conditions focus on quality of care delivered and the outcomes of that care
56
Q

accreditation

A
  • joint commission or american osteopathic association
  • accreditation is a private undertaking
  • it is voluntary for the hospital
  • it confers deemed status on hospitals
  • deemed status is not conferred on nursing homes
  • how you get paid
  • stamp of approval
57
Q

ethical and legal issues in patient care**

A
  • principles of ethics
  • legal rights
  • mechanisms for ethical decision making
58
Q

respect for others

A
  • autonomy- empowerment
  • truth telling- honesty
  • confidentiality- privacy
  • fidelity- duty and promises
59
Q

beneficence

A

-benefit to the patient

60
Q

nonmalficence

A
  • do no harm

- benefits > potential harm

61
Q

legal rights

A
  • challenges arise in treating incompetent and comatose patients
  • patient self determination act of 1990
  • inform patients of their rights upon admission
  • bill of rights and informed consent
  • advance directives - DNR, living will, durable power of attorney
  • main rights:
  • confidentiality
  • consent re: medical care
  • information on diagnosis and treatment
  • right to refuse treatment
  • formulation of advance directives
62
Q

informed consent

A
  • right to make an informed choice regarding medical treatment
  • right to obtain complete current information on diagnosis, treatment, and prognosis
  • patient centered care- organizational culture that promotes patient involvement, respects preferences, solicits patients inputs, and furnishes needed information and education
63
Q

advance directives

A
  • patients wishes regarding continuation or withdrawal of treatment when patient lacks capacity to make end of life decisions
  • 3 types:
    1. do not resuscitate (DNR) -> no CPR
    1. living will- patients wishes are indicated in advance
  • main drawback- limited in scope
    1. durable power of attorney:
  • patient appoints someone else to make decisions
  • main drawbacks- patients wishes may be bypasses
64
Q

ethics committees

A
  • develop guidelines and standards
  • address ethics issues
  • multidisciplinary
65
Q

moral agent

A
  • health care managers
  • moral responsibility to put patients needs above those of the organization
  • ethics transcends compliance with the law
66
Q

summary

A
  • almshouses and pesthouses evolved into public hospitals to serve the poor
  • key measures of inpatient utilization
  • hospitals are classified in numerous ways
  • ACA restrictions
  • ethical decisions making has been a special area of concern for hospitals
67
Q

downsizing phase: changes in reimbursement

A
  • from cost-plus to PPS

- decrease in inpatient utilization

68
Q

utilization measures and operational concepts: days of care

A

-cumulative patient days over a time period

69
Q

long stay hospitals

A
  • ALOS > 25 days
  • psychiatric
  • LTCHs
  • chronic care
70
Q

LTCHs

A
  • must meet medicare guidelines
  • patients with complex medical needs
  • rapid growth has occurred
71
Q

elderly/poor disparities

A

-inner city urban and rural hospitals treat poor and elderly disproportionately

72
Q

board of trustees

A
  • legally responsible for operations
  • establish mission and long term direction
  • evaluate major decisions and approve plans and budgets
  • monitor performance
  • appoint and evaluate the CEO
  • approve appointment of medical staff
  • committees (e.g. executive commitee, medical staff committee)
73
Q

chief executive officer (CEO)

A
  • carry out the mission and objectives
  • responsible for day to day operations
  • leadership
  • receives delegated authority from the board
  • answers to the board of trustees
74
Q

medical staff

A
  • accountable to the board
  • physicians are formally granted admitting privileges
  • chief of staff (medical director)
  • chiefs of service (for specialties) in major hospitals
  • committees: executive, credentials, medical records, utilization review, infection control, quality improvement
75
Q

licensure

A
  • a hospital must be licensed to operate *
  • state government oversees with own set of standards
  • emphasizes physical plant compliance with:
  • building codes
  • fire safety
  • climate control
  • space allocations
  • sanitation
76
Q

justice

A

fairness and equality

77
Q

learning objectives

A
  • perspective on hospital evolution
  • factors contributing to hospital growth prior to the 1980s
  • reasons for the decline of hospitals and their utilization
  • measures pertaining to hospital operations and inpatient utilizsation
  • compare utilization measures in US hospitals to other countries
  • differentiate among various types of hospitals
  • how the ACA affected physician owned specialty hospitals and nonprofit hospitals
  • basic concept in hospital governance
  • understand licensure, certification, and accreditation and the magnet recognition program
  • get a perspective on ethical issues
78
Q

hospital governance

A
  • board of trustees
  • chief executive officer
  • medical staff
79
Q

which of the following is legally responsible for the operations of the hospital

A
  • CEO -> responsible for day to day operations -> answers the to the board
  • chief medical officer
  • board of trustees** -> represent the community, business, hospital
80
Q

chief medical officer

A

-physician
-chief of surgery, chief of radiology -> answers to the chief medical officer
-

81
Q

which level of care would describe a patient receiving a liver transplant

A
  • primary
  • secondary -> limited duration, recovery, rehabilitation, common surgery,
  • tertiary -> transplant, invasive medical procedure, ICU

Issues in Healthcare (15 decks)

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