Admin Midterm

T/F: Many healthcare providers are moving to a flat fee for service (aka concierge service).

True

T/F: Medicare benefits are available to patients under 65 with permanent disability and individuals with end stage renal disease and those on hospice.

True

T/F: Patients who are more activated in their healthcare have better health outcomes and better care experiences.

True

T/F: Levels of management can be individual, operational, and regulatory.

True.

T/F: There has been a shift away from human resources and a shift toward talent management in order for health care organizations to get the necessary and top talent needed for a job role, rather than just filling the role.

True.

T/F: In 1962, JFK proposed the first Medicare bill to Congress and was defeated by legislative opponents in the Senate.

True. Raised awareness and set stage for LBJ to lead charge for passage of Medicare and Medicaid legislation in 1965.

T/F: After the war, concept of universal health insurance mechanism eventually became synonymous with "socizalized medicine" and all the negative associations with communism during the cold war of the 1950s.

True. The end result was a health insurance system rooted in the private sector.

"If you were treated equally in an organization, then you would be motivated to work for that organization." a. Adams Intrinsic Theory of Motivation b. Vroom Intrinsic Theory of Motivation c. Locke Intrinsic Theory of Motivation

a. Adams

Which person in HR... -prepares position description -prices jobs -prepares ads/recruitment materials -keeps track of applicants/maintains HR information system -checks applicant references -maintains personnel files -narrows candidate pool a. HR staff person b. Line manager

a. HR staff person

Amount of reimbursement is determined after the delivery of services, providing little financial risk to the providers in most cases. a. retrospective reimbursement b. prospective reimbursement

a. Retrospective Reimbursement

-private enterprises with no ownership interests -self sustaining from fees charged for goods and services -exempt from income taxes and may receive tax deductible contributions from those support their mission -must provide a certain amount of charity care or community services a. business oriented private organization b. government owned organizations and public corporations

a. business oriented private organization

-paid to or at 100% of submitted price/rates for care provided. -no financial risk for providers, so this method is becoming less common. a. charges "fee for service" b. charges minus discount or percentage of charges c. cost plus percentage for growth d. projected cost reimbursement e. reimbursement modified on basis of performance

a. charges fee for service

Skills that involve ability to critically analyze and solve complex problems a. conceptual skills b. technical skills c. interpersonal skills

a. conceptual skills

Organizations that provide care directly to a patient, resident, or client who seeks services from the organization. a. direct care b. non-direct care

a. direct care

Examples include: -community demographics -licensures -accreditation -regulations -stakeholder demands -competitors in the marked -medicare and medicaid -managed care organizations -insures a. external domains b. internal domains

a. external domains

Influences, resources, and activities that exist outside the boundary of the organization but that significantly affect the organization. a. external domains b. internal domains

a. external domains

Example: A healthcare organization giving bonuses to teams of workers when quality and pt satisfaction are demonstrated to be exceptional. Getting benefits, a flexible schedule, promotions, job responsibilities, etc. a. extrinsic factors/rewards b. intrinsic factors/rewards

a. extrinsic factors/rewards

Reinforcements that are given by another person. a. extrinsic factors/rewards b. intrinsic factors/rewards

a. extrinsic factors/rewards

-Developed by BCBS -the provider is paid either by insurer or paid out-of-pocket by the insured, who is then reimbursed by the insurer -typically insured must meet deductibles and make copays for their care. a. fee-for-service (retrospective pay) b. Prepayment (prospective pay)

a. fee-for-service

-investor owned healthcare organizations -required to pay taxes as a cost of doing business -includes most physician practices and SNFs a. For-profit b. Not-for profit

a. for profit

Financial data are provided concurrently or prospectively to internal users (managers, executives, and organization's governing board) a. managerial accounting b. financial accounting

a. managerial accounting

-covers hospital stay (inpatient) -allows 90 days of IP hospital coverage per benefit period (within a 60 day lifetime IP hospital reserve), IP SNF, coverage up to 100 days per episode (with a 90 day lifetime SNF reserve), currently pre qualified home health care services, and hospice care for the terminally ill. a. Medicare A b. Medicare B

