HSPM 500 Exam 2 - CH 8-14

Health care industry

- Over 16 million jobs in 2014. - Registered nurses = 2.7 million jobs, 61% of which are in hospitals. - Physicians = 691,400; majority working in metropolitan areas. - Physician assistants = 86,700 jobs, about 50% in physician practices, 25% in hospitals, and the rest in outpatient care.

costs of teamwork

- meeting time, meeting place, food and coffee - opportunity costs - perceived loss of autonomy - risk-taking associated with letting go of one's turf - resistance to organizational change

Selected key federal legislation affecting HR

1938: Fair Labor Standards Act 1964: Civil Rights Act 1967: Age Discrimination in Employment Act 1973: Rehabilitation Act of 1973 1974: Employee Retirement Income Security Act 1986: Immigration Reform and Control Act 1993: Family and Medical Leave Act 2003: Health Insurance Portability and Accountability Act 2010: Patient Protection and Affordable Care Act

a sampling of research sources

Agency for Healthcare Research and Quality American Public Health Association Centers for Disease Control and Prevention National Center for Health Statistics DHHS Office of Minority Health Healthy People 2020 Robert Wood Johnson Foundation To name but a few.

Future physician shortage

American College of Physicians estimated the "addition of one primary care physician per 10,000 U.S. citizens will result in 3.5 fewer people dying each year." (ACP, 20008)

ongoing medicare program concerns

Continuing expansions of benefits Access to Medicare participating physicians and providers Continuing increases in program spending Program solvency Reducing costs while increasing quality

health insurance coverage statistics, 2012

Coverage by: Employment-based private health insurance - 54.2% Direct purchase private health insurance - 9.7% Medicaid - 16.2% Medicare - 15.5% Military health care - 4.4%

Environmental forces affecting HR

Declining reimbursement, Low supply of workers, Increasing population needs, Increasing competition among HSOs, External pressure on HSOs for accountability and performance.

Sentinel event

Disruptive behavior (either MD or RN) is considered a "sentinel event, i.e., an unexpected occurrence involving death or serious physical or psychological injury, or the risk thereof" (The Joint Commission, 2010). Trust and good communication are central to excellence in health care delivery and a culture of safety.

benefits of cultural proficiency

Good business practice Improved patient and provider satisfaction Increased market share Decreased malpractice claims Improved return on investment Good workforce management Effective communications between staff and patients Decreased turnover Enrichment of the future talent pool Decreased lawsuits Ethical and moral imperative

Responsibilities of Line Managers in Recruitment

Line Staff: Clarifies job function/provides input into position description. Interviews candidates. Ranks candidates. Selects candidates. Negotiates with and hires candidates.

Physicians and teamwork

MD resistance to acknowledge RNs as professionals and colleagues leads to: poor teamwork. interpersonal conflict. potentially poor patient outcomes. Teamwork is essential to a culture of safety.

why health disparities?

Many factors: Access to health insurance Genetics and biology Socioeconomic factors Living and working conditions Patients' beliefs Patients' adherence to preventive and therapeutic measures

mHealth

Mobile technologies for health related activities (look at your phone—there is probably a health app on it!)

determining product costs

More recent methods for determining product costs tend to cross department lines of responsibility. Activity-based costing, for example, is more accurate than prior methods of cost allocation, because costs are determined on the basis of cost drivers, the activities involved in generating a unit of service.

Allied health professionals

More than 2000 programs in over 28 health science occupations. Assist physicians and nurses in providing care in a variety of settings. Many of the occupations have grown from the unmet demand for help in the highly specialized operating room environment. Others have grown out of the technological boom and the need for people to operate highly specific equipment.

NCLEX

National Council Licensure Examination (NCLEX) must be passed by nursing students to obtain nursing license. Pass rates on NCLEX act as proxy for quality of nursing school curriculum and the graduating nurse. Some states now require CBCs for RN licensure, for the same reasons as MDs.

New nursing graduates

New graduates worry about communication with MDs and about hurting patients. Nurse residency programs (NRPs) are one-year programs for ICUs, CCUs, and trauma centers that give new grads more education and training. Model NRPs have increased confidence in abilities, increased retention, and reduced RN turnover.

Physician workforce

Now facing shortages of MDs in many specialties. New medical schools have opened in the U.S. in response. Pipeline effect of education and training means students admitted in 2010 will not be prepared to provide primary care until 2017 at the soonest.

Board certification

Physicians may voluntarily submit documentation of education, training, and practice to an American Board of Medical Specialists (ABMS) Member Board for review. Upon approval of the medical specialty board and successful completion of examinations, the physician is designated as board certified in that specialty. Certificates are time-limited. Physicians must demonstrate continued competency and re-take the exam every six to ten years, depending on the specialty. Maintenance of Certification (ABMS MOC) is to ensure physicians remain current. Board certification is a form of credentialing a physician's competency in a specific area.

Telemedicine & Telehealth

Practicing at a distant site.

Assessing quality of work life

The health care manager needs to assess the quality of the work environment, including employee job burnout and job satisfaction. Some of the items to be included are: job autonomy, variety and significance. fairness of pay and benefits. opportunities for promotion and advancement. relationships with supervisors. relationships with coworkers. level of job burnout. overall job satisfaction.

HR functions

Workforce planning/recruitment Employee retention

EMRAM Stage 7

ability to share or exchange data with external entities

long term teams

committee, task force, meet on a regular basis for a period of times

wicked problems

difficult to define and not easily resolved - sometimes can never be truly solved due to multiple layers of issues, such as we see in healthcare

e-health

electronic data transfer

pros of virtual teams

less interpersonal conflict, reduced travel, and access to diverse employees and talents regardless of geography

Benefits

"Benefit" is defined as compensation provided in a form other than salary or direct wages, paid for totally or in part by employer (Jenks and Zevnik, 1993).

electronic medical record analytical model (EMRAM)

- Developed by industry association of health care information technology (HIT) professionals: The Healthcare Information and Management Systems Society (HIMSS). - EMRAM: model to gauge hospital EMR adoption. - Hospitals are scored in a national database. - Stages 0 - 7 indicate progressively higher and more clinically sophisticated uses of HIT.

Learning objectives

- Distinguish among the education, training, and credentialing of physicians, nurses, nurse aides, midlevel practitioners, and allied health professionals. - Deconstruct factors affecting the supply of and demand for health care professionals. - Analyze reasons for health care professional turnover and costs of turnover. - Propose strategies for increasing retention and preventing turnover of health care professionals. - Create a plan to prevent conflict of interest in a health care setting. - Examine issues associated with the management of the work life of physicians, nurses, nurses' aides, midlevel practitioners, and allied health professionals. - Investigate sources of data for health workforce issues.

