Week 6 Exam Flashcards
the process of identifying and defining the problem; determining what happened to cause it; and identifying what steps or possible solutions will be necessary to resolve it
problem solving
the process of choosing among several alternatives
decision making
what are the 5 steps in the decision making process?
- problem identification
- problem analysis
- criteria establishment
- alternative development and decision making
- problem solution and feedback
what are the 5 principles of LEAN?
- identify value
- map the value stream
- create flow
- establish pull
- seek perfection or continuous improvement
a LEAN manufacturing tool that helps to clean and organize the workplace, as well as improve how things are done through standardization
5S System
what are the components of a 5S System
- sort
- simplify
- shine
- standardize
- sustain
comparing measures of process against those of recognized leaders in the field and how it measures up to the standard set by those leaders. Typically has 4 categories
benchmarking
what are the 4 categories of benchmarking?
cost effectiveness, staff productivity, process efficiency, time cycle
developing ideas for creative problem solving. Objective is quantity not quality of ideas
brainstorming
pairs of numerical data with one variable on each axis, to look for a relationship between them. if the variables are correlated, the points will fall along a line or curve. the better the correlation, the tighter the points will hug the line
scatter diagrams
brainstorming activity that encourages participants in a discussion to look at an idea from more than one viewpoint. a valuable development of the pros and cons technique.
PMI - plus/minus/interesting
this is a visual way to look at cause and effect relationships which helps identify root causes of a problem
a fishbone diagram
these are maintained by local, county, state, or federal entities. these profits are held by the entity to further its cause. Exist to provide a service such as “healthcare.” these operate as a non-profit
public sector labs
privately held and its profits are distributed to the owners and its primary purpose is to generate revenue. “ for- profit”
private sector labs
process of planning, controlling, and evaluating available fiscal, material and personnel resources of an organization
financial management
a manager should be familiar with the basic accounting, economic, and financial principles, and their relationship to laboratory operations. this is how to….
maintain success
the analysis of cost and revenue data that provides information on operations and budgeting for managers.
managerial cost accounting
the process of determining the actual cost of performing a billable procedure
micro costing
fixed, variable, or semi-variable or mixed cost that may coincide with test volume
cost behaviors
includes all costs directly related performing the test. cost considers the test volume
direct cost
includes expenses that are part of doing business, but not directly related to the cost of the test being evaluated (all non-labor expenses, not test volume)
indirect cost
defined as the cost of providing a billable procedure
expense
a test that is billed to a payer
billable
contributes to the generation of a billable test result, but which is not directly reimbursable
non-billable
defined as the price of services rendered. it is the amount charged for a test or service
revenue
refers to the hospital, the outpatient department, the physician or healthcare professional who furnishes care to the patient
provider
refers to the government agencies and other public sources of funds: Trumpcare or Obamacare
payer
refers to agencies such as blue cross and other commercial insurers
private payers
people who do not have any other type of insurance
self payers
amount charged by the insurer to insure against specific risks
premiums
represents the amount the insured must first pay before benefits are payable
deductibles
the proportion of the total medical costs, or a pre-determined dollar amount that the insured must pay out of pocked each time health services are received after the deductible has been paid
co-payments
means providing healthcare services within a network of healthcare provide4rs
managed care
a patient classification system initially developed to evaluate quality and resource consumption in a hospital setting
diagnostic related groups
DRGs are used to reimburse hospital costs for medicare patients for……….
part A services (not physician services)
what does ICD stand for?
international classification of diseases
A doctor used the DRG system for services but used CPT coding to be reimbursed for all the labs they ordered for the patients hospital stay
physician reimbursement (Part B care)
what does CPT stand for?
current procedural terminology
what are the 3 relative value units that each code has?
work
practice expense or overhead
malpractice expense
what do the ICD-10 and CPT codes justify?
the medical necessity of treatment and lab tests ordered
used to pay hospitals for inpatient services
DRGs
used to calculate pay to physicians for inpatient and outpatient visits and services
RBRVs
to pay hospitals for outpatient services and emergency room care
APCs
what are the 3 payment methodologies
DRGs, RBRVs, APCs
prospective payment agreement between an insurance plan and provider (HMO policy)
capitation
in patient care may be reimbursed on a per diem or per day basis
per diem
reimbursement on a per case basis similar to the federal prospective payment system
per case
certain types of care will be carved out of the set reimbursement amount
carve out
what are computer systems composed of?
hardware, software, and tools for data entry and retrieval
connected to mainframe computer forming the hospital information systems
servers
allows communication between servers for different data management systems and between lab instruments and LIS software
interface software
an internationally recognized program and the only one of its kind that utilizes teams of practicing laboratory professionals as inspectors
CAP
improve patient safety by advancing the quality of pathology and laboratory services through education, standard setting, and ensuring laboratories meet or exceed regulatory requirements
the goal of CAP
American Society of Clinical Pathologists (ASCP) established
1922
first chemistry survey conducted CAP cooperates in American Medical Association blood bank survey
1949
-first bacteriology survey conducted
-national registry of forensic pathology founded with CAP support
-college sends brochure on cytology to all US physicians
first model laboratory operated at regular American Medical Association meeting
1958
online surveys educational enhancements launched
2004
what is the group decision-/making model approach? plan, do check, act. internal and external customers are taken into consideration
shewart cycle of management
which process improvement technique cuts waste, makes work easier and simplifies system. also eliminates non value added steps to improve efficiencies?
LEAN
which process improvement technique uses define, measure analyze, improve, control?
Six sigma DMAIC methodology
tracking the path or a person on paper who are performing tasks. this step by step documentation is a visual creation of the flow and describes than actual activities, distance from the last step, estimated task time, observations, and return rate.
standard work chart (spaghetti diagram)
amount of money and schedule when it is paid
cash flow
what is the formula for cost per test?
fixed cost + variable cost / # of test run
what does DRG stand for?
Diagnostic related groups
wjat does RBRVs stand for?
resource based relative value scale
what does APCs stand for?
ambulatory payment categories
with a new LIS do all SOPs need to be updated?
YES
electronic devices must be equipped with security measures to prevent
hacks
patient privacy HIPPA
prevent access by unauthorized users
how often does cap give inspection?
2 years
CVP
cost, volume,profit
formula for CVP
total fixed cost / contribution margin test
