Healthcare

1

• Healthcare

Jamie Phillips, FACHE Vice President,
Operations Nationwide Childrens Hospital
2
Highlights

• Healthcare
• 24 questions for 14 of exam
• 8 knowledge areas

3
Knowledge Areas

• Healthcare Medical Terminology
• Healthcare Trends
• Managed Care Models, Structures Environment
  (Group, Staff, IPA, PPO)
• The Acute Care Sector
• The Ambulatory Care Sector
• Interaction Integration Among Healthcare
  Sectors
• Ancillary Services (Lab, Radiology, Therapies)
• Nursing, Physicians Allied Health Professionals
  Roles

4
Healthcare

• This section will focus on your knowledge of the
• Key components of healthcare delivery systems
• Roles and relationships of the principal
  professionals involved in healthcare delivery
• General education and training requirements for
  major healthcare professions and occupations
• Primary professional associations with which
  healthcare professionals are affiliated
• Principle types of healthcare delivery settings
  in which inpatient and ambulatory care is
  delivered
• Differences in ownership, mission, service
  specialization, and other important features
  among hospitals
• Vertical and horizontal integration in recent
  years

5
Healthcare

• This section will focus on your knowledge of the
• Different types of ambulatory care settings and
  how they differ in structure and operations
• Varied configurations of physician practice
  arrangements
• Major types of managed care organizations and the
  products they offer
• Managed products and contracting arrangements
• Purchaser and consumer preferences have shaped
  managed care markets and how they may be changing
  over time
• Managed care organizations may differ in terms of
  ownership and affiliations
• Consumerism affecting healthcare organizations
  and professionals

6
Healthcare

• Healthcare straddles science, commerce and many
  other aspects of human behavior and draws on
  several different bodies of knowledge.
• Clinical
• Administrative
• Rapid pace of technological advances
• Policy changes

7
Healthcare

• Traditional healthcare delivery system is a
  sickness system
• Focused on clinical interventions
• Treated patients after they presented to the
  healthcare system

8
Healthcare

• As the scarcity of limited resources in
  healthcare has grown, executives are expected to
  become even more directly involved in RESOURCE
  MANAGEMENT and ALLOCATION DECISIONS.

9
Healthcare

• Efforts are made to re-orient the attention of
  healthcare systems more toward
• Health
• Health promotion
• Disease prevention
• Customer service
• Patient involvement in their care and decisions

10
Healthcare

• Understand the continuum of care
• Acute
• Curative care
• Long-term rehabilitative/custodial care
• Palliative care
• Outpatient/ambulatory
• Inpatient/institutional

11
Healthcare

• Settings of outpatient care
• home
• physician offices
• clinic-based settings
• outpatient departments of a hospital
• emergency departments of a hospital

12
Healthcare

• Implications of types of inpatient care
• Service complexity
• Specialization
• Medical staff membership
• Ownership
• Breadths of ancillary services
• Level of acuity

13
Healthcare

• Alternatives site of care
• Satellite facilities
• Joint venture partnerships with physicians
• Freestanding facilities
• Sub acute care
• Post-acute care

14
Healthcare

• Horizontal vs. vertical integration
• Vertical expanding services up and down the
  continuum of care
• Horizontal increasing and integrating points of
  care

15
Healthcare

• Understand the rise and fall of managed care
• Purpose of managed care
• Risk based compensation
• capitation
• Focus on wellness care management
• Operational efficiency
• But why did it not succeed?

16
Healthcare

• Need more in-depth resources?
• Delivery Health Care in America, 2nd ed. By Leiyu
  Shi and Douglas A. Singh
• Essential in Managed Health Care, 4th ed by Peter
  R. Kongstvedt
• Health and Healthcare in the United States, by
  Michael J. Long, Ph.D.
• Introduction to Healthcare Delivery
  Organizations Functions and Management, 4th Ed,
  by Robert M. Sloane, FACHE Beverly LeBov Sloane
  and Richard K. Harder
• Understanding the U.S. Health Services System,
  2nd Ed by Phoebe Lindsey Barton, Ph.D.