Physicians

- Pre-medical students can obtain a degree in any subject. -Must graduate with a strong foundation in mathematics, biology, chemistry, and physics. - Entry into medical school is competitive; applicants must have high grade point averages and high scores on the Medical College Admission Test (MCAT).

evolution of the automation of health care

- Repetitive workloads lend themselves to automation: filling prescriptions, resulting -laboratory tests, completing radiology images - Initial automation was in each clinical area and not 'hooked' together or integrated. - Primary caregivers did not use computers as part of their daily routines. - Systems were too cumbersome and time consuming. - Medical devices are more sophisticated - Robotic use has increased - Unification of medical devices and information systems - Systems more prevalent in the clinical setting - Health care managers will need to use these new systems in their daily routines

health information system (HIS)

- all components of computer systems - networks - data that systems create and capture through the use of software

what is EMR?

- an EMR is a computer application that includes: - clinical data repository - clinical decision support - controlled medical vocabulary - physician order entry - pharmacy and clinical documentation - used across inpatient and outpatient areas - used by all practitioners to document, monitor, and manage health care delivery - legal record of care for a patient during their encounter at a care delivery organization (CDO)

hospital EMR adoption

- as of Q1, 2015, 56% of all US hospitals progressed past stage 4 - only 3.7% (197) of over 5467 hospitals have progressed to stage 7 - slow progress due to: - high cost of systems - slow development of data standards - user unfriendliness of systems - patient lack of trust in the ability of the industry to hold their information secure

meaningful use

- concept of "meaningful use" criteria for EHRs focused on achieving five health outcomes policy priorities - improve quality, safety, efficiency, and reduce health disparities - engage patients and families in their health - improve care coordination - improve pop and public health - ensure adequate privacy and security of patient health information - providers expected to progress through three stages of development over the following five year period - 2011-2012: stage 1 - data capture and sharing - 2014: stage 2 - advance clinical processes - 2016: stage 3 - improved outcomes (healthIT, 2015)

barriers to adoption

- cost of purchasing a system - loss of productivity - annual maintenance costs - adequacy of training - finding EHR to meet practice needs

EMR or EHR?

- electronic health record (EHR) is a broader term than EMR - refers to total health of patient, including immunizations, allergies, medications, etc. - data in EHR accessible to many, including patient and other health providers

federal response

- establishment of the Notice of Privacy Practice (NOPP) - while influential on the development and enhancement of HIT, hasn't had any immediate impact to increase adoption and reduce other barriers - by 2009, adoption continued to be very slow - rising health care costs led the Obama administration to intervene - legislation = American Recovery and Reinvestment Act (ARRA) - ARRA includes Health Information Technology (HITECH) Act to increase adoption through incentives for hospitals and physicians (among other care providers)

historical uses of information technology

- health care settings include hospitals, physician practices, nursing homes, home health care, insurance companies - mainly used for administrative support - to support regulatory requirements such as those defined by JCAHO, CMS, and CAP - opportunity to reduce costs and increase patient safety and treatment effectiveness has encouraged use in more clinical settings

HIPAA

- in 1996, Health Insurance Portability and Accountability Act (HIPPA) established, among other things, - standardization of data, and - regulations on its privacy - heightened attention to measures to protect personally identifiable health information (PHI)

physician EMR adoption

- most patient care in the US occurs in physician offices - of all care settings, they have the LEAST amount of automation due to the previously defined barriers to adoption - 96.4% hospitals have some form of an EMR; 62.8% of physician practices have EMR

the challenge when working with teams

- most professional organizations there is not usually a class provided on teamwork and how to act as an effective member of a team - no formal training

problems with EHRs

- poor usability - time consuming data entry - interference with face-to-face patient care - inefficient and less fulfilling work content - inability to exchange health information, and degradation of clinical documentation

future of health information technology (HIT)

- portability - EMR in your pocket - there's an app for that - virtual health care - be "seen" without need for physical exam - future uses of technology in health care include: - patients wearing computer to regulate and/or monitor (smart vests) - embedded microchips - systems improvements for complex information

solutions? to EHRs

- scribes: - people trained in medical terminology and pathophysiology who make notes on EHR while physician speaks with the patient - better training and more intuitive systems: - difficulty using EHR decreases productivity, increasing provider frustration with hassle factor

systems in health care

- standard office applications such as word processing, spreadsheet management, and email and other administrative tools to enable collaboration - budget systems to manage expenses and income - cost accounting systems to model the profit (or loss) of key services/products - billing and accounts receivable systems used to bill clients and customers for the goods or services of the entity

legislative history of social insurance

1960 - Kerr-Mills Act 1965 - Social Security Act - Title XVIII - Medicare - Title XIX - Medicaid 1982 - Tax Equity and Fiscal Responsibility Act (TEFRA) 1989 - Omnibus Budget Reconciliation Act (OBRA) 1997 - Balanced Budget Act (BBA) 2003 - Medicare Prescription Drug, Improvement and Modernization Act (MMA) 2010 - Patient Protection and Affordable Care Act 2015 - Medicare Access and CHIP Reauthorization Act

HR Example

A large physician practice is in need of hiring someone to head up their information management area. The practice has grown from seven to 23 physicians in the past five years, and the practice administrator has realized that the clinical and financial records needs of the practice have outpaced current administration expertise. The administrator wants to define the job and then recruit.

Nurse anesthetists' quality of care

A review of six years of data from the Centers for Medicare & Medicaid Services (CMS) found no adverse outcomes in states where nurse anesthetists were allowed to practice solo, i.e., without the supervision of physicians (Dulisse & Cromwell, 2010). Cheaper, more available than MDs, and equally safe—who would you hire?

importance of medicaid

Accounts for 35% of safety-net hospital revenues Provides 40% of health center revenues Covers ¼ of all behavioral health care spending nationally Pays for nearly 50% of all births in the U.S. Covers 50% of the costs of long-term care and support of the disabled and elderly

tricare characteristics: eligibility

Active duty, retired military, and families covered Includes DOD's 536 hospitals and clinics Three program options: HMO PPO Fee-for-service

Human Resources Management

Addresses the need to ensure that qualified and motivated personnel are available to staff the business units operated by the health service organization (Hernandez et al., 1998).

Physician review of credentials

After the physician credentialing department does due diligence, the materials are submitted to a department credentialing committee, made up of physicians. Upon approval of that committee, documents are forwarded to a Medical Executive Committee, a subcommittee of the hospital Board of Directors (BOD). The subcommittee makes a recommendation to the BOD, which approves or disapproves the application. Time from submission of the application to final approval can take 3 to 6 months. Problems with the application can make the process even longer.

