BOG Test 1

What are the 5 Basic strategies used in Workforce Planning?

5 Basic strategies used in Workforce Planning: 1. Population-based estimating 2. Benchmarking 3. Needs-based assessment 4. Demand-based assessment 5. Training-output estimating

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

Timetables for activity completion.

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

Interact with their caregivers. Communication between caregiver and patients reduces error and help to ensure that treatment is understood

Healthcare organizations are routinely faced with accommodating competing space needs. The key considerations in resolving such issues should be based upon which of the following? Long-range facility plan. Return on investment for each use. Prospective donor's interest in the program. Board of trustee preference.

Long-range facility plan. It is the strategic plan for the construction and renovations.

An organization has made a commitment to begin training its employees to fill anticipated job openings in upcoming years. This is an Example of: Succession planning. Reengineering. Position control. Quality improvement.

Succession planning. = correct answer. Succession plan identifies the competencies required for a post, candidates currently prepared, and candidates that could be prepared though development plans. A critical step in succession planning is to forecast the demand and skill gaps for the position Succession planning is a vehicle for social responsibility (gives opportunity to or advance underrepresented or protected groups) Position Control is the documentation of number of approved employment positions, the identity and hours of persons hired for them,and the number of vacancies control the size of the associate force and protect against improper employment.

Which of the following statements best describes the statistics budget? It combines volume and expense rates to forecast costs. It is a profit forecast for the coming year. It combines volume and reimbursement data to forecast revenues. It provides input date for other budgets.

... It provides input date for other budgets. The statistical budget creates a measuring stick for the company to use when evaluating a department's performance. The statistical budget details the expected expenses and revenues for the future year. Throughout that year, the company compares the actual financial results to those documented in the statistical budget.

Which of the following is an Example of a capital expenditure? Land that is purchased for resale. Surgical equipment with a useful life of six months. A building with a useful life of 20 years. Medical supplies used for patient care.

...A building with a useful life of 20 years.

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

...A relational database containing all identification numbers assigned to patients.

Which of the following is the most important factor to consider in evaluating vendor software packages? Size of the vendor's marketing staff. Ability of the software to interface with existing systems. Programming language used to write the software. Geographic location of the vendor's corporation office.

...Ability of the software to interface with existing systems. Factors to consider when evaluating Software packages: a. Functionality --congruence with organizational requirements b. Ability to interface or integrate with other applications c. c. Level of satisfaction of other users d. Financial stability of vendor . e. Support available (training, updates, and maintence) f. Cost---lease/purchase, implementation, maintenance, cost of upgrades, cost of additional software

A typical use of the Internet by healthcare organizations is to: Deliver educational programs to employees. Provide the medical staff with electronic access to patient records. Advertise services available to the community. Communicate financial information to business units of the organization.

...Advertise services available to the community. Typical Application of INTER-net a. Advertising services b. Employee recruitment c. Patient appointment scheduling d. Providing health and wellness information e. Ordering Supplies & materials

A health services organization should use which of the following sequential processes to help establish human resources (HR) objectives and policies? Analyze the current HR situation, forecast HR demand, reconcile with the budget, forecast HR supply. Design HR recruitment and selection activities, develop an HR compensation plan, and establish HR appraisal systems. Determine best HR job structure, perform HR job evaluations, establish HR training and development plan. Conduct HR job analysis, determine best HR job structure, and establish HR information system.

...Analyze the current HR situation, forecast HR demand, reconcile with the budget, forecast HR supply.

In assessing the advantage of using a focus group over a survey in evaluating a program, one could say that focus groups: Are likely to use a larger sample size. Are more useful in designing improvements to a program. Are more precise in designing improvements to a program. Are useful only when maintaining objectivity is not important.

...Are more useful in designing improvements to a program.

Which of the following is a developing technology that will help control unauthorized access to computerized information? Optical scanners. Biometric access control devices. Wireless terminals. High-speed modems.

...Biometric access control devices.

Which of the following is likely to provide useful information for evaluating the profitability of a hospital's managed care business? Payor mix. Fixed. Contract terms. Changes.

...Changes.

What was the first major law to have a significant impact on individual privacy in the workplace? Civil Rights Act Fair Credit Reporting Act Polygraph Protection Act Privacy Act

...Civil Rights Act (answer but I don't agree) Privacy Act: safeguard individual privacy from the misuse of Federal records, to provide that individuals be granted access to records concerning them which are maintained by Federal agencies, to establish a Privacy Protection Study Commission, and for other purpose The Employee Polygraph Protection Act of 1988 (EPPA) in a United States federal law that generally prevents employers from using polygraph (lie detector) tests, either for pre-employment screening or during the course of employment, with certain exemptions. Under EPPA, most private employers may not require or request any employee or job applicant to take a lie detector test, or discharge, discipline, or discriminate against an employee or job applicant for refusing to take a test or for exercising other rights under the Act. The Act does permit polygraph tests to be administered to certain applicants for job with security firms (such as armored car, alarm, and guard companies) and of pharmaceutical manufacturers, distributors, and dispensers. The law does not cover federal, state, and local government agencies.

Forecasting organizational need for human resources by focusing on specific position openings that are likely to occur and using these for planning is called: Demand-pull approach. Supply-push approach. Succession analysis. Transition matrix.

...Correct answer = Demand-pull approach. Secession analysis= identifying potential candidates for promotion to executive positions. Transition matrix=probability models that forecast the internal flow of employees from one job to the next. Supply-push approach= Forecasting the internal flow of employees as they move from current job into others through promotions, lateral moves, and terminations.

