Management test 3

Common contributing issues for injury accidents

- not working within scope of practice - not working under/providing supervision for clients/peers - not effectively communication with client/medical team - failing to provide a safe environment - operating outside of organizational policies/procedures

Administrative directives examples

- pressure to provide intervention beyond practitioner's competency - unrealistic productivity demands - violations of the OT scope of practice - inability to d/c patients when goals are met - inadequate supervision - use of unqualified personnel to provide skilled service

Sstatutory law is created by

Congress (federal level)

EEOC

Enforces federal laws by investigating employee complaints, conducting investigations, and filing lawsuits on behalf of the employee

Debarred

OTs can be debarred from participation in healthcare programs as a consequence for fraud

Occupational therapy services

The skilled actions provided by an occupational therapy practitioner

Skilled services

Those services requiring the skills of physical therapists, speech language pathologists, or occupational therapists

OSHA recordable events

Work related injuries and illnesses that require more than simple first-aid management

An ethical workplace -

empowers employees

Client-centered care

issues with high productivity and point of service documentation limits client-centered practice however, role modeling and reflection can promote professional conducts that instills the need for ethical behaviors and standards

Key elements of job descriptions

job title, job function, reporting relationships, key performance expectations, qualifications, and essential functions

Vizient

largest member-driven group in the US for performance improvement

Measuring outcomes that matter most to patients has 4 benefits:

learn improve performance superior outcomes value-based payment

Regulations impose

legal obligations for practitioners and public response (ADA)

Salaries

many clinicians are paid a yearly salary versus hourly rate

Purpose is often referred to as the:

mission statement

PHI

protected health information

3 measures for determining the quality of health care

structural measures process measures outcomes measures

Co-insurance

% of a service that beneficiaries must pay per visit after their deductible is met

Examples of torts

- battery and assault - false imprisonment - intentional infliction of emotional distress - negligence - malpractice

Ethical culture can be promoted by:

- continuing education - awareness - promotion of available resources - application of framework for decision making

Contracts should state:

- definition of relationship - duties or responsibilities of contractor - services to be performed - specific licensure, certifications, or other qualifications - billing timelines - notice of termination or modification of contract

Why is quality measurement important?

- determine whether OT is meeting client needs - determines effectiveness of services - peers are moving toward quality-focused reimbursement measures, meaning will pay more for services that are efficient and effective

Practical issues that guide clinical implementation:

- ease of access (time to retrieve instruments) - test burden degrades instrument utility (patient endurance, staffing, etc)

Examples of malpractice in OT

- improperly transferring a client resulting in a fall - forgetting to tell nurse of client's complaints of chest pain, resulting in heart attack - improperly maneuvering a w/c resulting in a fall or accident - failure to secure sharp objects

Strategies to combat moral distress:

- managers should work with staff to identify alternative approaches to enable clients to achieve goals when OT sessions may be limited - discourage unethical conduct - start by ensuring OTs are working within state licensure

The challenges of measuring outcomes

- new outcomes are narrowly focused - practitioners "tweaking" existing measures - unnecessary creation of new instruments

How can entrepreneurs reduce risk?

- start a business part time while having traditional job - form a partnership with someone with business knowledge - having in-depth knowledge of characteristics of an entrepreneur

Strategic goals

- typically measurable over a 3-5 year period - typically 5 or less goals

Coding is used to....

-Describe the diagnoses of clients served -Identify the complexity of the occupational therapy evaluation -Describe the type and amount of intervention provided

Two levels of Healthcare Common Procedure Coding Set (HCPCS codes) used by CMS

-Level 1 codes: 5-digit AMA CPT codes -Level 2 codes: owned by CMS and can be recognized by their alpha-numeric format

Reimbursement payment process involves...

-Provision of OT services -Documentation of services -Coding of services -Billing of claims -Reimbursment for services

Three organizations that provide essential information for coding:

-World Health Organization (WHO) -American Medical Association (AMA) -Centers for Medicare and Medicaid Services (CMS)

Medicare fraud includes...