a. medicare A

Medicare hospital coverage. a. part A b. Part B

a. part A

-dollar amount paid per day for care provided -most common form of reimbursement in hospitals -presents risks and incentives -tends to be bad for acute only patients for whom greater costs are incurred earlier in care without the opportunity to make up differences later when less intensive care is needed. a. per diem b. per dx

a. per diem

Requires manager to set a direction and determine what needs to be accomplished. It means setting priorities and determining performance targets. a. planning b. organizing c. staffing d. controlling e. directing f. decision making

a. planning

Analysis of the availability of all subsets of health care providers who are critical to an organization's success a. power of health care workforce b. power of consumers and payers c. innovations in technology d. regulator environment e. competitive rivalry

a. power of health care workforce

-full bar -established franchise -everyone loves tacos -good business model -opened locations before a. strengths b. weaknesses c. opportunities d. threats

a. strengths

-born before 1945 -cohort size: 27 mil -"silent generation/mature" -respect authority a. traditionalists b. baby boomer c. generation X d. generation Y e. generation Z

a. traditionalists

-respectful of authority -value duty and sacrifice -value accountability and practical experience -strong work ethic with emphasis on timeliness and productivity -strong interpersonal skills -value academic credentials -accepted limited resources -local to employer and expect loyalty in return a. traditionalists b. baby boomer c. generation X d. generation Y e. generation Z

a. traditionalists

Motivated by... -loyalty hierarchial structure -status -rewards based on promotion and job tenure -recognition of hard work and ethic a. traditionalists b. baby boomer c. generation X d. generation Y e. generation Z

a. traditionalists

Principles the organization believes in and shapes the organization's purpose, goals, and day-to-day behaviors. a. values b. mission c. vision

a. values

"If you were motivated by performance and expected outcomes of your performance. a. Adams Intrinsic Theory of Motivation b. Vroom Intrinsic Theory of Motivation c. Locke Intrinsic Theory of Motivation

b. Vroom

-born 1946-1964 -cohort size 76 million -"Boomers/woodstock generation" a. traditionalists b. baby boomer c. generation X d. generation Y e. generation Z

b. baby boomer

-individuality -driven by goals for success -measure work ethic in hours worked and financial rewards -believe in teamwork -emphasize relationship building -expect loyalty from coworkers -career equals identity -demographic approach -competitive a. traditionalists b. baby boomer c. generation X d. generation Y e. generation Z

b. baby boomer

Motivational preferences: -works for managers who treat them as equals -assurance that they are making a difference -work life balance a. traditionalists b. baby boomer c. generation X d. generation Y e. generation Z

b. baby boomer

-health care organizations offer discounted charges to 3rd party payers in return for large number of patients -2nd most common form of reimbursement to hospitals a. charges "fee for service" b. charges minus discount or percentage of charges c. cost plus percentage for growth d. projected cost reimbursement e. reimbursement modified on basis of performance

b. charges minus discount or percentage of charges

Data are provided retrospectively to external uses (stockholders, lenders, insurers, government, and suppliers) a. managerial accounting b. financial accounting

b. financial accounting

Areas of focus that managers need to address on a daily basis...reflect the operation of the organization where the manager has the most control. a. external domains b. internal domains

b. internal domains

Examples include: -staffing -budgeting -quality services -patient satisfaction -physician relations -financial performance -technology acquisition -new service development a. external domains b. internal domains

b. internal domains

Derived from within the individual. a. extrinsic factors/rewards b. intrinsic factors/rewards

b. intrinsic factors/rewards

Example: A healthcare employee taking pride and feeling good about a job well done (providing great patient care) a. extrinsic factors/rewards b. intrinsic factors/rewards

b. intrinsic factors/rewards

Which HR employee... -clarifies job function/provides input into position description -interviews candidates -ranks candidates -selects candidates -negotiates with candidate -hires candidate a. HR staff person b. line manager

b. line manager

-covers OP services and physician visits -also called Supplemental Medical Insurance -provides coverage for visits to physicians, OP treatments, and preventative services (incl flu and Hep B vaccines, mammography, pap smears) a. Medicare a b. medicare b