Which of the following is not an advantage of an effective Corporate Compliance Program for a healthcare organization? Initiating immediate and appropriate corrective actions. Costs of implementation and operations. Developing processes to allow employees to report potential problems Identifying and preventing criminal and unethical conduct.

...Costs of implementation and operations.

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

...Describes future facility needs (either renovation or new construction) necessary to meet strategic and operational needs. "Master Facility plan defined as document that begins with an estimate of the space needs of each service or activity proposed in the service plan. It show the the future location of all services and documents the renovation, acquisition, or construction."

Which of the following is a major priority for system development in the managed care environment? Development of enterprise-wide computer networks. Development of repositories of computerized patient records. Development of operational inpatient systems. Development of strategic decision support systems.

...Development of operational inpatient systems.

Healthcare organizations often utilize special purpose software which allows rapid access to large archives of integrated data to assist management with decision making. This is typically referred to as a (an): System analysis program. Report writer. Decision matrix management tool. Executive decision support system.

...Executive decision support system. A decision matrix is a list of values in rows and columns that allows an analyst to systematically identify, analyze, and rate the performance of relationships between sets of values and information. Decision Matrix Analysis works by getting you to list your options as rows on a table, and the factors you need consider as columns. You then score each option/factor combination, weight this score by the relative importance of the factor, and add these scores up to give an overall score for each option.

Boards make better strategic decisions if they use information that is: Readily available on special board website. Generated from computer studies of departmental activity reports. Summarized in graphs for better understanding. Focused on measurable outcomes of service quality and economic vitality.

...Focused on measurable outcomes of service quality and economic vitality.

In negotiating a contract for an information system, healthcare organizations should: Form a negotiating team and utilize legal counsel. Use the standard contract provided by the system vendor. Employ a consultant from among a list provided by the vendor. Use a cost-plus contract to maximize flexibility in system design.

...Form a negotiating team and utilize legal counsel. Vendor Contracting: a. Use qualified legal counsel (firms in software contracting) b. Avoid vendor standard contract c. Carefully consider: i. Ownership of software source code (source code is the computer programming language that maintains the software......If the vendor maintains the source codes, then system upgrades and maintenance need to be part of the contract) ii. Interface responsibilities (responsibility of either the vendor or the contracting organization) iii. Warranty, cancellation, liability, and penalty clauses

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

...Heterogeneity correct answer. " Actual Care is heuristic (employs trial-and-error) and all physicians vary in their preference in treating patients but are guided by clinical protocols and guidelines to ensure that evidence-based medicine is practiced" R/O Intangibilty, which refers to patient satisfaction. Services have a mixed component of tangibility and intangibility. Intangibility is used in marketing to describe the inability to assess the value gained from engaging in an activity using any tangible evidence

What is the correct order of stages for accomplishing organization change? Identifying, planning, implementation, evaluation. Planning, identifying, evaluation, implementation. Evaluation, planning, implementation, identifying. Planning, evaluation, identifying, implementation.

...Identifying, planning, implementation, evaluation.

Which of the following describes the conflict management strategy that would have the most immediate effect on reducing conflict behavior? Imposition of formal authority to resolve or suppress conflict. Implementation of substantial, super-ordinate goals that require cooperation among units. Rotation of members of one unit into another unit. Provision of intergroup training that requires listing of perceptions and identifying differences

...Imposition of formal authority to resolve or suppress conflict.

The CIO for a healthcare organization is typically responsible for which of the following functions? Information systems and finance. Medical Records and patient registration Telecommunications and public relations. Information systems and telecommunications.

...Information systems and telecommunications. Role of Chief Information Officer (CIO): a. Serve as member of the executive management team i. b. Sets goals for strategic planning, effective use of IT, and decision support c. Advise executives on the effective use of information for patient care and strategic support d. Oversee organizational units responsible for telecommunication & information technology

The Information Systems Steering Committee for a healthcare organization should perform which of the following duties? Information systems planning, selection of software and development of related organizational policies. Selection and supervision of key information systems personnel. Negotiation of contracts with vendors for equipment, software and service. Design and development of the information system software.

...Information systems planning, selection of software and development of related organizational policies. Function of the Information Systems Steering Committee? 1. Directs the planning process 2. Development of priorities for new application and remote placement systems, 3. Specification of the IT infrastructure, 4. Development of the capital & operating budget requests for IT development

What is the primary advantage of the corporate form of organization for a healthcare provider? It exists by virtue of a statute providing for its formation. It has powers granted to it by its charter. Its continued existence is not affected by the death or disability of an owner. It has limited liability.

...It has limited liability.

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

...Lack of knowledge of drug.

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

...Meet the Conditions of Participation

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

...Minimize the number of times an item is handled from the time it is received by the organization to the time it is used.

Internal members of the healthcare organization's governing body: Serve on an ad hoc basis and are rarely voting members. Are kept to a minimum due to concerns regarding confidentiality. Often include the CEO, medical director and CFO. Often include the executive staff in planning and information management.

...Often include the CEO, medical director and CFO.

The facility's plan for a healthcare organization may include plans for renovation or new construction, energy requirements, acquisition of new property, financing options, etc. However, the facility plan begins with an estimate of each service or department's: Operational needs. Parking needs. Staffing needs. Equipment needs.