Sampling of research sources

Agency for Healthcare Research and Quality Bureau of Labor Statistics (BLS) Centers for Disease Control and Prevention Hospital Research and Educational Trust (HRET) Open Payments The Robert Wood Johnson Foundation To name but a few.

veterans health administration

All veterans are eligible Veteran Integrated Service Networks (VISNs) located in 22 regions Varying benefits based on enrollment categories

Health care manager's role

As a health care manager, you may find yourself working in the physician relations and credentialing department, and you may be responsible for determining whether the credentials offered by a physician are legitimate. Physician credentialing requires excellent interpersonal skills, organizational skills, persistence, an eye for details, and the ability to identify inconsistencies in data. VA (2010) study underscores need for diligence.

cultural proficiency

As an individual and an organization: the ability and willingness to respond respectfully and effectively to people of all cultures, classes, races, ages, sexual orientations, ethnic backgrounds, and religions in a manner that values all. Also referred to as: cultural competence cultural conditioning cultural sensitivity cultural congruence

management implications

As part of their HR activities, managers become involved in: Selecting health insurance plans for employees. Considering benefit packages, costs of coverage, and other issues. As part of patient-related activities, managers need to understand: Health insurance plans and coverages, including changes to Medicaid. Coding and billing. Reimbursement policies and procedures.

Compensation

Base pay: Tied to knowledge, skills, experience, and basic expectations for a specific job. Incentive compensation: Designed to improve organizational performance by motivating employees to higher levels of achievement and performance.

capital budgeting

Basic questions that need to be answered: Does this asset at least pay for itself? Does the asset add value to the organization? Types of items included in capital budgets: Land acquisition. Facility construction, acquisition, renovation. Routine capital equipment used in clinical areas. Information technology infrastructure and upgrades. Acquisition of staff physicians. Wish list submitted to managers and proposals submitted by managers to Finance Department. Methods ("Decision Rules") utilized to make capital budgeting decisions: Accept/reject Capital rationing - those selected have highest profitability index. Non-criteria-based - safety valve allowing purchase "no matter what." Approval by administration and governing body.

tricare characteristics: benefits/funding

Benefits Hospital care, physician services, prescription medications, diagnostic tests, preventive services Dental services for active duty personnel only Funding No enrollment fees Subsidized by the federal government Co-pays required (except for active duty personnel) Some required to meet annual deductibles

Advanced practice nurses (APNs)

Between 2010-2011, the number of NP graduates increased by 69%. Nurse Practitioners (NPs) are prepared in either an NP MSN program or a post-Masters certificate and must graduate from an accredited program that includes didactic and clinical components and a minimum number of hours (specified by the specialty) of supervised clinical practice in the specialty area. Can become certified in specific areas of care. Must pass a certification exam and maintain their competency through continuing nursing education and/or re-certification exams.

managing budgets

Budget: The plan for turning the objectives of the organization into a program for earning revenues and controlling expenditures. Involves all managers. Major Types of Budgets: Operating budget, or cash budget - annual budget that is a forecast of cash inflows, outflows, and net lending or borrowing needs. Expense budget. Revenue budget. Capital budget - plan for expenditures for long-term assets whose useful life is more than a year.

Indirect costs of PCP turnover

Burden of workload on remaining PCPs. Decreased morale. Decreased productivity. Loss of continuity of care. Loss of clients and revenue stream.

classifying costs: frequently utilized methods

By Behavior Fixed costs Variable costs By Traceability Direct costs Indirect costs Full costs By Decision Making Capability Controllable costs Uncontrollable costs

CNAs and turnover

CNAs are trained on the job in 75 hours of mandatory training and required to pass a competency examination. CNAs provide direct care to patients over long periods of time. Estimates of CNA turnover from LTC facilities ranged from 40% to 66%, with indirect and direct costs per lost worker ranging from $951 to $6,368, with a minimum direct cost of $2,500 per lost worker. The job of the health care manager is to improve retention by addressing the quality of work life.

crew resource management

CRM, in the high-stakes airline industry, has been developed to address attitudes, change behavior, and improve performance Sexton, Thomas, and Helmreich (2000) have applied crew resource management research to hospitals, where stakes are also high and lives depend on the smooth functioning of the health care team

setting charges

Charges are "published prices," however, wide disparity exists between published prices and contract prices, since most third-party payers negotiate lower rates with health care providers. Prices, on the other hand, involve the money actually spent, involving perceived value of the services and the other opportunities foregone by consumers to acquire the services.

Uses of Performance Appraisals

Compare absolute and relative performance of staff. Determine a plan for improving performance for those employees in need of improvement. Determine what additional training and development activities are needed to improve employee performance. Use the findings to clarify employee's interests and desires. Document performance in those cases where termination or re-assignment is necessary. Determine adjustments to compensation based on performance. Determine promotional or other advancement opportunities for the employee.

HR strategic activities

Compete for labor and want to have an adequate supply and the proper mix of high-quality staff, HSO staff ("Talent") should be viewed as a "strategic asset" to gain competitive advantage, Organizational performance depends on individual performance.

HIT Impact on the Manager

Complex and quickly evolving work environment. Effective managers must use technology themselves and understand well enough to manage effectiveness of their employees. Dependency will create new norms around computer competencies, processes to use during "downtimes," etc.

determinants of setting charges/prices

Consider legal and regulatory issues. Establish pricing goals and objectives. Estimate the economic market conditions involving supply and demand. Estimate costs and the break-even point. Consider policies of third-party payers. Consider other competitors in the market. Consider the effects of over- and under-pricing. Take into consideration allowable costs. Utilize pricing tactics.

Employee as drivers of performance

Core services provided by HSOs—patient care services—are highly dependent on the capabilities and expertise of the employees of the organization, HSOs are service organizations, unlike traditional businesses or manufacturing firms, They are highly specialized organizations that provide a range of care using individual employee expertise, Health care workers from different departments and units must work together to provide the overall services for each patient.

cost allocation

Cost allocation involves the determination of the total cost of producing a health care service through assigning costs from non-revenue-producing departments into revenue-producing departments. Purpose is to: Ensure patients are paying only for services and products received. Separate costs at the unit-of-service level to allow managers to measure changes in intensity and case mix and to identify inefficient functions.

medicaid program characteristics: eligibility

Coverage for the medically indigent TANF (formerly AFDC) and SSI recipients qualify automatically Expanded coverage for pregnant women, children, and infants Expanded coverage for children via CHIP Expanded coverage in some states to include those with higher incomes in relation to the federal poverty level

CHAMPVA

Coverage is provided for: Non-retired veterans Permanently and totally disabled individuals Spina Bifida Health Care Program Women Vietnam Veterans Health Care Program

eligibility for medicare

Coverage is provided to: Elderly citizens over 65 years of age Permanently disabled younger adults Individuals with end-stage renal disease (ESRD) Terminally ill patients in the end of life 55 million people were enrolled as of 2015

CHIP

Covers children in low-income families who aren't eligible for Medicaid. Jointly funded by states and federal government. The ACA increased the federal matching rate to 93%. As of FY 2013, 8.1 million children were enrolled.