b. medicare b

What the fundamental purpose of the organization seeks to achieve. a. values b. mission c. vision

b. mission

Support the care of the individuals through products and services made available to direct care settings. a. direct care b. non-direct care

b. non-direct care

-historically have taken care of poor, needy, and indignant residents of communities and are granted tax excempt status a. for profit b. not for profit

b. not for profit

-The overall design of the organization or the specific division, unit, or service for which the manager is responsible. -It means designating reporting relationships and intentional patterns of interaction. -Determining positions, teamwork assignments, and distribution of authority and responsibility are critical components of this function. a. planning b. organizing c. staffing d. controlling e. directing f. decision making

b. organizing

Medicare coverage of physicians and other OP services. a. part a b. part b

b. part b

-defined dollar amount paid per diagnosis -most common are those similar to rates utilized by CMS, DRGs, RUGs, and Home Health Resource Groups. a. per diem b. per dx c. Accountable care organization d. bundled payment e. fee scheduled by CPT code f. capitation g. medical home

b. per dx

Represents the influence of end-users and funding organizations on the access, quality, and delivery of health care. a. power of health care workforce b. power of consumers and payers c. innovations in technology d. regulator environment e. competitive rivalry

b. power of consumers and payers

Method of reimbursement to providers is established before the services are provided to patients. Primary method utilized by MCOs. a. Retrospective reimbursement b. Prospective Reimburseemntt

b. prospective reimbursement

Skills that reflect expertise or ability to perform a specific managerial work task, such as developing and maintaining a budget. a. conceptual skills b. technical skills c. interpersonal skills

b. technical skills

-price -high maintenance -slow a. strengths b. weaknesses c. opportunities d. threats

b. weaknesses

Establishing goals to motivate a person to take action. a. Adams Intrinsic Theory of Motivation b. Vroom Intrinsic Theory of Motivation c. Locke Intrinsic Theory of Motivation

c. Locke

-based on idea that groups of providers come together and take responsibility for delivering care to a defined patient population -uses PCPs to orchestrate the care delivered -relies on information technology a. per diem b. per dx c. Accountable care organization d. bundled payment e. fee scheduled by CPT code f. capitation g. medical home

c. accountable care organization

-health care institutions receives the cost for care provided plus small percentage to develop new services and products a. charges "fee for service" b. charges minus discount or percentage of charges c. cost plus percentage for growth d. projected cost reimbursement e. reimbursement modified on basis of performance

c. cost plus percentage for growth

-born 1965-1978 -cohort size: 60 mil a. traditionalists b. baby boomer c. generation X d. generation Y e. generation Z

c. gen X

Motivational preferences: -genuine and informal managers -training and growth opportunities -flexibility -work deadlines, but with freedom and flexibility on how to reach these deadlines -results oriented a. traditionalists b. baby boomer c. generation X d. generation Y e. generation Z

c. gen X

-self reliant -highly educated -questioning -risk averse -most loyal employees -want open communication -respect production over tenure -value control of their time -invest loyalty in a person, not in an organization a. traditionalists b. baby boomer c. generation X d. generation Y e. generation Z

c. generation X

Represents the threat of substitute products, as new technologies often replace standard operations and services. a. power of health care workforce b. power of consumers and payers c. innovations in technology d. regulator environment e. competitive rivalry

c. innovations in technology

Skills that enable a manager to communicate with and work well with others, including peers, supervisors, or subordinates. a. conceptual skills b. technical skills c. interpersonal skills

c. interpersonal skills

-alternative transportation -affluent neighborhood -close to HEB and Starbucks (Creates good traffic) -no other taco joint in area -minimal food options nearby a. strengths b. weaknesses c. opportunities d. threats

c. opportunities

-Acquiring and retaining human resources. -Also refers to developing and maintaining the workforce through various strategies and tactics. a. planning b. organizing c. staffing d. controlling e. directing f. decision making

c. staffing

The desired future state for the organization and what they want to be known for/recognized in the future. a. values b. mission c. vision