...Operational Needs Master Facility plan defined as document that begins with an estimate of the space needs of each service or activity proposed in the service plan. It show the the future location of all services and documents the renovation, acquisition, or construction." Understanding clinical operations and process is critical to designing Healthcare facility. Article: Form follows Functions

All areas of healthcare facilities are subject to safety, convenience and other regulatory requirements as dictated by the state life safety codes, JCAHO, OSHA, state fire marshal, etc. Which area of the facility typically has the highest standards? The energy plant. Highly used public areas. Areas under construction. Patient care areas.

...Patient care areas.

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

...Patients' current medication effectiveness. (function of research.)

The objective of maintenance and repair services is to keep the facility and its equipment operating like new. This goal is best achieved by emphasizing: Prevention. Efficiency. Productivity. Safety.

...Prevention.

Which of the following is an Example of an asset? Accounts payable. Accrued employee benefits. Property, plant and equipment Unrealized gain.

...Property, plant and equipment

What purpose do market plans fulfill for the healthcare organization? Provide a business plan (or plans) as a subset of the organization's marketing plan. Present general goals for the organization to attain in the next three to five years. Develop promotion methods to be used in attaining the organization's objectives. Provide specific objectives for utilization attainment the next fiscal year.

...Provide specific objectives for utilization attainment the next fiscal year. (Disagree with this answer)

In selecting an information system, a consultant can best be used to: Chair the selection committee. Make the final selection decision. Provide technical information and an outside prospective. Handle all communications and prospective vendors.

...Provide technical information and an outside prospective.

Statements of earnings, financial positions, changes in financial position and retained earnings are required to be submitted yearly by all: Publicly owned healthcare organizations. Privately owned healthcare organizations. Government owned healthcare organizations. Faith-based owned healthcare organizations.

...Publicly owned healthcare organizations.

A privilege of confidentiality exists in a physician-patient relationship when the physician-acquired information is: Documented in the patient's medical records. Substantiated by the patient's nurse. Related to the care and treatment of the patient. Confirmed and documented by the patient.

...Related to the care and treatment of the patient.

The first role of the governing body is to: Manage inputs of the healthcare organization to achieve the output that are its goals. Recruit members who understand the health services field. Set objectives and develop policy to guide the organization in achieving its mission. Develop the operating plan and monitor departmental performance.

...Set objectives and develop policy to guide the organization in achieving its mission.

The best way to facilitate information system integration within a healthcare organization is to: Centralize all computer activities. Use computer equipment from only one manufacturer. Use computer software from only one vendor. Standardize data definitions and data structures.

...Standardize data definitions and data structures. System Integration (most important purpose of IT planning): a. Systems must be able to share information electronically in seamless manner b. Integration requires system planning to insures compatibility of data definition and data coding systems

Forecasting the internal supply of employees as they move from their current jobs into others through promotions, lateral moves and terminations is called: Graphic rating approach. Supply-push approach. Demand-pull approach Rating scale method.

...Supply-push approach.= Correct =Forecasting the internal supply of employees as they move from their current jobs into others through promotions, lateral moves and terminations is called: Demand- pull approach= Forecasting organizational need for human resources by focusing on specific position openings that are likely to occur and using these for planning.

The central role of the health services organization board includes all of the following except: Setting the strategic plan and service values of the organization. Support for assessing changing market needs. Support in managing important service programs or departments. Assuring the recruitment, hire, support and reward of the CEO.

...Support in managing important service programs or departments.

Who has the primary responsibility to assure and maintain the integrity and security of electronic data in a healthcare organization? The Information Services Steering Committee. The Information Services Department. The CIO. The Safety and Security Department.

...The Information Services Department. 4 Roles of the IT Steering Committee? IT Steering Committee: 1. Directs the planning process 2. Development of priorities for new application and remote placement systems, 3. Specification of the IT infrastructure, 4. Development of the capital & operating budget requests for IT development

Law and tradition have established basic criteria for healthcare governing boards. One criteria is that: All members agree to receive care at the governed organization. Board members provide a specified amount of financial support. The actions of the board are reasonable and prudent. The board must meet a minimum of two times each year.

...The actions of the board are reasonable and prudent.

Which of the following best describes the responsibility of a hospital with an emergency department (ED) when a person comes to the ED for Examination or treatment? The hospital must admit the patient for observation and treatment if an emergency condition exists. The hospital must provide an appropriate medical screening to determine whether an emergency condition exists and, if so, stabilize the condition. The hospital may inquire as to the individual's method of payment or insurance status prior to rendering services. If the individual is uninsured, the hospital must transfer the patient to the nearest public hospital designated for the care and treatment of medically indigent persons.

...The hospital must provide an appropriate medical screening to determine whether an emergency condition exists and, if so, stabilize the condition.

How does physician self-referral or Stark laws apply to Medicare payments? The law applies to private party insurance and does not apply to Medicare payments. The law establishes an additional payment to the normal Medicare payment fees due to the added complexity of referrals. The law allows a claim to be filed with Medicare for a service provided by a physician who has a financial interest in the DHS. The law prohibits a provider from presenting a claim to Medicare or to any person or other entity for a prohibited DHS referral.

...The law prohibits a provider from presenting a claim to Medicare or to any person or other entity for a prohibited DHS referral.

The effective cost of debt is roughly the same for both not-for-profit and investor-owned organizations because: Both types of organizations can issue tax-exempt debt. The interest rate is the same on both tax-exempt and regular debt. Neither type of organization can issue tax-exempt debt. The tax deductibility of interest for investor-owned firms offsets the lower coupon rate on tax-exempt debt.

...The tax deductibility of interest for investor-owned firms offsets the lower coupon rate on tax-exempt debt.