managing working capital

Definition: "Total current assets," or short-term assets that can be converted to cash in one year (Nowicki, 2004), versus "current assets plus current liabilities" (McLean, 2003). Primary Sources of working capital: Permanent working capital. Net income, or profits. Temporary working capital, including equity, or net assets; short-term debt, or loans; and trade credit from delayed payments to vendors.

managing accounts receivable

Definition: Current assets, created in the course of doing business, consisting of revenues recognized, but not yet collected as cash (McLean, 2003). AR generally provide no interest, and their collection become less likely as time passes. AR comprise about 75% of a health care provider's current assets (Zelman et al., 2003). Having large dollar amounts in AR means lost opportunities for other investments. There are other costs associated with AR, including carrying costs, delinquency costs, and collection costs. The primary goal of managing AR is to reduce the collection period, or "days in AR." There is interdependence among almost all departments of a health care organization in reduction in the AR collection period. Health care providers often need to receive cash advances on outstanding AR to continue operations. Two methods used to finance AR: factoring receivables - selling at a discount. pledging receivables as collateral to negotiate a line of credit to cover temporary cash shortfalls.

utilization of the health care system by the uninsured

Delay seeking care or forgo care altogether, thereby increasing their chances of: Preventable health problems Disability Premature death Utilize the most expensive access point to the health care system-hospital emergency departments-to obtain care Do not have a primary care physician

insuring veterans, active and retired military personnel, and their families

Department of Defense (DOD) medical facilities TRICARE Plan Veteran Affairs (VA) medical facilities VA Civilian Health and Medical Program (CHAMPVA)

basic tenets of materials management

Develop close relationships with distributors, who control availability, pricing, and receiving schedule. Understand the costs of inventory, including purchasing costs, ordering costs, carrying costs, stock-out costs, and overstock costs. Calculate the economic order quantity (EOQ) and reorder point (RP) to know the right quantity of items to be ordered at the right time. Create an in-service training program for the management team regarding procedures for requesting purchase orders, negotiations with vendors, etc.

examples of health disparities

Diabetes Racial and ethnic minorities have worse control of the disease and are more likely to experience complications. Hispanics and American Indians/Native Americans are at particularly high risk. Infant Mortality Even when controlling for socioeconomic factors, the rate of infant mortality is more than twice as high among African Americans as compared to non-Hispanic whites (Office of Minority Health, 2014). HIV and AIDS Racial and ethnic minorities are disproportionately affected. Suicide LGBT youth are at increased risk for suicidal thoughts, behaviors, attempts, and actual suicides.

summary

Disproportionate burden of illness and injury among underserved populations. U.S. population becoming more racially and ethnically diverse, and also the patient population. Health care organizations must reflect and support the communities they serve with best practices in cultural proficiency.

Residency work hours

Effective July 1, 2011, all specialty and subspecialty residency training programs required to limit resident work hours to no more than 80 hours per week, and in-house continuous duty can't exceed 24 hours. No moonlighting allowed for PGY-1s. Work restrictions mean increased use of contract physicians or mid-level practitioners, physician assistants, and nurse practitioners. Healthcare organization may need to hire ancillary staff and allied health professionals to do tasks previously covered by resident physicians.

HR employee retention

Employee Relations and Engagement Training and Development Compensation and Benefits Employee Assistance Program Assessing Performance Labor Relations Leadership Development Employee Suggestion Program

Job satisfaction and burnout

Employee turnover has been clearly linked to job dissatisfaction and job burnout.

Direct costs of PCP turnover

Estimates of recruitment and replacement costs for individual PCPs for three specialties (in 2001): $236,383 for Family Practice (FP). $245,128 for Internal Medicine (IM). $264,645 for Pediatrics (Peds). These costs have only gone up over the past decade, not declined.

not-for-profit attributes

Exempt from taxes. Primarily serve community or public interests. May not participate in political campaigns or influence legislation. Must provide designated amounts of community benefit and indigent care.

Employed MDs and conflicts of interest

Fears about the influence of gifts and other financial incentives on MD prescribing practices and purchasing behaviors. Some states enacted laws earlier than others to prohibit pharmaceutical or medical device companies from giving more than $100 in gifts to physician organizations.

Nursing faculty shortage

Fewer nursing faculty mean fewer slots for nursing students. Nursing students must be supervised closely in clinical settings. Faculty supervisor can only have set number of students. Otherwise, patient safety and faculty licenses are jeopardized.

Impact of environmental forces

Fewer resources to recruit, compensate, and develop workforce, Shortage of skilled workers, changes in recruiting and staffing specialized services, lower satisfaction of workers, Increased volumes of patients and workload for HSOs, Competition for health care workers and pressure for higher wages/benefits, HR must ensure high performance in HSO.

national health expenditures, 2013

Five areas account for more than 75% of expenditures: 32.1% hospital care 20.1% physician and clinical services 9.3% prescription drugs 6.5% other professional, dental, and personal care services 8.1% nursing home and home health care The remaining 24% of spending includes: Administrative costs Structures and equipment Public health Other medical products Research

Board certified/Board eligible

For staff privileges and hiring purposes, most hospitals, HMOs, and other health care organizations require a physician to be board certified or board eligible, i.e., preparing to sit for the exams. Board certification is used as a proxy for determining the quality of a health professional's services. Assumption of quality is based on research that more education and training leads to a higher quality of service.

tax status of healthcare organizations

For-Profit, Investor-owned Serve private interests and pay taxes. Goal is to maximize profits for the owner. Must also serve the community. Not-for-Profit Serve public interests and are tax-exempt. Goal is to provide community benefit and optimal patient care (including the indigent). Two types: business-oriented (private), and government-owned. Must also turn a profit for sustainability.

sources of medicare revenues, 2013

General Revenues: 41% Payroll Taxes: 38% Beneficiary Premiums: 13% Interest/Other Sources: 3% Payments from States: 2% Taxation of Social Security Benefits: 2%

major objective of financial managment

Generate a reasonable net income. Set prices for services. Facilitate relationships and manage contracts with third-party payers. Record and analyze cost information. Prepare, audit, and disseminate the organization's financial reports. Invest in long-term capital assets. Ensure that payroll is covered and that suppliers are paid. Protect the organization's tax status. Respond to government regulators, external auditors, accrediting agencies, and quality consultants. Control financial risk to the organization.

ongoing medicaid program concerns

Growth in Medicaid spending, as a result of: Increases in volume Increases in provider payments Increasing numbers of beneficiaries as a result of: Downturns in the economy Rising unemployment Increases in the uninsured population The ACA expansion Continued expansions of benefits States that did not expand under the ACA

Conclusion

HIT impact on health care/manager increasing. Costs have risen; quality has not. While still many barriers, adoption of clinical systems is increasing. There is a model, EMRAM, that helps gauge adoption.

Responsibilities of HR Staff in Recruitment

HR Staff: Prepares position description. Performs job pricing. Prepares advertisements/recruitment materials. Keeps track of applicants/maintains HR info system. Checks applicant references. Keeps personnel files. Narrows candidate pool.