-knowingly submitting, or causing to be submitted, false claims or making misrepresentations of fact to obtain a federal health care payment for which no entitlement would otherwise exist -knowingly soliciting, receiving, offering, and/or paying remuneration to induce or reward referrals for items or services reimbursed by federal health care programs -making prohibited referrals for certain designated health services

Negligence must be proved in 4 elements:

1) duty to act in a particular way 2) a breach of that duty 3) actual harm or damage 4) casual connection between the breach of duty and the harm or damages

2 types of professional liability policies

1) occurrence-based 2) claims made

Two approaches to conduct a market analysis:

1) organizational assessment (self assessment) 2) environmental assessment (trends)

Job function

1-2 sentences that capture the main purpose of the job

The IRS considers 3 aspects of control when defining contractor eligibility:

1. behavioral control 2. financial control 3. the parties' relationship

Two types of W-2 employees

1. exempt from overtime 2. nonexempt from overtime

Outcome measures must meet these 5 specific objectives:

1. identification of specific outcomes to be measured 2. selection of assessment tools and outcome measures are standardized, reliable, and valid 3. use of measurement approaches that reduce confounding factors - standardized procedures 4. enhanced data collection, interpretation, and analysis 5. effective dissemination of results to meet objectives

4 steps in market management

1. market analysis 2. planning 3. implementation 4. monitoring

4 steps to implementation of program

1. needs assessment 2. program planning 3. program implementation 4. program evaluation

Fiscal year

12 month period that is not always Jan - Dec; this is how a budget is typically submitted

How many identifiers are there in PHI?

18

Contractors pay ____ types of taxes ___ times per year

3 types, 4 times per year 1. federal income tax 2. federal self-employment tax 3. state and local income tax

National average of units billed in PT/OT

3.5 units per patient

Marketing trends

3/4 of patients use search engines before making appointments

How much is recommended for contractors to put aside for taxes?

30%

How long should a therapist provide direct, one-on-one therapy for to receive reimbursement for a time based treatment code?

8 minutes

Strategic planning

A process used by organizations to chart or map future plans and goals

State-run workers' compensation programs

Administered by a state agency, commission, or board following general regulations set forth by the individual state's legislative body

Employment laws cover which areas of employment?

All - hiring, performance reviews, compensation, workplace wellness programs, employee benefits, and termination

False claims act

Also called the "lincoln law" or "whistleblower law", imposes liability on anyone who knowingly submits a false claim to the federal government

14th Amendment

Amendment of the US constitution prohibits discrimination based on national origin, race, or gender

Who publishes CPT codes every year and updates the codes used for submitting claims?

American Medical Association (AMA)

Maximum medical improvement (MMI)

An individual has exhausted all reasonable medical interventions to improve his or her condition and recovery has reached a plateau

Billing agents

Are aware of the rules and language set by specific providers related to submitting electronic claims and understanding the explanation of benefits that are returned to providers

Civil monetary penalties law (CMP)

Authorizes the imposition of substantial civil money penalties or very large fines against entities that engage in certain prohibited activities

How is permanent partial disability calculated?

Calculated based on a count of body parts or the percentage of the body affected or impaired by the injury or calculated the same way as other types of disability, that is, based on severity of the resulting disability due to impairments in functional performance.

OSHA is enforced by the.....

Department of Labor (DOL)

The Federal Occupational Safety and Health Act (OSHA)

Designed to prevent injury and disease among workers

Return-to-work hierarchy

Establishes a preferential structure of return-to-work goals based on the highest probability of success due to the least amount of challenges or barriers

Independent medical examination

Examination conducted by a physician or health care provider who has not been previously involved in the determination or management of the claim for a second opinion on the severity of the injury or impairments, recovery prognosis, or disability status.

Threats in a SWOT analysis

External actions or events - current or potential- that may cause harm to the organization's strategic growth, well-being, and possible competitiveness

Opportunities in a SWOT analysis

External events or possible or current changes in the environment that may affect the organization in a potential positive capacity

Title VII of the Civil Rights Act

Federal law that prohibits discriminating against employees on the basis of sex, race, color, national origin, and religion

Reimbursement

Financial remuneration for services provided.

What defines and sets limits on disclosure of PHI?

HIPPA

L-codes

Identify specific types of orthotics provided to beneficiaries by durable medical equipment companies

Fair Labor Standards Act

Imposes minimum wage and overtime standards on most employers

Direct medical expenses

Include hospitalization and physician visits, diagnostic tests and surgical procedures, outpatient procedures and rehabilitative interventions, and drug and prescription costs.