Continuous quality improvement assumes that: Achievement will be rewarded. There is direction from top management. There is no upper limit to excellence. Interconnected work teams are in place.

...There is no upper limit to excellence.

Probability models that forecast the internal flow of employees from one job category to another use a: Graphic rating approach. Supply-push approach. Transition matrix. Curriculum path.

...Transition matrix. = correct Supply-push approach= Forecasting the internal flow of employees as they move from current job into others through promotions, lateral moves, and terminations.

All of the following are primary functions of the information services department except: Ensuring the integrity, quality and security of data. Archiving and retrieving data. Training and supporting users. Utilizing information for operational decision making.

...Utilizing information for operational decision making

Which of the following is considered the best source of information to help a healthcare organization improve its existing services? Ongoing patient and internal customer satisfaction surveys. Focus groups to gather information and statistics from non-patients. Telephonic surveys of anyone who may decide to use the healthcare organization. Weekly meetings with staff members to determine organizational deficiencies.

...Weekly meetings with staff members to determine organizational deficiencies.

Multi-rater assessment (360 degrees feedback) of managers in healthcare organizations is best used: In the development of a specific action plan by appraises. As part of a training or coaching session. As part of the performance appraisal system of the organization. When the appraisers are held accountable for their ratings.

..In the development of a specific action plan by appraises.

Which would be a reasonable basis on which to allocate administrative overhead costs? Salaries. Amount of supplies used. Hours worked. Square footage.

Amount of supplies used....

A healthcare facility can best meet its social and economic goals by: 1) developing a realistic and coordinated approach to long-range planning. 2) devoting most of its efforts to the development of efficient operational practices. 3) having a good public relations program, which will focus the facility in the community. 4) providing all reimbursable services desired by the community.

Answer 1 is correct. Key words are best meet and social and economic. Both social and economic goals are met through the long-range planning process. Also, the key word in the answer is developing. The other responses may meet some goals, but the best way to meet goals is through developing an approach. Again, this is a much more proactive response

Which one of the following classifications or groups of financial ratios would be most useful as a guide to long-range financial viability of an organization in undertaking facility replacement? 1) leverage ratios 2) profitability ratios 3) liquidity ratios 4) composition ratios

Answer 1 is correct. The question requires a basic knowledge of finance. The key words are long-range financial viability related to facility replacement.Leverage ratios give an indication of the facility's long-range financial viability and the amount of cash available for undertaking facility replacement.

The evaluation of senior management is best administered: 1) when criteria are established and known to both parties. 2) on a scheduled periodic basis. 3) after consultation of the executive committee of the board. 4) in conjunction with a salary adjustment.

Answer 1 is correct. The question requires a basic knowledge of human resources issues. Performance evaluations are most effective when the evaluator and manager have established criteria before the evaluation.

Committees are an important management tool primarily because: 1) they provide a mechanism for reconciling differing opinions and facilitating decision making. 2) they are the only way of providing for intrastaff communication. 3) they keep staff up to date on new professional developments. 4) they ensure self expression and participation by staff

Answer 1 is the correct response because it is the most inclusive and proactive. The key word in this question is primarily. While up-to-date information regarding professional developments, self expression and participation may be goals in the formation of committees, it is not their primary function

Environmental changes, including shifts in public attitudes, community health needs, provider practices and actions of competing institutions, may alter a healthcare institution's direction. Healthcare executives could be forced to: 1) reduce levels of patient care to the level of payments received. 2)scrutinize all new ventures from a variety of perspectives, including financial, environmental, ethical and quality of care. 3) eliminate patient-care programs that do not pay for themselves. 4) place ceilings on those financial categories of patients that pay less than full operating costs.

Answer 2 is a proactive response and it is the most inclusive answer. It provides a variety of perspectives that must be considered when changing a healthcare institution's direction

The administrator's relationship with the board of directors should be one in which the administrator: 1) minimizes board involvement in any operational issues. 2)draws upon skills of board members in facilitating appropriate discussion and decision making. 3) identifies those topics with which the board should involve itself. 4) serves as the functionary for implementing all board of directors' decisions.

Answer 2 is correct because it is a proactive response. The key word is facilitating. The administrator's role is to facilitate the board discussion and decision making. Answer 4 may be correct, but only after answer 2 is accomplished.

The major purpose of the code of ethics for members of a healthcare executive's association is to: 1) enhance the image of the healthcare management profession. 2) set forth standards of ethical behavior for healthcare executives. 3) set ethical guidelines for the advancement of members within the organization. 4) provide a forum for dialogue on healthcare policy issues.

Answer 2 is correct. A code of ethics sets guidelines and standards for behavior (not for advancement, as in answer 3). Answers 1 and 3 may happen as a result of having a code of ethics, but they are not the major purpose.

To survive the turbulent and revolutionary changes facing the healthcare field, executives must manage internal, external and interface stakeholders better. To do so, these executives must: 1) minimally satisfy the needs of marginal stakeholders while maximally satisfying the needs of key stakeholders. 2) establish goals for relationships with current and potential stakeholders as part of an effective strategic management process. 3) identify stakeholders who are involved in the local community healthcare delivery system. 4) react to the demands of the stakeholders so that their expectations can be met.

Answer 2 is correct. This question requires a knowledge of the term stakeholders. Also, establish is a key word because it makes answer 2 the most proactive response. Answers 1, 3 and 4 contain less active words.