Clinical nurse specialists (CNS)

Have in-depth education in the clinical specialty area at a Master's degree level and must have all of the same educational qualifications as an NP, but in their area of focus, plus a minimum number of specified hours of supervised clinical practice in their specialty area. Can become certified in specific areas of care. Must pass a certification exam and maintain their competency through continuing nursing education and/or re-certification exams.

Current Research in Human Resources Management

High performance work systems and best practices: staff engagement, staff acquisition and development, staff empowerment in decision-making, and leadership alignment and development. Involvement of senior human resources professionals in organizational strategic planning. Predictive Analytics: large, internal datasets on employee skills, capabilities, and business performance help identify employee needs, ways to better deploy staff, factors affecting employee engagement, and ways to reduce turnover.

IMGs serve poor and inner city

IMGs provide services where U.S. medical graduates won't go. Must pass English language, clinical skills assessment, and written exams before being allowed to apply for residencies. U.S. physician workforce has more U.S.-born IMGs.

controlling costs

Importance of Cost Accounting in Providing Managers with Information: To estimate and manage their costs. To set charges and analyze profits. To make decisions regarding adding, enhancing, or eliminating services. To provide methods for classifying, allocating, and determining product costs.

managing materials and inventory

Importance of Materials Management Delivery of appropriate patient care. Provision of cost control. A non-productive asset, inventory loses value over time. Improvement of the organization's bottom line through best pricing and reducing over-utilization. Methods for Stocking Inventory: Just-in-time (JIT) - Products are literally delivered to the provider "just in time" for use; decreases holding costs and obsolescence. ABC Inventory Method - Each supply item is assigned to one of three groups and is thus monitored according to cost.

LPNs/LVNs

In 2012, about 738,400 Licensed Practical Nurses (LPNs) or Licensed Vocational Nurses (LVNs) worked under the supervision of physicians and nurses in the U.S. After graduation from high school, LPNs are trained in one-year, state-approved programs, then must pass the LPN licensing exam, the NCLEX-PN. LPNs do basic nursing functions, such as taking vital signs; observing patients; and assisting patients with activities of daily living (ADLs) like bathing, dressing, and feeding. With additional training, where state laws allow, they can also administer medications.

Physician assistants (PAs)

In 2012, there were 86,700 PAs employed in the U.S. (BLS, 2014). Over 196 accredited educational programs that must confer graduate degrees. PAs take the Physician Assistant National Certifying Examination and must demonstrate competency, to be recertified every 10 years, and earn 100 CME hours every two years. PAs are versatile, valuable members of the health care team and are highly sought after by physician practices, hospitals, and other employers.

Home health aides

In 2012, there were 875,100 home health and personal care aides employed in the U.S. (BLS, 2014). Hospitals are discharging patients quicker and sicker, which means more and more health care that used to be provided strictly in hospital settings is now given at home (Landers, 2010).

Nursing assistants and orderlies

In 2012, there were about 1.5 million nursing assistants and orderlies employed throughout health care organizations. Nursing aides, nursing assistants, certified nursing assistants (CNAs), orderlies, and other unlicensed patient attendants work under the supervision of physicians and nurses, answering call bells, and assisting patients with ADLs. Regardless of employment setting, aides are front-line health care personnel.

financial governance

In Order of Responsibility: Governing Body, or Board of Directors/Trustees Chief Executive Officer (CEO) Chief Financial Officer (CFO) Controller Treasurer Internal Auditor All managers in the health care organization

ACOs

In addition to financial costs of physician turnover, there is an impact on accountable care organizations (ACOs) responsible for the health of a given population. Turnover interrupts continuity of patient care and incurs costs with repeat testing, especially in organizations without EMRs.

Home health growth

In addition, due to the demographic tsunami of aging baby boomers who wish to age in place (i.e., at home) and due to the increasing longevity of individuals with chronic diseases and disability, this area of employment is expected to grow dramatically over the next decade—and hospitals will be in this business, too.

RN continuing education units

In many states, nurses are required to obtain nursing continuing education units (CEUs) to renew and maintain their nursing license. Hundreds of providers of nursing CEUs and multiple ways to obtain nursing CEUs are available. It is the responsibility of the RN to maintain his or her license. The role of the health care manager is to ensure that resources, i.e., money and time, are available for nurses to participate in these educational opportunities.

CBCs and CNAs

In the past, CNAs were not required to have criminal background checks (CBCs), and elder abusers, sexual predators, and thieves preyed upon the elderly. Now the majority of states and employers require CBCs. A clean CBC doesn't guarantee that the person hasn't or won't abuse a patient. The health care organization must have policies about neglect and abuse prevention in place, and the health care manager must be vigilant and enforce them.

Transition to nursing practice

In the past, hospitals (the major employer of RNs) have thrown RNs into nursing units after a minimal orientation period. Nursing turnover has resulted, leading to massive costs to the organization, with up to $65K per lost nurse. This becomes millions of dollars when multiplied by the numbers of RNs quitting.

Nurse-physician relations

In the past, physicians had at least twenty more years of formal education than the RNs they worked with. The educational gap between the two health care professional groups has diminished dramatically. Women have also "come of age" since the women's rights movement in the 1970s. Nurses are no longer the doctors' handmaidens.

Employed PCPs and turnover

Increasing numbers of employed MDs means they will no longer be independent contractors, but employees of health care organizations. One recruiter reported that in some communities as many as 90% of the physicians may be employees (Butcher, 2008). Turnover of employed MDs is of concern.

health insurance total cost of premiums, 2014

Individual Coverage $6,025 - All plans $6,223 - HMOs $6,217 - PPOs $6,166 - POSs $5,299 - HDHP/SO Family Coverage $16,834 - All plans $17,383 - HMOs $17,333 - PPOs $16,037 - POSs $15,401 - HDHP/SO

reimbursement efforts to control medicare spending

Inpatient hospital stays - Diagnosis-Related Groups (DRGs) Physician office visits - Resource-Based Relative Value Scales (RBRVS) Skilled nursing facilities - Resource Utilization Groups (RUGs) Home health agencies - Home Health Resource Groups (HHRGs) Hospital outpatient department services - Hospital Outpatient Prospective Payment System (OPPS)

International medical graduates

International Medical Graduates (IMGs) can be U.S. citizens who attend school abroad or foreign-born nationals who come to the U.S. IMGs represent 25% of the U.S. physician workforce or about 245,005 MDs. 60% of IMGs are in primary care; 75% are in direct patient care. The top country for sending foreign-born physicians to the U.S. is India.

Disruptive behaviors

Intimidating and disruptive behaviors include "overt actions such as verbal outbursts and physical threats as well as passive activities such as refusing to perform assigned tasks or quietly exhibiting uncooperative attitudes during routine activities" (The Joint Commission, 2008).

what is financial management?