False claim

Includes knowingly making a false or fraudulent claim for payment or causing others to and knowingly using or causing others to use false records or statements, such as false progress notes or false bills

Remuneration

Includes the transfer of anything of value, directly or indirectly, overtly or covertly, in cash or in kind.

Sexual harassment

Includes unwelcome sexual advances, requests for sexual favors, and verbal or physical harassment of sexual nature

Strengths in a SWOT analysis

Internal assets or characteristics within the organization or unit that enhance the organizations capacity for growth or change

Weaknesses in SWOT analysis

Internal conditions or characteristics within the organization or unit that hinder or restrict the organization's growth potential

Stakeholder input

Key information or data collected from individuals, agencies, organizational units, and consumers who are invested in the success of the organization and its mission

Most widely used Level 2 HCPCS codes

L-codes and G-codes

Doctrine of respondent superior

Latin for "let the master answer" from the historical master-servant relationship

Key performance expectations

List format that lists frequent and important job tasks that a person much perform in order to meet the clinic's expectations

Fraud

Making false statements or representations of material facts to obtain some benefit or payment for which no entitlement would otherwise exist

Work related injuries and illnesses

Medical conditions directly resulting from activities, incidents, or exposures related to the workplace and occurring during the course of employment

Strategy

Methods or activities that enable achievement of the plan's goals

Current Procedural Terminology (CPT) codes

Numerical codes assigned to each intervention, treatment, or procedure and is sometimes referred to as a "procedure code"

Liability

OT practitioners, managers, or administrators must realize the possibility of complaints or accusations of improper conduct, inappropriate treatment, or ethical violations because complaints can be brought to employers, state boards, NBCOT, AOTA, or even civil court

Professional responsibility

OTs are responsible for all aspects of OT service delivery and are accountable for the safety and effectiveness of services

Disclosure exfeptions

OTs have a legal obligation to report suspected child abuse, elder abuse, credible threats to potential victims by persons being treatment by mental health professionals, and impaired drivers based on OT assessment

Lost-time claims

Occurs when an injury or illness prohibits an employee from continuing to carry out the essential functions of a job in a safe or effective manner

Failure rate

Of all US companies, greater than 50% fail after 5 years, and greater than 70S% fail after 10 years

Relators

People who discover a false claim

Direct access laws

Permit the provision of occupational therapy services without a physician or other qualified provider's prescription or referral

Medicare abuse

Practices that, either directly or indirectly, result in unnecessary costs to the Medicare program. It is not possible to establish if the acts were committed knowingly, willingly, and intentionally.

Indemnity costs

Primarily provide financial support to cover wages lost by a worker who has sustained an injury

Professional liability

Professional liability = professional services + responsibility + accountability

Stark Law

Prohibits physicians from referring Medicare patients for certain "designated health services" to an entity with which the physician (or an immediate family member) has a financial relationship, unless an exception applies

Family and Medical Leave Act

Protects job security for employee leave

Vocational rehabilitation

Provide support for people with disabilities through a comprehensive regime of services meant to maximize their ability to participate in productive activities

Permanent total disability (PTD)

Provided in extreme cases where impairments from an injury restrict an individual's ability to return to work of any sort

Anti-Kickback Statute (AKS)

Purpose of this is to limit the influence of financial incentives on health care. Specifically prohibits kickbacks by making it a criminal offense to knowingly and willfully offer, pay, solicit, or receive any remuneration to induce or reward referrals of items or services reimbursable by a federal health care program.

Permanent partial disability

Received when an individual reaches maximum medical improvement (MMI) and impairments in function persist that reduce the ability to perform job tasks at a previous level

Gainful employment

Refers to a situation in which individuals are able to maintain continuous participation and successful performance of job duties, realizing benefits through financial or other positive rewards

Third party payers

Refers to the insurance company or other entity that is paying for services (patient is the first party, provider is second)

Improper retention of overpayments

Requires overpaid providers to report overpayments and return them within 60 days of identification. On the 61st day the retained overpayment becomes a false claim, even if the original error that resulted in overpayment was an innocent mistake.