17
Healthcare

• Ready for some test questions?

18
Healthcare Test Questions

• An efficient Formulary and Therapeutics Committee
  in many hospitals evaluates all of the following
  except?
• Symptoms of adverse reactions.
• Patients current medication effectiveness.
• Contraindications.
• Specific drugs in terms of appropriateness to
  caseload.

19
Healthcare Test Questions

• Which of the following would represent the most
  common cause of adverse drug events?
• Lack of standardization.
• Lack of knowledge of drug.
• Preparation errors.
• Transcription errors.

20
Healthcare Test Questions

• Participating providers in the federal Medicare
  program must
• Be accredited by the Joint Commission.
• Serve Medicaid beneficiaries.
• Meet the Conditions of Participation.
• Be in compliance with state Certificate of Need
  laws.

21
Healthcare Test Questions

• Which physician organization is responsible for
  accrediting residency training programs?
• ACGME
• AAMC
• CAT
• BPQA

22
Healthcare Test Questions

• According to CMS Conditions of Participation,
  under what circumstances, if any, is it
  permissible to deny a patient access to his/her
  medical record?
• The information requested consists of
  psychotherapy notes.
• The request comes from the patients personal
  representative instead of directly from the
  patient (if allowed under state law).
• The provider organization will incur significant
  costs in copying or forwarding the requested
  records.
• It is never permissible to deny a patient access
  to his/her records.

23
Healthcare Test Questions

• Communication Health Intranet Networks (CHINs)
  were developed for what purpose?
• To provide a platform for an electronic medical
  record.
• To provide a way to disseminate community level
  health data.
• To provide an inexpensive way of sharing health
  information.
• To provide a community-based hub for sharing
  health information.

24
Healthcare Test Questions

• In planning for future community health services,
  it is important to understand population health
  needs. Which ethnic category tends to
  proportionately use physician services the most?
• African American.
• Asian.
• Latino.
• White.

25
Healthcare Test Questions

• Which of the following limitations would cause a
  hospital OB unit to see no change in volume over
  a four year period?
• Organizational.
• Market.
• Financial.
• Clinical.

26
Healthcare Test Questions

• The overall goal of the HIPAA Act of 1996 is
• To insure the privacy and confidentiality of
  patient medical records.
• To standardize the sharing of clinical and
  administrative information.
• To strengthen healthcare data security standards
  and practices.
• Improve portability and continuity of health
  insurance, and to combat fraud.

27
Healthcare Test Questions

• The four important aspects of clinical support
  services are technical quality, patient
  satisfaction, continuity of integration and
• Cost-benefit analysis.
• Outcome.
• Appropriateness.
• Health promotion.

28
Healthcare Test Questions

• Medicare Conditions of Participation for
  hospitals require that a prescribing practitioner
  authenticate a verbal order within ____, if not
  defined by the state.
• 24 hours.
• 48 hours.
• 7 days.
• 30 days.

29
Healthcare Test Questions

• What is true about the relationship between acute
  care hospitals and long-term care organizations?
• Hospitals and patients frequently have difficulty
  arranging for nursing home care services.
• Hospitals generally do not want to refer patients
  to nursing homes since part of the patient care
  revenue must be shared.
• Nursing homes generally do not want to refer
  patients to hospitals since this interferes with
  state or federal length of stay requirements.
• Nursing homes are generally thought to be
  superior to hospitals at chronic disease
  management.

30
Healthcare Test Questions

• Under HIPAA, Congress required the Secretary of
  HHS to adopt standards to
• Create Pay-for-Performance Standards for CMS.
• Provide for standard data elements and code sets.
• Require electronic health records by 2010.
• Publish clinical outcome results on Medicare
  patients.

31
Healthcare Test Questions

• The principle goal of a Health Services
  Organizations medical /hospital model is
• Security.
• Disease treatment.
• Quality of life.
• Comfort.

