NE BC Flashcards
What is a not-for-profit hospital?
A Tax-Exempt organization considered a charity by the IRS
What are not-for-profit hospitals required to do?
Required to treat all conditions/people regardless of insurance or ability to pay
What is a for profit hospital?
An organization that is funded by investors or shareholders that can lawfully release a patient who does not have ability to pay for service (after EMTALA)
What is the Medicare System
A federal insurance program developed in 1965 providing health insurance coverage for citizen 65+, or any age with end stage renal failure or disabilities.
Consists of 4 parts A,B,C,D
How is Medicare funded and who is eligible
-Funded by the payroll tax
-Must be US citizen/Permanent Legal Resident 5+ years.
-Spouse or self must have paid in for at least 10 years.
What does Medicare Part A Cover
Hospital Insurance/inpatient hospital care
Some hospice/HH
No monthly premium
What does medicare Part B cover
Medical Insurance
Physician Fees, outpt care, labs DME, some meds
PT/OT
Monthly premium
What does Medicare Part C cover
Medicare Advantage Plan
Similar to HMO or PPO
Includes part A and B
May offer Dental/Vision/Wellness
Most include part D
What does Medicare Part D Cover
Prescription Drug Plan
Available to everyone
Must join a Medicare Plan that includes part D
Monthly Premium
What is Medicaid
Medicaid is a 1965 Fed/state funded insurance program managed by the states govt for health insurance for low income families, children, pregnant women and elderly
What are the requirement for receiving Medicaid
One must be a U.S. Citizen or permanent legal resident. Includes Low income adults children and disabled.
What was signed into Law in 2010 with the goal of making Health insurance available to more people
The Patient Protection and Affordable Care Act
What is a Health Maintenance Organization (HMO)
Est. in 1973 by the HMO act
Provides a predetermined set of services focused on preventative care
Paid as a set of fees or dues
What is a Preferred Provider Organization?
Established in the early 1980s
Provides more options than an HMO
Participants have an option to utilize “In-network” providers at a discount with more benefits.
What term is used to describe the phenomenon where healthcare providers receive rates of reimbursement for care?
Diagnosis related groups (DRGs)
How is the reimbursement rate of a DRG calculated?
Based on the average cost of services
How many DRGs exist?
> 400
Define prospective payments.
Rates agreed upon in advance by insurance companies and the hospital based on DRGs
Why would a hospital use a Prospective Payment System (PPS)?
To develop a budget based on the number of clients per DRG they serve on avg
What are the four quality measures for pay for performance reimbursement?
Performance
Outcomes
Patient Satisfaction/Experience
Structures and Technologies (EHR)
What is Value Based Purchasing?
CMS pay-for-performance incentive program for acute-care hospitals
Pay is yearly based on total performance score (TPS)
What is budget?
A plan for how to SPEND, MONITOR, and REDISTRIBUTE available money as needed
What is the purpose of a budget?
To manage the business’s finances in an organized way
What are the components of a budget cycle?
Development
Monitoring
Reporting
Justifying
Variance Allowance
What are the four types of budgets for which a nurse manager/leader may be responsible?
Revenue
Expense
Capital
Operational
Define Revenue
Anticipated amount of income during a budget period
Define Expense (4)
Salary
Non-Salary
Fixed
Variable
What are fixed expenses?
Cost that remain the same no matter the number of patients
Rental fees
Printer/copy fees
Contract fees
What are variable expenses?
Vary based on the census or acuity level
Define Capital budget
Long range planning tool for organization for items that typically have a lifespan of >1 year
Equipment
Renovation Costs
What Factors should be addressed in a capital budget?
Why is it necessary
What would we do without it
What is the expected return on investment
What new patient population would it draw
What education/renovation/addt’l personnel is required
Define amortization
assigning cost of an asset over its lifetime (must know life expectancy)
What is depreciation?
The amount written off annually on a piece of equipment and buildings
Explain an operating budget
Annual budget
Activity of unit current year planning for next fiscal year
Includes revenue and expense
Closely monitored and followed by nurse mgr ensuring goals are met
What are the steps in developing an operating budget?
Productivity Goals
Patient days
Workload (HPPD)
Non-productive time
Productive time/Nonproductive time over the long term
Non-labor costs
What is the primary role of the nurse manager in the budget process?
Monitor a unit-based budget and provide feedback to the finance dept.
How are patient days calculated?
ADCx365
What is average daily census (ADC)?
The avg # of pts on an inpatient unit at a certain point in time for a set period of time. almost always collected at midnight.
How is the ADC calculated?
Total Patient days/365
Define full time equivalent (FTE)
FTE refers to the number of hours worked that add up to one full time employee
How are FTEs calculated?
Total number of nursing hours of care in a year / 2080
Why are full time equivalents (FTE) important?
FTEs are a good budget tool because it factors in part-time employees, which is more reflective of the amount of work than the total number of nurses working if there are a lot of part time workers
Calculate Hours per patient day (HPPD)
Productive hours / ADC
Define Productive time.
The time (actual number of hours) a nurse or staff spends providing direct patient care.
Why is calculating Productive Time important for the budget?
Productive time for finance purposes is the number of hours actually worked. It is calculated by taking 2080 - benefit time. This is an important figure because a nurse does not work every single day and addt’l staffing is needed for the benefit days
How do you calculate productive time?
2080 hours - benefit time
Define non-productive time
Time workers are paid that are not directly related to the workload (PTO, education, orientation)
What is benefit time?
Benefit time is a financial term that includes the average number of vacation days, holidays, personal days, and average sick time used
List non salary operating expenses that must be figured into the budget
Medical Supplies
Office Supplies
Pharmacy
Linen
Contracts
Travel and Education
Printing
other
What is the purpose of EEOC?
The Equal Emplpyment Opportunity Commission (EEOC) enforces laws regarding discrimination and harassment in the workplace