With growing frequency, employees who have been dismissed are resorting to lawsuits for redress. In such cases, the court may find in favor of the plaintiff if the employer dismissed that plaintiff: 1)for cause, but without using progressive discipline. 2)without cause. 3)before the end of the plaintiff's probationary period. 4) for union-organizing activities.

Answer 2--requires knowlege of HR issues. Courts are increasingly finding in favor of employees who are dismissed without cause.

Investor-owned healthcare systems are usually distinct from not-for-profit systems because: 1) investor-owned healthcare systems provide no uncompensated care. members of the medical staff of investor-owned healthcare systems may use any healthcare facility owned by the corporation. 3) investor-owned healthcare systems consolidate balance sheets. 4) local boards have governing authority.

Answer 3 is correct. This question requires a knowledge of the forms of ownership and the differences between them.

A well-developed marketing plan will include all of the following, except: 1) staffing considerations. 2) competitive analysis. 3) quality of care considerations. 4) pricing considerations.

Answer 3 is correct. While quality of care issues are a concern of healthcare administrators, they are not the tools used in marketing.

The primary purpose of the quality assurance/risk management program is to: 1) comply with licensure and accreditation standards as required by state and federal legislation. 2) monitor medical staff practices in order to control the increases in malpractice rates. 3) identify potential problems that will keep the hospital from becoming a party to litigation. 4)monitor, control and direct the institution's efforts toward achieving delivery of the optimal level of care

Answer 4 is correct because the primary purpose of a quality assurance program is the delivery of the optimal level of care. The other responses are secondary to the purpose of having a QA program. Remember that in a healthcare facility, patient care comes first.

In consultation with the board, the administrator has decided that an effort must be made to increase the level of involvement among management personnel in quality assessment and assurance. Which one of the following options is most likely to achieve the desired results? 1) Send all key management personnel to quality assessment workshops over the next year. 2) Delegate quality assessment functions in question to the medical records committee. 3) Delegate quality assessment education functions to the utilization review coordinator. 4) Develop an in-house program using trained key personnel for presenting and discussing quality assurance and its implications for the organization.

Answer 4 is correct. The key word is develop. Answers 2 and 3 can be immediately disqualified because results are less likely to be achieved through delegation. Answer 4 is the most inclusive and proactive answer.

In the planning of construction, modernization and alteration programs, fixed equipment: 1) is not shown in construction documents if it is owner-provided and installed by the vendor. 2) includes equipment with quick-disconnect connections to utilities. 3) consists of major technical equipment. 4) is usually included as part of the construction contract.

Answer 4 is correct. The question requires a basic knowledge of plant and facility management. The key word is fixed equipment, which should be included in construction contracts.

In a dispute between two staff physicians, the primary role of the CEO is to: 1) ask a representative of the governing authority to mediate the dispute. 2) avoid any involvement in the dispute. 3) meet with both parties as soon as the problem is identified. 4)request the appropriate chief(s) of service to investigate and report back.

Answer 4 is correct. This question requires knowledge of the CEO's role in mediating disputes and the reporting relationships within a healthcare facility. The staff physicians report to the chief(s) of service who, in return, report to the CEO.

fter determining your own management strengths and weaknesses, the most effective method for follow-up is to: 1) seek out educational offerings specific to your identified needs. 2) attend short courses that address current industry issues. 3) read current trade journals. 4) create a developmental plan with goals and time frames.

Answer 4 is the correct answer because it involves establishing a plan with goals and time frames and is much more proactive compared to the other responses.

The principles of quality improvement require that healthcare executives change their management philosophy from: Finding fault with employees to finding problems in processes. Finding fault with employees to involving them in the improvement of processes. Focusing on enhanced inspection techniques to focusing on variance. Focusing on employees' roles to focusing on process outcomes.

Finding fault with employees to finding problems in processes....In QI, the goal is not only to improve the average performance, but also to eliminate inappropriate variations in the process. By standardizing or improving the process, all employees create the desired output on a consistent basis. QA focuses on eliminating the defect. In QA approach, the manager would terminate the employees who fail to meet the threshold of productivity. continuous improvement approach will analyse the process that led to the defect so the process can be modified so that similar defects will not arise in the future. Quality Assurance Catch "bad apples" - people or worker focus • Eliminate the bad performers • Detect problems • A program • Results oriented • Evaluate the outcomes Quality Improvement (aka Continuous Improvement) Examine and improve the processes • Does not find fault • Integration into work • Process oriented • Maintain standards/systems • Focus on best practices so all can learn/benefit

Selection of an information system in a healthcare organization should begin with:? Meeting with several information systems vendors to determine the scope of available technology. Hiring an information systems consultant to determine the organization's strategic needs. Development of an information systems plan that supports the organization's existing strategic objectives. Evaluation of available hardware and software to best determine what meets the organization's needs.

Hiring an information systems consultant to determine the organization's strategic needs.

Facing struggles such as declining profit margins, nonprofit healthcare organizations have become more dependent on what source for financing capital needs? Philanthropy. Bond financing. Capital leases. Operational leases.

...Philanthropy.

Who gives final approval of the medical staff bylaws? The board. The medical staff. The board executive committee. The medical staff executive committee.

...Board

Governing boards are typically more effective at what size? 10 to 15 members. 15 to 25 members. 5 to 10 members. More than 25 members.

...10 to 15 members.

What type of review involves evaluation of management staff by their superiors, subordinates, and internal and external customers? Annual review. 360-degree review. Competency review. Peer review.

...360-degree review.

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

...48 hours

What does a liquidity ratio measure? A firm's ability to meet its current obligations in a timely manner. Size of dividends to be paid to shareholders. The percent of total funds provided by creditors. Days in accounts receivable

...A firm's ability to meet its current obligations in a timely manner.