It is the process of: Providing oversight of the health care organization's day-to-day financial operations. Planning the organization's long-range financial direction (both internal and external). Increasing the organization's revenues and decreasing its costs.

HR workforce planning

Job Analysis Workforce Planning Establishing Job Descriptions Recruitment Interviewing, Selection, Negotiation, and Hiring Orientation

LTC and LPNs

LPNs are the backbone of the long-term care (LTC) sector of the health care industry, providing around-the-clock care and supervision of certified nurse's aides (CNAs) in nursing homes and convalescent centers. Many LPNs go on to earn their RN, and in some states, LPNs can take challenge examinations to earn their RN licensure. LPNs are important members of the health care team and should be included in the health care manager's tuition assistance plans.

Certified nurse midwives (CNMs)

Licensed as independent practitioners in all 50 states. As of 2010, all CNM applicants were required to have graduate degrees and to have graduated from a nurse-midwifery education program accredited by the American College of Nurse-Midwives (ACNM) Division of Accreditation (DOA) and pass a national certification examination.

tricare concerns

Limited network of providers in rural areas Difficult to provide care to National Guard and Reserve personnel Ensuring sufficient providers for 9.2 million beneficiaries

Criminal background checks

Majority of states now have authority to require criminal background checks (CBCs) for physician licensure. Reasons: increasing societal concerns about alcohol and drug abusers, sexual predators, and child and elder abusers. If CBC shows convictions, boards review the application, looking for level and frequency of criminal behavior, basing their decision on that, along with other materials submitted by the applicant, such as proof of alcohol and drug rehabilitation.

summary

Managing costs and revenues in health care organizations is a complex process involving understanding of: the interrelatedness of multiple processes. the interplay of many departments. the importance of external influences. Managers at all levels of the organization are involved in addressing these functions.

COI policies

Many health care organizations have specific policies for physicians and executives regarding COI. Employees must disclose any COIs for themselves or their family members, including spouses. COI documents must be updated annually. HCMN manager is responsible for COI documentation and policy enforcement.

managing reimbursements from third-party payers

Methods Used by Private Health Plans: Retrospective - determined after service delivery Charges Charges Minus a Discount Cost Plus Prospective - determined before service delivery Per Diem Per Diagnosis Capitation Methods Used by Medicare and Medicaid: Reimbursements to Hospitals Contractual Allowances Diagnosis-Related Groups (DRGs) Case Mix, or Patient Mix Reimbursements to Physicians Resource-Based Relative Value Scale (RBRVS) Capitated managed care plans Reimbursements to Other Providers

Midlevel practitioners

Midlevel practitioners work midway between the level of an RN and an MD. They include Advanced Practice Nurses (APNs), such as Nurse Practitioners (NPs), Clinical Nurse Specialists (CNS), Nurse Anesthetists, and Nurse Midwives. Physician Assistants (PAs). Serve in a variety of settings: hospital emergency rooms or departments covering hospital floors for physicians, community health clinics, physician offices, and health maintenance organizations. Are usually less expensive than physicians, often replacing MDs at a 2:1 ratio. Are much sought after by health care organizations because they can provide many of the same services as physicians, at a lower cost.

More education, better care

More nurse education and training leads to a higher quality of service and lower patient mortality. It makes financial sense to employ more RNs per patient and to hire RNs with a baccalaureate-level degree or higher.

Foreign-educated nurses

Most U.S. state nursing boards have stringent requirements for foreign-educated nurses, including completion of the Commission on Graduates of Foreign Nursing Schools (CGFNS) certification program (CGFNS, 2006). The annual number of internationally educated NCLEX passers has declined from nearly 23,000 in 2007 to 6,100 in 2011 (HRSA, 2013).

Physician licensure

Most physicians are eligible to obtain a license to practice medicine after one year of post-graduate training. Licensure is granted by the state, required for physicians, nurses and others to practice, and demonstrates competency to perform a scope of practice. State Boards of Physician Quality Assurance (BPQA) establish requirements for medical licenses.

Continuing medical education

Most states require physicians to complete a certain number of continuing medical education (CME) credits to maintain state licensure and to demonstrate continued competency. Hospitals may require CME credits for their physicians to remain credentialed. Accreditation Council for Continuing Medical Education (ACCME) establishes criteria for determining which educational providers are quality CME providers and gives its seal of approval only to those organizations meeting their standards.

Residency training

National Residency Matching Program (NRMP) matching process for graduating medical students for Graduate Medical Education (GME). Length of the residency training program from three years (for family practice) to ten years (for cardio-thoracic surgery or neurosurgery). After completion of residency, physicians are eligible to take their board certification examinations and practice independently.

Certification of nurses

Nurses can specialize in practice areas and take examinations that credential their competency. Some examples of certification areas: Ambulatory Care, Cardiac Rehabilitation, Cardiac Vascular, Case Management, Critical Care, and Gerontological. Must demonstrate continuing competency and renew certification on a periodic basis.

Open payments

Open Payments, aka the Sunshine Act led to more transparency in health care and a sense of urgency in the creation of COI policies. Open Payments means records of gifts made by group purchasing organizations, medical device companies, and research grants must be reported on the CMS website by the donor. Open Payments is available to the public.

Organizational climate

Organizational climate is critical to promoting job satisfaction and retention of nursing staff. Nurses who perceive that they have access to opportunity; honest relationships; open communication with peers, co-workers, and managers; and trust their managers are more likely to be retained and to have higher job satisfaction.

RNs and patient morality

Overwork of nurses and high patient-to-nurse ratios lead to patient mortality, nurse burnout, and job dissatisfaction. The difference from 4 to 6 and from 4 to 8 patients per nurse was accompanied by 14% and 31% increases in mortality, respectively (Aiken, Clarke, Sloane, Sochalski, & Silber, 2002).

medicare "parts"

Part A - Hospital Insurance (HI) Part B - Supplemental Medical Insurance (SMI) Part C - Medicare Advantage Plans (MAs) Part D - Prescription Drug Benefit

Conclusions

Performance of HSOs is tied directly to the motivation, commitment, and skills of clinical, administrative, and support staff. HR actions are undertaken for both strategic and administrative reasons. HR staff are responsible for coordinating HR management; serve as a support for line managers. HR management is being assessed for contribution to organizational performance. HR management will increase in importance in the future due to heightened external and internal pressures to recruit and retain committed and high-performing staff.

Physician credentialing

Physician credentialing is the process of verifying information that a physician supplies on an application for staff privileges at a hospital, HMO, or other health care organization. Physician credentialing is a time consuming, labor intensive, costly process that must be repeated every two years. When physicians apply for privileges at a hospital, they must specify what they want, not only by specialty, but in the surgical specialties, by procedure.