Secretary of labor

Responsible for administration of OSHA including development and implementation of occupational safety and health standards

Basic budget

Revenue - expenses (total overhead) = profits

Goals are based on

SWOT analysis, mission, and vision

Medical necessity

Services are medically necessary if the documentation indicates that they meet the requirements for medical necessity including that they are skilled, rehabilitative services, provided by clinicians (or qualified professionals when appropriate) with the approval of a physician/NPP (nonphysician practitioner), safe, and effective

Strategic plan

Sets the pathway for an organization's development and success

Medical reviewer

Someone hired by an insurance company to review documentation and determine whether the services are covered by the insurance policy

Vision

States an ideal of what the organization perceives as its desired and prized benchmark of achievement

No-fault workers' compensation

System guarantees payment for medical expenses for a work related injury or illness without either the employer or the employee being identified to have been at fault.

Essential functions

The activities and tasks that constitute the reason a particular job exists and are the components of a job an employee must be able to perform with or without reasonable accommodation to maintain employment

Temporary total disability

The most common wage loss benefit, is paid to an employee who must take time away from work while initially recovering from a workplace injury.

Documentation

The official written record that details or summarizes the provision of occupational therapy services

Mission

The stated purpose of an organization that provides the foundation for its very existence and plans

Harassment

Unwelcome behavior baed on race, color, religion, sex, pregnancy, national origin, age (40 years or older), or genetic information

ICD-10 codes

Used in health care to identify specific diagnoses for clients served

G-codes

Used on claims forms to identify the type of provider

Upcoding

When OT practitioners, facilities, or practices Bill for interventions with billing codes that reimburse at a higher amounts instead of billing codes for the services that were actually provided, which reimburse at a lower rate

Self-identified overpayment

When a provider through the exercise of reasonable diligence, determines that they received an overpayment and quantified the amount of the overpayment. The provider must pay back the overpayment within 60 days

Unbundling

When health care practitioners, facilities, and practices bill for codes separately instead of using a predetermined group, or "bundled code"

Mission statement answers-

Why does the clinic exist? What function does it perform? For who does the clinic perform this function or who are the primary beneficiaries? How does the clinic go about filling this function?

Organizational ethics

a common sense of purpose and values within an organization that includes culture, trust, processes, outcomes, and character - conveyed through mission statements, policies, and practices - sometimes there is a disconnect

Independent contractor financial consideration

a contractor must track expenses and understand how to write off expenses

Defamation

a false statement that the employer tells another individual about an employee and the statement results in harms to the employee

Qualifications

a listing of required and preferred education, experience, and credentials required for the job

Entrepreneurship

activities associated with participation in the creation of a business structure that has a goal of taking a new idea to market, usually for a profit

Abuse

acts not able to be proven committed knowingly, willfully, or intentionally, which fraud is

Marketing examples

advertising, sales promotions, public relations, personal setting

Target marketing

allows you to reach, create awareness in, and ultimately influence the group of people most likely to select your products and services as a solution to their needs

Vicarious liability

an employer or supervisor can be found liable for the harm caused by their employees and subordinates - supervisors must be able to demonstrate/document that they took reasonable steps to prevent inappropriate conduct

Budget

an itemized summary of estimated or planned expenditures for a set time period

Duty of loyalty

an obligation of the employee not to steal or disclose the employer's confidential or proprietary information (secret formulas, processes, and methods used in production) - often employers will have employees sign and other agreements such as a non-compete

How often should policies and procedures be reviewed?

annually

Negligent supervision

another basis for malpractice when superior is held liable for actions of others that were not their fault for incompetence; meaning employees were inadequately trained or supervised

Independent contractor

autonomous service provider who delivers therapy for a predetermined contractual rate - these individuals control their own hours, liability, and expenses

How do managers calculate revenue?

based on payer reimbursement history per unit of service provided and average number of patient visits per week/day/month

Job title

brief 2-3 word phrase characterizing the job

Local laws (case laws)

can affect federal laws and regulations

Ethical dilemmas

can arise as managers seek to balance the business priorities and the needs of staff and their patients

Bundled codes

certain codes that are billed as a group rather than individually

Legal claims fall into 2 main categories:

civil and criminal claims

Client satisfactions is related to:

client-provider relationship client inclusion in treatment plan communication physical environment

Managers must support both -

clinical needs of clients and appropriate clinical decision making by staff while ensuring profit

Practice guidelines

clinical practical guidelines - systematic review of evidence

Space analysis considerations

clinical space per therapist how many clients seen appropriate privacy appropriate space for equipment accessibility - entrance/parking other factors - flooring, lighting, line of sight, restrooms, break rooms, storage, waiting area