Incident reports should be initiated by: A member of the medical/professional staff or by any employee. Any person with direct patient-care responsibilities. The department director or supervisor. The risk manager/quality assurance coordinator.

...A member of the medical/professional staff or by any employee.

Congress enacted Stark II to prohibit which of the following? A physician or an immediate family member from referring a patient to an entity with which they have a financial relationship. Hospitals and physicians from partnering to build in-patient acute care facilities. Hospitals and physicians from joint venturing in the offering of outpatient imaging centers. A hospital from referring a patient to a wholly-owned entity of which it has total ownership.

...A physician or an immediate family member from referring a patient to an entity with which they have a financial relationship.

Which of the following statements is in accordance with the principle of delegation? The executive who subscribes to the principle of delegation knows what he/she wants to accomplish and exercises control over the work schedule of subordinates. An executive explains how he/she wants things done and points out how the subordinate's contribution fits into the overall plan. A successful executive gives instructions, telling subordinates exactly how and in what sequence things should be done. In applying the principle of delegation, an executive makes relatively few decisions personally and frames orders in broad general terms.

...A successful executive gives instructions, telling subordinates exactly how and in what sequence things should be done.

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

...ACGME

Which organizational theory is illustrated by governing activities with explicit and specific procedures, arranging offices in a hierarchal fashion, and selecting candidates on the basis of their technical competency? Bureaucratic Contingency Institutional Technological

...Bureaucratic

The primary reason for the decision to move from a freestanding voluntary facility to an investor-owned healthcare organization: Economy of scale. Access to the equity market. Access to patients. Improved visibility in the community.

...Access to the equity market.

Revenue cycle billing management typically includes what broad activities? Billing and collections for inpatient, outpatient and surgical services. Claims processing, denial management and claims payment. Processing accounts payables, denial management and billing for outpatient services. Activities before services are rendered, activities that occur simultaneously with the services and activities after services are rendered.

...Activities before services are rendered, activities that occur simultaneously with the services and activities after services are rendered.

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

...Allocation of materials.= best and correct answer. The remaining answer are all functions of Material Management but are too narrow. Allocation of resources is all-encompasing and the best answer. Material Management works to identify the most economical supplies consistent with patient needs. Staff strives to standardize items, reduces the number of items purchased, establish criteria for appropriate quality, and eliminate unnecessary purchases. Functions: 1. Material selection & control 2. Purchasing 3. Revenue enhancement & cost accounting (integration of clinical ordering and patient billing systems) 4. Processing 5. Storage, protection, and receipt

The qui tam provision of the federal False Claims Act is a statute aimed at those who commit fraud against the government: Have minimal impact in the healthcare industry. Prohibits the citizen from sharing in the recovered funds. Allows any citizen to bring suit in the name of the United States. Can be generated from news media reports.

...Allows any citizen to bring suit in the name of the United States.

The asset turnover ratio is useful in measuring managerial performance because it indicates the: Amount of resources required to generate a dollar of revenue. Profitability per dollar of revenue. Effectiveness of capital structure decisions. Effective use of current assets.

...Amount of resources required to generate a dollar of revenue. Asset turnover is a financial ratio that measures the efficiency of a company's use of its assets in generating sales revenue or sales income to the company. Asset Turnover = Sales or Revenues/Total Assets

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

...An increase in productivity occurs when a reduction occurs in the ratio of hours worked to the number of units of service rendered.

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

...Appropriateness.

In a unionized organization, what is the most effective contract dispute resolution finalization alternative? Mediation. Corporate Campaigns. Arbitration. Strike.

...Arbitration.

The governing authority of a healthcare facility can terminate the privileges of any member of the medical/professional staff: At any time, if it follows its own adopted procedures. At any time, with or without due process. Only if termination is recommended by the medical/professional executive committee. Only if termination is recommended by the medical/professional staff.

...At any time, if it follows its own adopted procedures.

One of the techniques most frequently used in industry to aid management in interpreting a form's balance sheet is computation of the acid-test ratio, which is the ratio of: Current assets to current liabilities. Total assets to total liabilities. Cash to short-term department. Cash, marketable securities and accounts receivable to current liabilities.

...Cash, marketable securities and accounts receivable to current liabilities. Debt Ratio is total liabilities to total assets. Current Ratio =current assets divided by current liabilities Acid-test Ratio= A stringent indicator that determines whether a firm has enough short-term assets to cover its immediate liabilities without selling inventory. The acid-test ratio is far more strenuous than the working capital ratio, primarily because the working capital ratio allows for the inclusion of inventory assets. Must know the financial formulas well to answer this question

If a physician abuses a patient in the healthcare organization, initial corrective action should be taken by the: Chief of staff. Chief of services (department chairman). Nursing unit supervisor. Chief executive officer.

...Chief of services (department chairman).

The practice of a provider seeing a patient more often than is medically necessary, primarily to increase revenue through an increased number of services, is called: Cost shifting. Buffering. Turfing. Churning.

...Churning The practice of a provider seeing a patient more often than is medically necessary, primarily to increase revenue through an increased number of services. Churning may also apply to any performance-based reimbursement system where there is a heavy emphasis on productivity Cost Shifting- the practice of shifting costs to some payers to offset losses from other payers.

