Regulatory Principles in Physical Therapy Flashcards
Fair Labor Standards Act (FLSA)
wages and overtime
Immigration and Nationality Act
aliens authorized to work in the U.S. under certain nonimmigrant visas
Occupational Safety and Health Act (OSH Act)
regulates the safety and health conditions
Comprehensive Omnibus Budget Reconciliation Act of 1985 (COBRA):
one part mandates that employers allow for the continuation of employee health care insurance after termination of employment
Family and Medical Leave Act (FMLA)
applies to employers of 50 or more employees;
requires employers to allow up to 12 weeks of unpaid, job-protected leave to eligible employees for the birth or adoption of a child or for the serious illness of the employee or a spouse, child, or parent
Worker Adjustment and Retraining Notification Act (WARN)
requires that employers give employees early warning of upcoming layoffs or plant closings
Uniformed Services Employment and Reemployment Rights Act:
allows for certain persons who serve in the armed forces (regular or reserve) the right to reemployment with the employer they were with when they entered service
Americans with Disabilities Act (ADA) (2007)
- Communications provisions
- Employment provisions
- Public accommodations
- Transportation (also four parts: communications, employment, public accommodations, transportation)
Federal Food, Drug, and Cosmetic Act =
regulates such things as definitions, standards, packaging, and labeling for food, food supplements, drugs, medical devices, and cosmetics
Health Insurance Portability and Accountability Act
The primary goal of the law is to make it easier for people to keep health insurance, protect the confidentiality and security of healthcare information and help the healthcare industry control administrative costs.(HIPAA) has five parts. Most relevant to PT are Titles I and II.
HIPAA Title I
Health Care Portability, and Renewability
Protects health insurance coverage for workers and their families when they change or lose their job
HIPPA Title II
Preventing Health Care Fraud and Abuse, Administrative Simplification, and Medical Liability Reform
privacy of PHI
Written procedures for who has access to PHI, how it will be used, and when PHI would/would not be disclosed
A designated privacy officer
Inquiry and grievance processes for patients
Ensure business associates protect PHI
Training for employees on privacy procedures
Freedom of Information Act (FOIA)
broadens access to certain types of government-generated information
Disadvantaged Minority Health Improvement Act
assistance to develop programs to provide bilingual or interpreter services to people with limited English proficiency
Omnibus Budget Reconciliation Act of 1989 (OBRA) =
regulates physician self-referral
Also known as Stark Law I
Prohibits physicians from referring Medicare patients for certain designated health services to an entity the physician or an immediate family member has a financial relationship with unless an exception applies
Omnibus Budget Reconciliation Act of 1993
Stark II =
expanded physical self-referral areas to include:
Home health services
Inpatient and outpatient hospital services
Occupational therapy
Physical therapy
Federal False Claims Act
“Lincoln Law” is a federal law that imposes liability on persons and companies (typically federal contractors) who defraud governmental programs.
The law includes a provision that allows people who are not affiliated with the government, called “relators” under the law, to file actions on behalf of the government (informally called “whistleblowing” especially when the relator is employed by the organization accused in the suit).
Persons filing under the Act stand to receive a portion (usually about 15–25 percent) of any recovered damages.
organizational chart
An organizational chart depicts managerial and non-managerial authority/coordination relationships.
Direct reporting relationships (solid lines on the chart) indicate accountability and responsibility.
These reporting relationships provide the foundation for the coordination of the business’ work.
5 stages of organizational growth
Craft stage
Entrepreneurial stage
Bureaucratic stage
Divisional stage
Matrix/adhocracy stage
Craft stage is:
The most basic stage of organizational development
A small organization, e.g., a private practice clinic
No formal division of labor
Typically, everyone helps out/accommodates each other to get the work done
MUTUAL ACCOMODATION
Supervision is sometimes used for coordination
The Entrepreneurial Stage
labor divided into management and non-management categories, e.g., practice owner and staff PT
Additional supervision and support is required
Further division of labor does to improve performance through increased efficiency
Communication takes a little more time because of the division of labor and leads to greater separation between senior management, employees, and customers.
How organization larger by horizontal and vertical integration
Horizontal integration (offering current services to new groups of customers)
Vertical integration (offering new services)
The Bureaucratic Stage
large, necessitating additional means of coordinating work.
- Large management structure
- Large divisions of labor
- Distinct operating departments divided by specialization
- Heavy reliance on work standardization
- Sometimes, additional divisions of the organization
Traditional challenges of a large organization include:
Slow to respond to change
Difficulty generating new ideas
Slow recognition of customer and employee needs
Divisional stage
To minimize large organization challenges, an organization can be segmented into divisions based on geography, services, or other distinctive characteristics.
Control of the organization may be centralized, or it may be localized within a division.
The organization can be segmented into divisions based on geography, services offered (product line), or other distinctive characteristics.
matrix structure
blends the traditional bureaucratic and product line structures.
Efficiency is achieved through standardization and mutual accommodation; less reliance on supervision
Independent department managers (e.g. Physical Therapy Department Manager) and program managers (e.g. Cancer center, stroke center manager) coordinate the staff involved in delivering services incorporated in the program
Program staff are accountable to coordinate both managers
The model creates a dual system of responsibility and accountability
Staff working in a matrix structure are accountable to meet the expectations of both department and program managers
Can be difficult at times if there is an adversarial relationship between the two mangers
Work design
is the process of fleshing out a job, i.e., assigning content to job categories
Training requirements Job duties Responsibilities Interactions Work process
Work design is one way to coordinate work.