32
Healthcare Test Questions

• Which of the following regulations exempted
  self-funded employer-sponsored health insurance
  plans from state insurance regulations?
• BBA.
• TEFRA.
• COBRA.
• ERISA.

33
Healthcare Test Questions

• The single most important way patients can help
  prevent medical errors from affecting them is
  to
• Interact with their caregivers.
• Research medical error rates among organizations.
• Read and understand consent forms.
• Chose large, reputable healthcare providers.

34
Healthcare Test Questions

• In a hospital setting, a critical pathway is beet
  described as
• A document that focuses on efficiency and
  describes a standard set of activities to be
  performed for a defined category of patients.
• A set of guidelines that focus on identifying
  those decision points which should lead to the
  consistent provision of appropriate clinical
  practice.
• Any attempt to standardize clinical activities
  based upon diagnostic categories and projected
  outcomes.
• Decision tree that focuses on physician decision
  making.

35
Healthcare Test Questions

• Under a capitated payment system, the risk
  sharing arrangements involve which parties?
• Insurers and patients.
• Physicians and purchasers.
• Hospitals and patients.
• Hospitals and patients.

36

• Management
• Business

37
Highlights

• Management
• 19 questions for 11 of exam
• 6 knowledge areas
• Business
• 20 questions for 12 of exam
• 7 knowledge areas

38
Knowledge Areas - Management

• Implementation Planning (e.g., operational plan,
  management plan)
• Contingency Planning (e.g., emergency
  preparedness)
• Organizational (systems) Theory Structuring
  (e.g., span of control, chain of command,
  interrelationships of organizational units)
• Management Functions (e.g., planning, organizing,
  directing, controlling)
• Leadership Styles/Techniques
• Mediation, Negotiation, Dispute Resolution
  Techniques

39
Knowledge Areas - Business

• Basic Statistical Analysis
• Strategic Planning Principles
• Basic Business Controls (e.g., legal and
  financial implications)
• Marketing Principles Tools (e.g., market
  analysis, market research, sales, advertising)
• Techniques for Business Plan Development
  Implementation
• Principles of Public and Community Relations
• The Functions of Organizational Policies
  Procedures

40
Management Business

• Management or managing is a process comprising
  interrelated social and technical functions and
  activities.
• Establishing organizational objectives
• Providing organizational context within which
  direct and support work can be performed
  effectively
• Preparing an organization to deal with the treats
  and opportunities in its external environment

41
Management Business

• The five management functions
• Planning
• Organizing
• Controlling
• Directing
• Staffing
• All are connected by decision making problem
  solving

42
Management Business

• Managing vs Leading
• Managing
• caretaking
• maintaining status quo
• transactional
• Leading
• visionary
• dynamic
• transformational

43
Management Business

• Managerial skills
• technical
• conceptual
• interpersonal
• Senior managers make greater use of conceptual
  skills
• Middle/entry level managers tend to have a more
  even mix of the three

44
Management Business

• Mintzbergs research managerial roles
• Interpersonal
• Figurehead
• influencer
• Informational
• Monitor
• spokesperson
• Decisional
• Entrepreneur
• negotiator

45
Management Business

• Managerial competencies
• Conceptual
• Technical managerial/clinical
• Interpersonal/collaborative
• Political
• Commercial
• Governance
• others

46
Management Business

• Managements authority or power
• Legitimate (formal)
• Reward
• Coercive
• Expert
• Referent
• Understand the risks and benefits of each

47
Management Business

• Leader traits and skills
• Assertive
• Cooperative
• Decisive
• Dependable
• Intelligent
• Conceptually skilled
• Creative
• Persuasive

48
Management Business

• Leadership styles (Likert)
• Autocratic
• Benevolent
• Consultative
• Participative/democratic

49
Management Business

• Designing Formal Organizations
• Genesis in the planning function
• Authority and responsibility relationships
• Departmentation
• Coordination and relationships of components