Physician imposters

Physician imposters: rare, potentially dangerous individuals, can obtain fraudulent credentials from medical schools in other countries, or even in the U.S. You must have direct contact with the authorities at the institution where the person claims to have been educated or employed You will be required to handle telephone inquiries with tact, to ensure that you obtain verification. If no one at an institution knows the individual, or if the medical school has "burned down, leaving no records," alarm bells should be ringing and you must notify your manager. Some companies will do this for health care organizations (HCOs), but accountability still rests with the HCO.

example: national standards on culturally and linguistically appropriate services (CLAS)

Principal Standard Provide effective, equitable, understandable, and respectful quality care and services that are responsive to diverse cultural health beliefs and practices, preferred languages, health literacy, and other communication needs. Other Standards Governance, Leadership and Workforce Communication and Language Assistance Engagement, Continuous Improvement, and Accountability

IMGs and quality of care

Quality of care provided by IMGs has been found to be as good as or better than that given by persons who graduated from U.S. medical schools (Norcini, Boulet, Dauphinee, Opalek, Krantz, & Anderson, 2010). Role of HCMN manager is to ensure credentials of IMGs are verified and that they are legally allowed to work in the U.S.

Why nurses leave

RNs quit jobs where they feel overworked, underpaid, and disrespected. RNs are concerned about: being unable to physically continue to do the work. increases in their daily workloads. the lack of ancillary staff to support them.

Registered nurses (RNs)

RNs used to be trained in hospital-based programs and received diplomas upon graduation, essentially an apprenticeship, without a set curriculum. In 2011, they represented only 10% of the nursing schools in the U.S. The majority of nursing education is now provided in degree-based settings: community colleges, earning an associate degree in two to three years; or university and college baccalaureate programs for professional nursing practice, earning a Bachelors of Science in Nursing (BSN) in four years.

Allied health shortages

Respiratory therapy is particularly affected, along with radiology technologists and certified nursing assistants. One survey found all three groups were dissatisfied with current work life, and claimed inadequate staffing was the "number one problem they face." They felt health care professional shortages compromised patient care, and that turnover was impacting retention and recruitment. Recommendations included: increased salaries, improved staffing ratios, better health benefits, more input into decisions, flexible schedules, increased support staff, and continuing education. These are all under the control of the health care manager.

medicaid program characteristics: funding

Second-largest social health insurance program Jointly funded by federal and state governments Federal share = 50-77% of costs State share = 23-50% of costs "Bare bones" programs "Rich" programs -- offer extensive expanded eligibility and benefits Program expansion was a major provision of the ACA, with 100% federal funding through 2016 Enrollment now at approximately 70 million people

for-profit attributes

Serve private interests. Pay state and federal income taxes. May participate in political campaigns. Motivated by profit. Have a limited obligation to provide indigent care. Able to issue stock to raise capital.

medicaid program characteristics: benefits

Services mandated by federal legislation: Inpatient hospital stays Outpatient hospital services Physician services Lab and x-ray Nursing facilities Home health services EPSDT Services added at a state's discretion: Dental care Mental health care Drug and alcohol treatment Rehabilitation Preventive care Prescription drugs Prostheses

causes of growth in medicare spending

Shift from acute to chronic care Growth in hospital expenditures Fee-for-service reimbursement Growth in pharmaceutical costs Advances in medical technology Increased payments to health plans Increased payments to rural health providers Rising medical malpractice premiums

Major Types of Benefits

Sick leave Vacation Holidays Health insurance Life insurance Retirement plan Flexible spending account

No gaps in resumes

Since physicians are tracked from the moment they graduate from medical school, the first thing you want to verify is that there are no gaps in their resumes. Physicians rarely take time off "to find themselves." A significant gap between educational or employment placements is a red flag and you need to question it. You will be responsible for safe, effective patient care, and you must be mindful about who is providing that care.

Certified registered nurse anesthetists (CRNAs)

Specialize in providing anesthesia, working in cooperation with anesthesiologists, surgeons, dentists, and other health care professionals. To become a CRNA, in addition to having a BSN and an RN and having worked at least one year as an RN in an acute care setting, the nurse must graduate from an accredited master's degree nurse anesthesia program. CRNAs must also pass a national certification examination.

Hallmarks of the professional nursing practice environment

The American Association of Colleges of Nursing white paper identifies attributes of hospitals with work environments that support professional nursing practice, and provides a list of questions a new graduate should ask. The questions posed by the AACN challenge health care organizations to rise to higher standards.

Foreign RNs and HCMN manager

The CGFNS Certification Program removes a major burden; however, the health care manager must ensure that foreign-educated nurses have fulfilled all the requirements of the State Board of Nursing, and that they are legally allowed to work in the U.S. Different cultures bring varying expectations to the work setting. Excellent interpersonal skills, conflict management, cultural competency, and sensitivity to diversity issues are critical for you to be able to be an effective health care manager for these employees.

National practitioner data bank

The National Practitioner Data Bank (NPDB) was created to have a system to identify, discipline, and report those who engage in unprofessional behavior. The intent of the NPDB is to restrict the movement of incompetent physicians and dentists from state to state without disclosure. "The information contained in the NPDB should be considered together with other relevant data in evaluating a practitioner's credentials; it is intended to augment, not replace, traditional forms of credentials review"(NPDB, 2010).

NRPs

The University HealthSystem Consortium (UHC)/AACN Residency Program has 92 practice sites in 30 states that offer the year-long post-baccalaureate residency. More than 26,000 nurses have completed the program. Satisfaction is reflected in a 95.6% retention rate (AACN, 2015).

Physician credentialing

The hospital must conduct diligent research on that surgeon before granting privileges, or it can be held liable in a court of law for allowing an incompetent physician on its staff, should there be a bad outcome. It is preferable to obtain primary verification and documentation, i.e., to contact each place individually by phone and obtain original documents, such as transcripts with raised seals.

impact of the ACA on the uninsured

The percentage of uninsured decreased from 17.1% to 12.9% between 2013 and 2015. States that expanded their Medicaid programs saw their uninsured rates drop more than 7%. Those covered have included young adults under age 26, who could stay on their parents' insurance policies.

Baccalaureate nurses (BSNs)

The undergraduate nursing school curriculum (BSN) is rigorous, requiring a good understanding of the biological sciences. At some universities, nursing students are eligible to continue to the third year after completing a specific sequence of courses and maintaining a 3.0 or B average overall and in all science courses.

HR administrative activities

There are a number of administrative functions and action steps carried out in support of the human resources of the HSO to ensure high levels of performance.

reimbursements by the uninsured

Those without insurance are billed for full charges. Has resulted in the rise of personal bankruptcies, due to inability to pay such large sums of money. Uncompensated Care - Two Major Types: Bad Debt - no payment received for billed services; written off by the organization. Charity Care - organization provides care, knowing the patient will be unable to pay.

purposes of working capital management

To increase revenues and reduce expenses by: Making capital assets (buildings, etc.) productive by managing current assets (labor, etc.). Conserving cash by cutting financing costs to take advantage of short-term investments. Managing cash flow or amount of inflows and outflows. Managing the liquidity of the organization. To enhance "goodwill" toward the organization: by paying vendors and employees on time. by demonstrating to lenders that the organization is "creditworthy." To undertake changes that add value to the organization.