Which of the following networks is intended to reduce costs and improve quality by giving access to financial, clinical and administrative information? Community health information network (CHIN) Local area health network (LAHN) Virtual private health network (FPHN) Health file transfer network (HFTN)

...Community health information network (CHIN)

Which of the following is not considered part of the labor budget? Staff salaries. Hourly wages. Employee benefits. Contract staff expenses.

...Contract staff expenses.

The most useful way for a healthcare organization to deal with outside regulatory and credentialing bodies is to: Identify opportunities to influence political outcomes. Regularly maintain both formal and informal relationships with these agencies. Deal with these agencies only in written form so as to have a clear paper trail for subsequent review and analysis. Provide only the minimum amount of information required to comply with the regulations of the agency.

...Deal with these agencies only in written form so as to have a clear paper trail for subsequent review and analysis.

When third-party policies and programs impede the healthcare facility's fiscal capacity to renovate and model its plant as routinely scheduled, the healthcare facility—to protect itself—should first: Delay capital improvements until funds are available. Reduce the level of operating services Limit the number of admissions from selected third-party payments sources. Resort to the regulatory agency to obtain a waiver.

...Delay capital improvements until funds are available. The remaining answers don't make sense

When introducing a new information technology system to a healthcare organization, resistance can be effectively addressed by: Eliminating existing social groups that appear within the organization. Employing a policy of mandated use throughout the organization. Focusing on the system users and being responsive to their needs. Rapidly introducing the system changes to allow the staff to see the cost savings.

...Focusing on the system users and being responsive to their needs.

To guard against the loss of assets, an administrator should do which of the following? Encourage off-site storage of equipment. Allow service directors to determine the frequency of asset inventories. Ensure that billing and collections are handled by the same team. Implement detailed procedures, risk control and annual outside audits.

...Implement detailed procedures, risk control and annual outside audits.

Which of the following is the depreciation method that best recognizes changes in the general purchasing power of the dollar and/or changes in the replacement cost of specific assets? Declining-balance depreciation. Straight-line depreciation. Price-level depreciation. Sum of the years' digits depreciation.

...Depreciation Methods. Price-level depreciation.=depreciation method that best recognizes changes in the general purchasing power of the dollar and/or changes in the replacement cost of specific assets Declining-balance depreciation= involves applying the depreciation rate against the non-depreciated balance. Instead of spreading the cost of the asset evenly over its life, this system expenses the asset at a constant rate, which results in declining depreciation charges each successive period. Straight-line depreciation estimates the salvage value (scrap value) of the asset at the end of the period during which it will be used to generate revenues (useful life). (The salvage value is an estimate of the value of the asset at the time it will be sold or disposed of; it may be zero or even negative). Straight line method depreciates cost evenly through out the useful life of the fixed asset. The company will then charge the same amount of depreciation each year over that period, until the value shown for the asset has reduced from the original cost to the salvage value. Declining balance method of depreciation is a technique of accelerated depreciation in which the amount of depreciation that is charged to an asset declines over time. In other words, more depreciation is charged during the beginning of the life time and less is charged during the end. Sum of the years' digits method of depreciation is one of the accelerated depreciation techniques which are based on the assumption that assets are generally more productive when they are new and their productivity decreases as they become old.

Cost accounting is an important tool which enables the CFO to: Meet Joint Commission fiscal requirements. Ensure supplies are competitively purchased. Determine the actual cost of providing patient care. Improve revenue cycle returns.

...Determine the actual cost of providing patient care.

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

...Determining the range and types of services to be offered.

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

...ERISA

A major advantage of capitation for primary care gatekeepers is it: Guarantees primary care physicians will make more money than they ever made in fee-for-service. Encourages primary care physicians to be more judicious in their referrals to specialists. Elevates the primary care physician's status in the eyes of his/her patients. Makes it easier for health plans to collect utilization data from physicians.

...Encourages primary care physicians to be more judicious in their referrals to specialists.

Which of the following activities is illegal for tax-exempt health organizations? Allowing an employee to testify before a legislative body regarding pending decisions which would affect organizations. Lobbying members of Congress for healthcare reform. Endorsing a candidate for public office. Sponsoring a political action committee in a for-profit subsidiary.

...Endorsing a candidate for public office.

A balanced scorecard is a set of performance measurements used to: Assess patient satisfaction. Ensure the organization does not exceed one performance metric at the expense of another. Provide a scorecard for annual performance monitoring. Gather and monitor financial data.

...Ensure the organization does not exceed one performance metric at the expense of another. Balance Scorecard translates the organization's strategy into 4 perspectives, with a BALANCE between the following: 1.between internal and external measures 2. between objective measures and subjective measures 3. between performance results and the drivers of future results As a performance management tool, Balance Score Card goes beyond the standard financial measures to include the following additional perspectives: Financial perspective, customer perspective, Business process perspective, and learning & growth perspective.

What is the most common operating indicator used to measure overall staff productivity? Full-time equivalents per occupied bed. Total salaries and benefits as a percent of operating expenses. Full-time equivalents per adjusted averaged daily census. Nursing salary and benefits as a percentage of total expenses.

...Full-time equivalents per adjusted averaged daily census.

The first step in any strategic management scenario planning is to: Develop "what if" scenarios Gather information from as many sources as possible. Develop courses of action that fit within future organizational resources. Conduct a make vs. buy analysis.

...Gather information from as many sources as possible.

When seeking information about fixed assets, payroll, regulatory and tax reporting, and accounts payable, an administrator will access what information management system? Physician practice management. Patient administration and management. Home health management. General financial management

...General financial management

Emerging physician organizations are usually private, for-profit corporations. In order to gain not-for-profit status, such organizations must: Give 50% of profits to charity. Have a community-dominated board of governance. Create a partnership with a nonprofit hospital. Minimize double taxation to members by passing proceeds directly to the members.