Mutual accommodation
It is agreed upon give and take, offering and accepting assistance, etc., that occurs between individuals working toward the achievement of their shared goals
It occurs continuously
It is used in all organizations, but as the primary work coordination means in craft stage organizations
Standardization
intended to reduce variations with less supervision.
Several approaches to standardization are:
- –Work processes and task standardization
- –Output (outcome) standardization
- –Skill standardization
Supervision
Supervision requires that the supervisor have direct knowledge of the work of a group of employees to:
Guide and assist employees to perform their work in a manner and time frame that complements the work of others in the work group
medical model of disability
illness or disability, being the result of a physical condition intrinsic to the individual
care is directed by the doctor
Team model of disability
Multidisciplinary Model:
disciplines work in parallel; toward particular client goals, with very little overlap between disciplines. (rehab)
VERTICAL communication
Team model of disability
Interdisciplinary Model:
inpatient rehab
matrix-like model in which lateral communication is predominant.
entire team working toward the attainment of common client-centered goals.
Team model of disability
Transdisciplinary Model:
patient has a primary provider from the team, who then is guided by the team in caring for the client.
flexibility and receptiveness on the part of the team members because individual roles are less distinct.
(ie SNF, Homecare)
Private practice owner requires n=knowledge of
- strategic planning
- marketing
- hiring
- managing people
- fiscal management (income expenses and budgeting)
Current Procedural Terminology (CPT)
communicate uniform information about medical services and procedures among physicians, coders, patients, accreditation organizations, and payers for administrative, financial, and analytical purposes.
ICD-10
10th revision of the International Statistical Classification of Diseases and Related Health Problems (ICD), a medical classification list by the World Health Organization (WHO).
It contains codes for diseases, signs and symptoms, abnormal findings, complaints, social circumstances, and external causes of injury or diseases.
ICD-10 vs CPT
International Classification of Diseases codes are a set of diagnosis codes
—E.g. late effects of cerebrovascular disease, vertigo,” = ICD-10 code I69.398 to indicate your diagnosis
CPT codes identify services rendered rather than diagnoses on claim forms.
—E.g.. Treatment included canalith repositioning on your patient, = CPT procedural code 95992
Unique Health Care Market Characteristics
Unlike other consumer markets
The relationship between supply and demand DOES NOT effectively control health care prices and limit market growth.
For the majority of consumers, health insurance pays for much of their health care.
With a third party paying, price does not limit consumer demand for health care services
Value (quality/cost), price, and payment are not necessarily related.
Poor quality can result in higher prices and payments for health care services.
These disconnects have resulted in runaway growth in the demand for and cost of medical and other health services.
Health care businesses:
What needs to happen to be successful in todays marketplace?
- Reduce their COST of operations
- Be more PRODUCTIVE with the resources that they have
- Be more accountable for delivering QUALITY care
- Give quality care at a reasonable PRICE
Strategic Planning
A strategy is a plan to meet organizational goals.
The plan includes:
–A mission statement that clearly defines why the business exists
–The vision for the future
Business goals, objectives, and action plans
–Assessing the organization’s internal strengths and weaknesses against external opportunities and threats
MISSION, VISION, GOALS, OBJECTIVE, ACTION PLAN
SWOT
what strategic planning addresses?
Strategic planning addresses, in general, the questions of how and when we should take action.
7 elements of strategic plan:
- A MISSION statement
- A VISIOM statement
- Strategic GOALS
- Strategic OBJECTIVES
- Tactical ACTION PLANS or
operational plans - Implementation PLANNING SCHEDULE
- OUTCOME MEASURES
The mission statement
The mission statement states the purpose for the business to exist.
vision
vision defines the business’ “ideal” future state
Strategic goals
areas of focus that, when addressed, will CLOSE THE GAP between the current and ideal state (the vision).
Strategic objectives
statements that, when enacted, will move the business toward achievement of its GOALS.
tactical action plans.
Objectives are achieved through
tactical action plans.
- -Are specific
- -Have set timelines for achievement (implementation schedule)
- -Assign responsibility
- -Produce measurable outcomes
implementation planning schedule
defines the annual planning cycle that will be followed.
Outcome measures
specific indicators of success for each implemented strategy.
balanced score card
management tool that can be used to share and report outcome measures.
Value statements
describe the forces that motivate a business and the behaviors it promotes in its employees.
Critical issues
describe internal weaknesses or external threats that must be addressed.
SWOT analysis.
External factors seen as opportunities and threats
Internal factors seen as strengths and weaknesses
Consideration of these 4 factors is known as a SWOT analysis.
PEST analysis.
Basic external environment factors are:
Political (e.g., tax rate, price regulation)
Economic (e.g., state of economy, interest rate)
Social (e.g., market demographics, attitudes)
Technological (e.g., new devises, infrastructure)
Business plan
is derived from the strategic plan and provides more specificity regarding how the business will be operated.
Key elements of the business plan include:
- Marketing plan
- Operations plan
- Financial plan