c. vision

-based on idea of providing a single payment for a specific episode of care or procedure -instead of paying multiple providers to perform specific tasks, for example a TKR surgery, a single payment is made, the group of providers receives a fixed payment that covers the average cost of a bundle of services. a. per diem b. per dx c. Accountable care organization d. bundled payment e. fee scheduled by CPT code f. capitation g. medical home

d. bundled payment

Monitoring staff activities and performance and taking the appropriate actions for corrective action to increase performance. a. planning b. organizing c. staffing d. controlling e. directing f. decision making

d. controlling

-image conscious -need constant feedback and reinforcement -idealist -team oriented -want open communication -search for an individual who will help achieve their goals -search for ways to shred stress -racial and ethnic identification of reduced importance -organized and prefer structure a. traditionalists b. baby boomer c. generation X d. generation Y e. generation Z

d. gen Y

Motivational preferences: -value instant gratification -collaborative and positive interactions -achievement oriented -coaching and support focused -personal fulfillment in job a. traditionalists b. baby boomer c. generation X d. generation Y e. generation Z

d. gen Y

-born 1979-1995 -cohort size: 88 mil -"millenials" a. traditionalists b. baby boomer c. generation X d. generation Y e. generation Z

d. generation Y

-organization reimbursed for project cost, expressed as a percentage of charges -provides smallest amount of reimbursement to providers -little risk unless full cost (direct cost of care + indirect cost/overheard) are not recognized a. charges "fee for service" b. charges minus discount or percentage of charges c. cost plus percentage for growth d. projected cost reimbursement e. reimbursement modified on basis of performance

d. projected cost reimbursement

-high turnover location (volatile spot) -poor parking a. strengths b. weaknesses c. opportunities d. threats

d. threat

Power that local and other competitors may have on an organization's strategy a. power of health care workforce b. power of consumers and payers c. innovations in technology d. regulator environment e. competitive rivalry

e. competitive rivalry

Initiating action in the organization through effective leadership and motivation of, and communication with, subordinates. a. planning b. organizing c. staffing d. controlling e. directing f. decision making

e. directing

-most common reimbursement of specialty physicians -more complex and time consuming procedure the higher rate of reimbursement a. per diem b. per dx c. Accountable care organization d. bundled payment e. fee scheduled by CPT code f. capitation g. medical home

e. fee scheduled by CPT code

-born after 1995 -cohort size: 20 mil -"linksters" a. traditionalists b. baby boomer c. generation X d. generation Y e. generation Z

e. gen Z

-tech savvy, struggle with face-to-face communications -value structure routine, predictability -prefer clear, direct job descriptions/duties, and expectations -strong work ethics -leaders in online collab -strong ability to multitask -high entrepreneurial attributes a. traditionalists b. baby boomer c. generation X d. generation Y e. generation Z

e. gen Z

Motivational preferenceS: -search for and value to improve the world they live in -prefer management practices and workspaces that best support their needs -appreciation of collaboration tools -regular and consistent feedback -rewards that are consistent and tied to specific performance goals a. traditionalists b. baby boomer c. generation X d. generation Y e. generation Z

e. gen Z

Represents the collective effects of legislative issues on local, state, and federal levels on an organization's strategy. a. power of health care workforce b. power of consumers and payers c. innovations in technology d. regulator environment e. competitive rivalry

e. regulatory environment

-provider is reimbursed based on quality measures, patient satisfaction, etc. -more risk for providers a. charges "fee for service" b. charges minus discount or percentage of charges c. cost plus percentage for growth d. projected cost reimbursement e. reimbursement modified on basis of performance

e. reimbursement modified on the basis of performance

-agreement which health care provider is paid a fixed amount per enrolle per month by health plan in exchange for contractually specified set of medical services in the future -most common reimbursement method for primary care physicians, providing penalties and withholdings for too much care and bonuses as an incentive for ordering lower levels of care. a. per diem b. per dx c. Accountable care organization d. bundled payment e. fee scheduled by CPT code f. capitation g. medical home

f. capitation

Making effective decisions based on consideration of benefits and the drawbacks of alternatives. a. planning b. organizing c. staffing d. controlling e. directing f. decision making

f. decision making

-focuses on connecting patients to primary care, linking them to all types of services and developing a system that encourages and assures quality of care. a. per diem b. per dx c. Accountable care organization d. bundled payment e. fee scheduled by CPT code f. capitation g. medical home

g. medical home

What are the 4 types of reinforcement according to the Extrinsic theory (Skinner's Reinforcement theory)

- Positive reinforcement -Avoidance (negative reinforcement) -punishment -extinction

What makes up the triple aim of healthcare?