Composite

combines multiple measures for a comprehensive evaluation of overall care

Cons of W-2 employee:

company determines work hours dress code equipment use overall policy and procedures

Compensatory damages

compensate injured party with monetary relieve

Independent contractor and IRS control

contractor's rate is usually higher than a salaried position, but contractor is responsible for all scheduling, taxes, expenses, and time management

HEAT - Healthcare Fraud Prevention Enforcement Action Team

coordinated efforts by DOJ, HHS, OIG to fight fraud

Fixed costs

costs that do not change over a period of time - rent, salaries, benefits

Variable costs

costs that vary directly with output (changes with the volume of services provided) - can be medical supplies, office supplies, utilities, repair and maintenance, and advertising

Manager's role in billing

create policies about how to bill and what to bill for to ensure accurate billing procedures and teaching staff how to submit daily billings

Strategic planning

creates the means for an organization to both examine its current position and chart a future course, anchored by mission and vision, and based on SWOT analysis

Essential functions

critical for physical, cognitive, or emotional abilities that are required for job performance

Fraud

defined as making false statements or representations of material facts to obtain some benefit of payment - knowingly, willfully, and intentionally

Quality

defined as the degree to which health care services increases the likelihood of desired health outcomes

Scope of practice

defined by the licensure regulations of the state where services are provided - managers need to be sure that job descriptions, policies, and procedures fit within

Market position

defining an organizations unique proposition (how its service is different/special)

How to manage risk

demonstrate a proactive commitment to best practice and safety

Outcome measures

determine the impact of the care provided on the client's overall health and wellness

Regulations

developed by federal and state agencies examples include CMS and state health departments

Contract

document that governs the relationship between parties, usually generated by the organization or contractor

Job descriptions

document that serves to shape employee roles and helps managers with recruitment, orientation, and staff development

75% productivity example

each FTE is expected to spend 6 hours of an 8 hour day performing billable activities sometimes called benchmarks

Employee right to privacy

employees have a limited right to privacy in the workplace

Social media

employees may restrict employee access to social media during working hours but cannot control after hours - some states have enacted lifestyle discrimination statutes that forbid employer restrictions on employees' behavior off duty and off employer's premises

Who pays professional liability insurance?

employer (often times)

GINA & employer

employer is permitted to request genetic information for limited exceptions such as providing a wellness program; however, employer must keep info confidential

Employer liability

employers can be directly liable for their actions and indirectly liable for actions of employees

NLRB - National Labor Regulations Board

enforces employee's right to organize and use unions as their bargaining representative

Intrapreneur

entrepreneur who starts an innovative process within a larger organization that brings new products and programs to market

Deductible

established amount that a client must pay before the insurance begins covering services

Vision statement

expresses the aspirational and inspirational messages about what a department of organization would like to become as it seeks to begin its mission

Negligence

failure to exercise the standards of a reasonable, prudent person would exercise in a similar situation; involves careless action or an unintentional mistake example: not placing a wet floor sign on a recently washed floor

Most common injuries sustained in OT

falls, burns, and equipment injuries

Business plan includes:

finances partners timelines costs and profit customers price points

Documentation

first place a legal team will investigate when claims are filed against OT, so we must write with the expectation that it will undergo a detailed critique

Copays

flat fee for service that beneficiaries must pay per visit

Process measures

focus on delivery of care and the adherence to best practice treatment protocols

Exempt employee

generally paid a salary, so not eligible for overtime pay 3 categories: executive, professional, and administrative

COPM

gold standard for evaluating client-centered, occupation-based, and evidence-based OT services throughout the continuum of care in a variety of settings

Employers can't:

hack into employees person emails or search bags, purses, or vehicles

Direct medical expenses

hospitalization, physician visits, diagnostic tests, surgical procedures, rehabilitative interventions, and prescription drug costs

Productivity

how many units of work employees are expected to produce in a given time period

Proforma

hypothetical balance sheet and income statement based on a set of assumptions

First step in strategic planning

identifying the purpose of the organization

Privacy

implies the right of patients to be left alone and free from intrusion, and to choose whether or not to share oneself

Malpractice

improper or unethical conduct or unreasonable lack of skill by a holder of a professional or official position; often applied to physicians, dentists, lawyers, and public officers to denote negligent or unskillful performance of duties when professional skills are obligatory

Compliance

in order to ensure this, managers must be knowledgeable with relevant laws, regulations, and payer policies