50
Management Business

• Levels of Organization
• Health systems composed of health service
  organizations
• Health service organizations
• Clusters of workgroups (clinical groups)
• Workgroups (departments, teams)
• Individual positions

51
Management Business

• Organization within an organization
• Formal structure and formal organization
• Informal organization dynamic behavior and
  activity patterns
• Combination of both the formal and the informal
  are the actual organization

52
Management Business

• Strategic Planning Operational Planning
• Strategic planning addresses the longer-term
  direction and goals selected by the governance
  and management
• Operational planning focuses on the direction and
  activities of individual units and departments of
  the organization. The operational plan must be
  coordinated with and is subordinate to the
  strategic plan

53
Management Business

• Contingency planning
• Anticipating the unknown
• Mitigating the potential negative implications
• Turning the unknowns into economic or competitive
  advantages
• External disasters
• Internal disasters

54
Management Business

• Managers as Negotiators
• Know the art of negotiating
• Conflict in negotiations
• how resources are to be divided
• resolving psychological dynamics and satisfying
  the personal motivation of those involved

55
Management Business

• Resolving Disputes
• Alternative dispute resolution (ADR)
• binding finding and nonbinding arbitration
• mediation
• mini-trials
• neutral fact
• Legal action

56
Management Business

• Need more in-depth resources?
• Haimanns Healthcare Management, 7th ed by Rose
  T. Dunn, FACHE
• Healthcare Strategic Planning Approaches for
  the 21st Century by Alan M. Zuckerman, FACHE,
  FAAHC
• Health Service Management Readings and
  Commentary, 7th Ed., by Anthony R. Kovner, Ph.D.
  and Duncan Neuhaser, Ph.D.
• The Leaders Change Handbook, by Jay A. Conger,
  Gretchen M. Spreitzer, and Edward E. Lawler III
• Leadership for the Future Core Competencies in
  Healthcare, by Austin Ross, LFACHE Frederic J.
  Wenzel and Joseph W. Mitlyng
• Managing Health Services Organizations and
  Systems by Beafort B. Longest, Jr., Jonathon S.
  Rakich, and Kurt J. Darr, J.D., Sc.D, FACHE
• Mastering the Negotiation Process A Practical
  Guide for the Healthcare Executive, by
  Christopher L. Laubach
• The Well-Managed Healthcare Organization, 5th
  Ed, by John R. Griffith FACHE and Kenneth R.
  White, Ph.D., FACHE

57
Management Business

• Ready for some test questions?

58
Management Business Test Questions

• Hospitals pursuing strategic alliances are faced
  with issues of vertical integration. One example
  of vertical integration is
• Acquiring a long-term care facility.
• Creating a super physician-hospital
  organization.
• Developing a system of local hospitals.
• Outsourcing laboratory services.

59
Management Business Test Questions

• The concept of demand management consists of
• Concurrent review.
• Risk assessment.
• Disease management.
• Chart review.

60
Management Business Test Questions

• You are planning to conduct an assessment of the
  utilization patterns in your organizations
  emergency department over the past three years.
  Which of the following techniques would be most
  appropriate? (186)
• Strategic Planning.
• Trend Analysis.
• Situational Analysis.
• Survey Research.

61
Management Business Test Questions

• Which of the following is not an example of a
  marketing function?
• Promoting the organization.
• Convincing patients to select the organization.
• Managing external relationships.
• Reviewing organizational costs.

62
Management Business Test Questions

• The arrival of women for obstetrical deliveries
  or patient flow in an emergency department can
  best be analyzed through the use of which
  technique?
• Pert Charting.
• Stochastic Modeling.
• Gant Charting.
• Monte Carlo Simulation.

63
Management Business Test Questions

• All of the following are essential components of
  strategic planning except
• The corporate mission statement.
• Timetables for activity completion.
• Competitive analysis.
• Assessment of the external environment.

64
Management Business Test Questions

• Operational planning can be correctly defined
  as
• A function of establishing the annual budget by
  accumulating departmental information.
• The process by which short range objectives and
  actions are established and implemented in
  accordance with the strategic plan.
• An annual process of developing, evaluating and
  implementing goals based on community needs.
• Determining the major types of services offered
  based on profit margins.