-Improving the individual experiences of care for the patient -improving the health of populations -reducing the per capita costs of care

What are the types of public insurance in the US?

-Medicare -Medicaid -The Children's Health Insurance Program (CHIP) -Military Health System

Discuss the roles of the manager.

-establish and maintain the culture of the organization -talent management -ensure high performance within the organization -involved in both leadership development and succession planning for the future of the organization -involved with innovation and management of change -responsible for the effective implementation of healthcare policy within the organization

What are restrictions that PTAs have in regards to providing health care?

-medically stable and predictable -no evaluations, only following through a POC developed by PT -work under supervision of PT -varies by states

What are the 6 key functions to healthcare management?

-planning -organizing -staffing -controlling -directing -decision making

List the 5 components of the Porter Model.

-power of health care workforce -power of consumers and payers -innovations in technology -regulatory environment -competitive rivalry

What are the 3 general areas of focus for health care management?

-self -unit/team -organization

What are unlicensed aids and techs able to do in regards to providing health care?

-set up care -work under supervision of therapists -perform answering call bells -assist patient with ADLs

What are the 5 key features of a learning organization?

-shared vision -mental models -systems thinking -team learning -personal mastery

Employees who are non-exempt from minimum wage and overtime provisions must be paid minimum wage and time and a half for hours beyond 40 hours/week. Special provisions for health services organizations.

1938 Fair Labor Standards Act (Amended several times)

Provided for federal matching grants to the states for a new category of "medically indigent" individuals but still did not cover elders other than those who had become poor.

1960 Kerr-Mills Act by Congress. Pivotal role as precursor to Medicaid.

Prohibits discrimination in screening, hiring, and promotion of individuals based on gender, color, religion, or national origin (Title VII).

1964 Civil Rights Act

When was Medicare Part A/B and Medicaid established?

1965 Amendments to the Social Security Act of 1935

Prohibited employment discrimination against employees age 40 and older.

1967 Age Discrimination in Employment Act

Requires employers to maintain a safe workplace and adhere to standards specific to health care employers.

1970 Occupational Safety and Health Act

Protects the rights of handicapped people (physical or mental) and protects them from discrimination.

1973 Rehabilitation Act

Grants protection to employees for retirement benefits to which they are entitled.

1974 Employee Retirement Income Security Act (ERISA)

Requires employers to consider pregnancy a "medical condition" and prohibits exclusion of pregnancy in benefits and leave policies.

1978 . Pregnancy Discrimination Act

Protects employees who report employer misconduct or wrong doing with respect to compliance with federal and state law.

1989 Whistleblower Act

Gives people with physical and mental disabilities access to public services and requires employers to provide reasonable accommodations for applicants and employees.

1990 Americans with Disabilities Act

Permits employees in organizations to take up to 12 weeks of unpaid leave each year for family or medical reasons.

1993 Family and Medical Leave act (FMLA)

Affords employee protection from outside access to personal health information and limits employers' ability to use employee health information under health insurance plans.

2003 Health Insurance Portability and Accountability Act (HIPPA)

Intent to expand access to care by providing increased health insurance coverage and bringing the uninsured into coverage.

2010 Affordable Care Act (Obamacare)

Enacts various health insurance reforms, including requiring employers to offer coverage, prohibiting denial of coverage/claims based on preexisting conditions, and extending insurance coverage for dependent children to age 26.

2010 Patient Protection and Affordable Care Act

-influenced by political interests but are exempt from taxation and have the ability to issue directly debt that pays interest exempt from federal taxation -includes government owned hospitals and public health clinics a. business oriented private organization b. government owned organizations and public corporations

B. government owned organizations and public corporations

Type of employee benefit that is limited to illness that requires hospitalization.