Policies and procedures manual

include step by step instructions and information about official department and institutional policies

Payers

includes individuals, insurance carriers, employers, and the government

Corporate overhead

includes the administrative aspects of a business, such as HR, billing services, and the executive administration

Reporting relationships

indicate whom the person in the job reports to as well as who is responsible for supervising

Entrepreneur

individual who sells a product or service in the hope of a profit but often at considerable risk

Tort law

intentional or negligent harm or wrong against another that results in damages for which one party may be liable

Quality benchmarking

involves voluntary, active collaboration targeting use of optimally efficient indicators, practices, and costs

Why would a company want to hire contractors?

less costly for the company overall because company does not have to pay payroll taxes, health benefits, training, workers comp, overtime, or supplies

Organizational chart

management tool that visually depicts the following aspects: major functions relationships of functions or departments channels of supervision lines of authority and communication position by job title

negligent hiring

managers are expected to do background checks on future employees to avoid this, which is important when employees are responsible for the care of others

FCRA - Fair Credit Reporting Act

mandates accuracy, fairness, and privacy of the files of consumer reporting agencies - if an employer decides to fire or not fire a person due to a credit report, the employer must provide individual with a copy of the report and employee can dispute this

Monitoring

marketing plans must undergo periodic reevaluations to assess effectiveness; should be a process that analyzes all aspects of the client's marketing journey

Disclosure

means giving another party access to a pt.'s protected health information without permission; can result in drastic consequences for patients

Calculating square footage

measure the length x width of the room

Employers can:

monitor use of company's mail or email as long as employee is notified, search company lockers and desks, collect confidential info, but must protect info

Managers and the environment

must be sure environment is safe and uncluttered and equipment is working and maintained to avoid falls and other injuries

Standardized measures

must be used to make accurate comparisons between providers (COPM, DASH, FIM/GG, KELS, WRI, etc)

Assault

occurs as a threat that another will engage in an offensive touch or cause them immediate harm

Battery

occurs when a person intentionally comes in physical contact with another person

Intentional infliction of emotional distress

occurs when through extreme and outrageous conduct, someone intentionally causes severe emotional or mental distress - example: OT cursed and screamed at client with depression for showing up late and insisted they leave

Performance improvement collectives

often institutions join performance improvement collectives to have access to pooled-data analytics, strategic research, and advocacy resources

Vision statements

often lay out the most important primary goals but does not outline a plan to achieve goals

Capital expenses

often not included in yearly budget and have a minimum dollar amount with detailed justification (equipment, how/why it is used, etc.) - ranges from $2500 - $10000

Overhead

operating expenses of a business, including costs of rent, utilities, salaries/labor, interior equipment, taxes, supplies, materials, etc

External aspects of SWOT analysis

opportunities and threats

Benefits may include:

paid vacations, sick leave, health insurance, holidays, liability insurance, continuing education, and disability insurance

Employment law

plays an important role protecting worker safety, prohibiting discrimination, and preserving employee and employer rights

Administrative directives

policies or mandates from management affecting patient care that may override clinical judgment

Consensus statements

practice recommendations developed by experts to make recommendations for treatment interventions

Pros of being W-2 employee:

predictable paycheck taxes withheld from every paycheck employer shares in tax responsibilities benefits

Risk

probability of threat or damage, injury, liability, loss, or any other negative occurrence that is caused by external or internal vulnerabilities, and that my be avoided through preemptive action

Assault and battery in healthcare typically occur when:

procedures are performed without informed consent (a rational informed decision about a particular treatment or procedure)

Marketing research

process of gathering, analyzing, and interpreting information about a market; about a product or service to be offered for sale in the market; and about past, present, and potential customers

7 P's of marketing

product, price, place, promotion, people, process, and physical evidence

GINA - Genetic Information Nondiscrimination Act

prohibits employers from requesting, requiring, or purchasing genetic information about applicants or employees

Professional liability insurance

protects the policyholder by providing legal defense resources, as well as paying claims and compensatory judgments (damages) typically about $100/year

Modifiers

provide specific information that permits payment of services

Marketing plan

provides a framework for creating goals and specific marketing strategies to support growth of business

Punitive damages

punishment of the party who caused the harm

Implementation

putting the marketing plan into action

Patient experience measures

records a patient's perspectives on the care they received

Confidentiality

refers to information or data about the patient that OTs have an obligation to preserve by OT Code of Ethics and HIPPA law