NPs and independent practice

Twenty-one states permit nurse practitioners to practice independently, i.e., without physician supervision. This enables NPs to evaluate patients; diagnose, order and interpret diagnostic tests; and initiate and manage treatments, including prescribing medications under licensure of the state board of nursing.

MD retention strategies

Women and older male MDs are more likely to opt for part-time employment. One of the more effective retention strategies found in a national survey was the use of mentoring. "Setting clear expectations" for new hires was cited as another useful retention strategy (Cejka & AMGA, 2007, p.8).

HR domains

Workforce Planning/Recruitment: Determine the future staff needed and acquire them. Employee Retention: Care, support, and development of the staff.

cultural proficiency initiatives

Workforce diversity Supportive leadership and culture Appropriate human resource policies Assessment on individual and organizational levels Education and training Multilingual services and support materials - CLAS Evaluation and research Community outreach and engagement Public policies - Healthy People 2020

EMRAM Stage 2

ability to start bringing disparate data together

key changes in the evolution of the health insurance industry

advent of comprehensive health services and benefits. increased role of the public and private sectors in health care coverage. health insurance as an employee benefit. changes in reimbursement for care provided. shift from fee-for-service to managed care. continual rise in the cost of health care.

Health informatics, analytics, and big data

aggregating, analyzing, and sharing data trends will inform research and policy.

networks

can be categorized as Intranets, which are internal to an organization, or Extranets, which are external and allow users to share info

benefits of effective teams

can lead to improved coordination, quality of care, use health care services more efficiently, increase job satisfaction among team members, increase patient satisfaction, and increase productivity

other concerns relating to health insurance

choice of provider access to care restrictions on care moral hazard pre-existing conditions buy-downs coordination of benefits

types of HMOs (health maintenance organizations)

closed-panel group model open-panel staff model independent practice association (IPA model) network model

cons of virtual teams

communication challenges, intellectual property issues, need for careful selection of team members, work hours may not be limited to normal work week; problems with determining who the supervisor is when there are HR issues

types of health insurance

conventional indemnity insurance managed care plans - health maintenance organizations (HMOs) - preferred provider organizations (PPOs) - point of service plans (POSs) - high deductible health plans with savings option (HDHP/SO)

Core privleges

cover a multitude of activities that a physician is allowed to do in a health care services organization.

tame problems

defined and while not easy, can be solved

good managers

don't mind if a new staff member asks a list of questions and asks for clarification and direction coaching, mentoring, and guiding are all part of the manager's role good managers want thoughtful observations from a new perspective

Tuckman's Stages (4)

forming storming performing adjourning

Eisenhardt, Kahwajy & Bourgeois (1997)

found that effective teams: work with more information developed multiple alternatives had common goals injected humor into the process maintained balanced power structures kept focus on the facts and not on personalities in open dialogue

forming stage

getting oriented to the team goals and each other, finding out what the tasks are, and who they will be working with

what is a team?

group of people with complementary skills who are committed to a common approach for which they hold themselves mutually accountable, working together to achieve a common goal

participative work climate

healthcare employees who view their work unit climate as participative as opposed to authoritarian provide higher levels of customer service, commit fewer clinical errors, and express less likelihood of leaving the organization patient centered care requires excellent interdisciplinary teamwork

EMRAM Stages 3-6

implementation of advanced clinical systems

storming stage

intragroup conflict, attempts at dominance, passive-aggressive behavior, along with information withholding and other forms of resistance to team tasks and goals

Job burnout

is a prolonged response to chronic emotional and interpersonal stressors on the job. The organization is the primary cause of job dissatisfaction and burnout. It is the health care manager's role to address these issues.

Conflict of interest

is a term used to describe when an individual can be influenced by money or other considerations to act in a way that is contrary to the good of the organization for whom he or she works or the patient for whom he or she should be advocating.

Job satisfaction

is the pleasurable or positive emotional state resulting from the appraisal of one's job or job experiences.

history of major pieces of health insurance legislation

national health insurance - discussed in 1930s - seen as socialized medicine - not enacted medicare and medicaid enacted in 1965 children's health insurance program (CHIP) legislated in 1997 patient protection and affordable care act passed in 2010

short term teams

one issue, solve, dissolve

Myers-Briggs Type Indicator (MBTI)

paper-and-pencil personality inventory used for understanding differences in team members' personalities, based on Jung's theory of psychological types assesses four domains and four subsets within those domains on a four-by-four grid

performing

peace breaks out and team members actually begin the work at hand, have open dialogue with one another, and share information to accomplish the team's goals

Emotional Contagion (EC)

people emotionally in tune with others can read emotions within nanoseconds women and physicians scored higher on EC scale, ability to read other people's emotions teammates catch each other's moods

when you get to choose the team: who do you choose?

person that belongs to an area that's affected by the problem at hand have the knowledge, skills, and disposition to do the tasks at hand have a clearly defined role on the team have the authority to make decisions and implement recommendations follow through on assignments and tasks meet deadlines think beyond the confines of a department or discipline work collaboratively and respectfully with other disciplines

virtual teams

remote locations, such as rural areas, space stations, and the Antarctic require the use of virtual teamwork the health care industry has adopted telecommuting for some segments of the industry, such as billing, revenue recovery, and customer service

terms in health insurance

risk pooling forms of payment - fee for service - prepayment cost sharing - copayments - deductibles - coinsurance policy limitations - max out of pocket expenditure - lifetime limits types of benefits - comprehensive - basic/major medical - catastrophic coverage - disease-specific - medigap - long term care

health disparity

significant differences in the rate of disease incidence, prevalence, morbidity, mortality, or survival rates in a specific population as compared to the health status of the general population. Many definitions, sometimes subjective.

paying for care

sources of payments - out of pocket 11.6% - private health insurance 32.9% - public funding, medicare, medicaid, schip 49.8% - investments 5.6%

HR includes activities that are:

strategic and administrative

adjourning

team members have worked together over a long period of time, have developed respect for the team as a whole and become sad that they are disbanding

EMRAM Stages 0-1

very basic automation of individual areas

questions you can ask when assigned to a team

what are the goals of the team? how will they be measured? what are the short-term/long-term deadlines? when and where does the team meet? to whom do I report? what is my role on the team? what are my responsibilities in that role?

Specific priveleges

would be those activities outside the core privileges and would require documentation of required additional training and expertise in a procedure.

characteristics of the uninsured

¼ from families with incomes below the poverty level. Most from families with incomes above the poverty level, but under the 300% level. Most were workers or dependents of workers employed in industries that don't provide health insurance. More uninsured people live in the South and West than in the East and Midwest. Aren't covered because they can't afford it, not because they don't need it.