65
Management Business Test Questions

• Which of the following statements best defines
  increased productivity?
• An increase in productivity occurs when the
  number of units of service rendered in a given
  year increases over the number rendered in the
  previous year.
• An increase in productivity occurs when an
  increase occurs in the volume or number of units
  of service rendered.
• An increase in productivity occurs when a
  reduction occurs in the ratio of hours worked to
  the number of units of service rendered.
• An increase in productivity occurs when an
  increase occurs in the revenue from a given
  number of full-time equivalent employees.

66
Management Business Test Questions

• Materials management can best be defined as a
  system of effective
• Purchasing of materials at the lowest possible
  cost.
• Distribution of materials on a scheduled basis.
• Allocation of materials.
• Control of inventories.

67
Management Business Test Questions

• Before submission of the annual business plan to
  the governing authority, the plan should be
  developed by
• Recommendations from the finance committee, on
  the basis of its estimate of income for the
  budget year.
• The heads of the profit centers, considering each
  centers anticipated revenues and expenses, with
  the CEO collating.
• Key executives, after receiving recommendations
  from the head of operating divisions.
• The heads of the operating divisions, with the
  CEO collating.

68
Management Business Test Questions

• From a marketing viewpoint, the development of
  the standards of practice, clinical pathways,
  clinical guidelines and protocols can all be
  viewed as efforts to deal with which unique
  aspect of delivering services
• Inseparability.
• Intangibility.
• Heterogeneity.
• Perishability.

69
Management Business Test Questions

• The master site plan (or master facility plan)
  for a healthcare organization
• Describes future facility needs (either
  renovation or new construction) necessary to meet
  strategic and operational needs.
• Provides detailed design documents for all
  construction programs along with specific costs
  for each project.
• Must be prepared by an outside planning or
  architectural firm to ensure sufficient
  objectivity.
• Is necessary to ensure that the organization
  complies with certificate of need and other
  regulatory requirements.

70
Management Business Test Questions

• A master patient index (MPI) can best be
  described as
• A relational database containing all
  identification numbers assigned to patients.
• A system for converting social security numbers
  to medical record numbers.
• A system for converting medical record numbers to
  patient account numbers.
• A longitudinal record of all patient encounters
  for a fixed period of time.

71
Management Business Test Questions

• A bar chart format, with the items rank ordered
  on a dependent variable, such as cost, profit, or
  satisfaction that examines the components of a
  problem in terms of their contribution to it is
  known as
• A run chart.
• A frequency table.
• Pareto analysis.
• Deming cycle.

72
Management Business Test Questions

• The best way to reduce/contain the costs of
  distributing supplies throughout an organization
  is to
• Purchase the most modern supply distribution
  system for your organization
• Minimize the number of times an item is handled
  from the time it is received by the organization
  to the time it is used
• Utilize a computerized materials management
  system that allows the organization to minimize
  inventory levels
• Negotiate a contract with an outside vendor who
  specializes in supply distribution to provide
  these services

73
Management Business Test Questions

• To guard against the loss of assets, an
  administrator should do which of the following?
• Encourage off-site storage of equipment
• Allow service directors to determine the
  frequency of asset inventories
• Implement detailed procedures, risk control and
  annual outside audits

74
Management Business Test Questions

• Medicare DRG payment is highly dependent upon a
  hospitals case mix index. This index represents
  the average relative weight for all Medicare
  patients treated in a
• Specific nursing unit or specialty area
• Specific period
• Common geographic market
• Specific facility

75
Management Business Test Questions

• What is the first effect of demographic trends on
  a health service organizations strategic
  planning process?
• Appraising financing sources and payment levels
  for programs.
• Establishing future staff by type and estimating
  staffing levels.
• Determining the locations of delivery units for
  the next period.
• Determining the range and types of services to be
  offered.