Marketing mix

refers to the tactical, controllable, and operational components of a marketing plan

EEOC - Equal Opportunity Employment Commission

responsible for enforcing laws making it illegal to discriminate against job applicants or employees based on race, color, religion, sex, national origin disability, or genetic information

DOL - Department of Labor

safeguards employees wages, working conditions, opportunities for advancement, and work related benefits

ICHOM (international consortium for health outcomes measurement)

seeks to transform health care systems worldwide by measuring and reporting patient outcomes in a standardized way also provides condition-specific standard sets of outcome measures

COPM as an outcome measure

semi-structured interview format structured scoring method designed to detect perceived changes over time valid and reliable

HIPAA - Health Insurance Portability & Accountability Act

sets standards for protecting PHI

Mission statement

setting forth a department's purpose, including definitions, products, or services

Structural measures

setting, physical environment, number of personnel, availability of specialists, and staff-to-client ratios

Employer liability responsibilities

should verify OT state license, background check, searching US Dept of Health & Human Services

Termination

sometimes called "lay off" employers generally have the right to terminate employees or a variety of reasons

Target market

specific group of consumers or clients at whom a company aims its products and services - clients/potential clients, payers, referral sources

Typical start up costs

staff (salaries and benefits) space/rent utilities equipment/supplies administrative supplies corporate overhead marketing training

Regulatory law is created by

state or federal agencies

Characteristics of an entrepreneur

strength in specific skills knowledge perseverance ability to develop positive relationship creative problem solving and critical thinking leadership abilities experience working with effective teams adaptability in an ever-changing environment dedication, confidence, and fortitude goal-minded receptive to new idea/change networking

Internal aspects of SWOT analysis

strengths and weaknesses

Recommended ways to measure quality

structural process outcome patient experience measures composite

Needs assessment

systematic approach used to identify gaps between current practices and desired practice conditions to determine a course of action

Cost of doing business

take all expenses (overhead) for the year and break it down to monthly, daily, and housefly expenses to get an idea of what it takes to break even

Marketing

the art and science of exploring, creating, and delivering value to satisfy the needs of a target market at a profit

Qualified privilege

the employer may communicate employee information if it serves a legitimate business purpose and the employer believes it to be true

Social entrepreneur

the entrepreneur of a nonprofit organization where the focus is on social equality rather than financial profit

Location

the facilities in which a program is housed are often a key factor in whether or not a program is successful

Program evaluation

the ongoing process of assessing the impact and quality of program process and outcomes and making the continuous improvements in efficiency and effectiveness

Program planning

the process of identifying the steps and sequence of action to be taken to plan for initiation of the program

Program implementation

the process of initiating intervention; typically in trial format and then in a more formal and sustained manner

Keys to becoming a successful contractor:

time management organization understanding of expectations of prospective employers how to market services cash flow management

Non-billable time

time spent in family conference, interdisciplinary meetings, discussing a case with MD, documentation, on the phone ordering equipment, marketing, looking up evidence, etc

Most lawsuits filed against OTs fall under this law

tort law

Malpractice

type of negligence that can occur when a practitioner fails to follow the standard of care and the failure results in harm or injury to a client; practitioner is aware of actions and proceeds anyway - can result in compensatory damages or punitive damages

Market analysis

use of assessment techniques to understand customers, markets, and marketing effective: then the information is used to generate a plan

Quality measurement

using data to measure the performance of the health care provided

Managers have a responsibility to create a workplace culture based on:

values of integrity, accountability, fairness, and respect

Changes are often in the form of a:

vision or vision statement

Break even

when costs are equal to money brought in for services, leaving no debt and no profit

Moral distress

when one knows the right thing to do but encounters a barrier preventing action

False imprisonment

when someone violates another's basic personal right to freedom from wrongful confinement - in healthcare, this could be from restraining patients in a SNF without documented plan for safety

Professional isolation

with new areas of entrepreneurship, there may not be many others doing similar activities; helpful to connect with professional organization, blogs, academia, and online groups

Federal law requires that employers provide the following benefits:

worker's compensation time off for jury duty or military service tax withholding & FICA state & fed unemployment tax compliance with FMLA

W-2 consideration

workers who are not independent contractors have W-2 employment status