Base, major medical and hospital surgery policy.

Type of employee benefit that has very high deductibles.

Catastrophic coverage policy.

Type of employee benefit that covers a broad range of inpatient/outpatient with exclusions.

Comprehensive policies

Type of employee benefit that only covers specific diseases.

Disease-Specific policies.

Opportunities and threats are (internal/external)

External

T/F: Only direct care health care services require health care management.

False. Both direct and non-direct care require health care management.

T/F Title XVII set up Medicaid.

False. Title XIX set up medicaid.

When were there discussions about creating a national health insurance policy that would provide a system of universal health insurance coverage in the US?

Great Depression 1930s. The AMA and others opposed. Funding was not available due to US involvement in WWII

Difference in access, utilization, quality of care, health status, health environment, or health outcome between groups; medical conditions that can vary significantly between different populations or groups.

Health Disparities

HSA

Health Savings Account Similar to private pay, typically acquired through an insurance provider incentive

HMO

Health maintenance organization

-Process of providing oversight for the healthcare organization's long-range financial direction. -works to increase revenue and decrease costs

Healthcare financial management

The process (comprised of social and technical functions and activities) occurring w/in organizations for the purpose of accomplishing predetermined objectives through human and other resources.

Healthcare management

HDHPSO

High deductible health plans with saving options

What division of a corporation is involved in: -employees relations and engagement -training and development -compensation and benefits -employee assistance programs -assessing performance -labor relations -leadership development -employee suggestion programs

Human Resources

What division of corporations is involved in job analysis, manpower planning, job descriptions, recruitment, selection, negotiation, hiring and orientation?

Human Resources

Strengths and weaknesses are (internal/external)

Internal

Who is credited with development of Medicare and Medicaid?

LBJ -1960s (I think 1966 is when medicare began) Actually and idea by congress during the Eisenhower administration of the 1950s.

Organization that fosters a person's capacity to expand, learn and grow within the context of the goals and vision of the organization.

Learning Organization

Type of employee benefit that covers assisted living and SNF.

Long-term care insurance.

Process, comprised of social and technical functions and activities occurring within organizations for the purpose of accomplishing predetermined objectives through human and other resources.

Management

Entitles financially qualified indigent and low-income persons to basic medical care.

Medicaid

Type of employee benefit that provides certain benefits not covered by other policies.

Medigap policies

-established National Center on Minority Health and Health disparities to lead, coordinate, support, and assess NIH efforts to eliminate health disparities

Minority Health and Health Disparities Research and Education Act (Public Law 106-525) Passed in 2000

-licensure is granted by the state and demonstrates competency to perform a scope of practice -must have already passed the boards NBCOT (National Board of Certification in OT)

OT/COTAs

-established by the US Department of health and human services in 1986 and was reauthorized by the Affordable Care Act. -focus is on public health programs affecting American Indians and Alaska Natives, Asian Americans, Blacks/AAs, Hispanics/Latinos, Native Hawaiians, and other pacific Islanders

Office of Minority Health

The character, personality, and experience of organizational life i.e. what the organization really "is", prescribes the way things are done, and is manifested in staff attitudes and behaviors.

Organizational culture

-Licensure is granted by the state and demonstrates competency to perform a scope of practice -must have already passed the boards FSBT (Federation of State Boards of PT)

PT/PTAs

What do organizations use to measure performance ?

Performance appraisals are performed at the end of a probationary period, usually lasts 3 months after hiring.

POS

Point of service plan

PPO

Preferred provider organization

Initial planning phase that aims to identify internal strengths and weaknesses or an organization, along with external market opportunities and threats.

SWOT analysis

What is the largest determinant of health disparities is...

Social determinants. Ex: living or working conditions, geographic isolation, income and SES, education, access to insurance

-align with values, mission, and vision -codes of conduct that define expectations of behaviors of all staff members of an HSO -specify attitudes and behaviors that each employee will exhibit in carrying out their position

Standards of Behavior