...Have a community-dominated board of governance

Health Savings Accounts (HSAs), were established through which law? Consolidated Omnibus Budget Reconciliation Act Medicare Prescription Drug Improvement and Modernization Act Health Insurance Portability and Accountability Act Americans with Disabilities Act

...Health Insurance Portability and Accountability Act= Correct. The Medicare Prescription Drug, Improvement and Modernization Act of 2003 (MMA), established the Medicare Prescription Drug Program, also known as Medicare Part D, making prescription drug coverage available to Medicare beneficiaries. The MMA also provides for extra help (a subsidy) with prescription drug costs for eligible individuals whose income and resources are limited. This help takes the form of subsidies paid by the Federal government to the drug plan in which the Medicare beneficiary enrolls. The subsidy provides assistance with the premium, deductible and co-payments of the program Balanced Budget Act of 1997 added Medicare Part C, which expanded the types of health plans from which Medicare beneficiaries could to receive their benefits (fee-for-service, medical savings accounts, coordinate care plans)

When facility maintenance is deferred, which of the following outcomes is predictable? Higher costs. Lower costs. Deferred risk. Higher liability exposure.

...Higher costs. Facilities maintenance includes utilities supply, waste removal, housekeeping/groundskeeping, hazardous materials, and plant/equipment maintenance. Facilities maintenance must respond to OSHA & EPA. Risk is not deferred but elevated. Higher liability is also possible but too narrow of answer because it only addresses one of the many function of facilities maintenance.

A positive net present value indicates that the investment has a rate of return: Higher than the discount rate used in the calculation. Lower than the discount rate used in the calculation. Equal to the discount rate used in the calculation. Equal to the accounting profit averaged over the life of the investment.

...Higher than the discount rate used in the calculation. Net present value (NPV) is the difference between the present value of cash inflows and the present value of cash outflows. If a long-term project has a positive net present value, then it is expected to produce more income than what could be gained by earning the discount rate, which means the company should go ahead with the project. Positive NPV means that project is in state of positive cash flow and the investment is worth taking. Negative NPV means a status of discounted cash-flow. Negative NPV will have rate of return lower than discount rate in the calculation Internal rate of return (IRR) is the discount rate often used in capital budgeting that makes the net present value of all cash flows from a particular project equal to zero.

Which of the following activities should be performed by the Board of Directors? Calculating patient care fees. Determining staffing patterns. Recruiting new medical staff. Hiring the CEO.

...Hiring the CEO.

Which segment of the healthcare delivery system is exclusively dedicated to terminally ill patients? Level I trauma centers Tertiary care centers Hospice programs. Pastoral care services.

...Hospice

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

...Hospitals and patients frequently have difficulty arranging for nursing home care services.

Budgets for new capital expenditures include requests for: Infrastructure. Wage adjustments. New employee insurance plans. New gain share agreement with staff physicians.

...Infrastructure.

Information system departments most often utilize which one of the following methods to ensure confidentiality? Issue security codes and limit access to the system. Centralize access to the computer system. Do not allow physician and vendor access to the system. Monitor and audit all entries into the system.

...Issue security codes and limit access to the system.

What is a primary reason for conducting continuing education for staff? Staff will think the organization cares about them. There are significant short-term operating efficiencies. It is a long-term commitment to the patient. The Joint Commission and NCQA required it.

...It is a long-term commitment to the patient.

Which of the following best summarizes the legal status of the physician- patient relationship? It is based on an expressed or implied contract, from which certain elements of duty arise. It is based on acceptance of remuneration for services rendered unless charity care is designated. It has no legal status in that it is a private business relationship, unless the patient is a Medicare beneficiary. It is governed by the hospital or health system's medical staff bylaws.

...It is based on an expressed or implied contract, from which certain elements of duty arise.

Which of the following are important aspects to consider when establishing a joint venture? Joint ventures involve independent management teams and independent governance structures. Joint ventures involve capital investment by all parties, can be difficult to dissolve, and are usually expected to be permanent. Joint ventures are managed like an internal organization and are usually re- negotiated annually. Joint ventures are developed to acquire portions of the parent organizations and are generally accepted as irreversible.

...Joint ventures involve capital investment by all parties, can be difficult to dissolve, and are usually expected to be permanent.

Hospitals known for their ability to attract and retain nurses despite the significant nursing shortages are called: Professional excellence centers. Shared Governance facilities. Magnet hospitals. Baldrige award winners

...Magnet Hospitals The Magnet Recognition Program is a recognition program operated by the American Nurses Credentialing Center that recognizes healthcare organizations that provide excellence in nursing.

How should supervisors behave toward informal leaders in the organization? Maintain a positive attitude toward informal leaders. Ensure informal leaders remain at a moderately low status within the work group. Grant informal leaders occasional favors. Pass information on to informal leaders before giving it to formal leaders.

...Maintain a positive attitude toward informal leaders.

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

...Market

Performance improvement teams should consist of: Experts in process management. Members from the involved Microsystems. Middle managers with experience. Physicians and other users.

...Middle managers with experience.

You work for a county organization that has decided to issue bonds to fund a new building. What type of bond would be sold on behalf of your organization? Mortgage bond. Corporate bond. Capital bond. Municipal bond.

...Municipal bond. A municipal bond is a bond issued by a local government, or their agencies. Interest income received by holders of municipal bonds is often exempt from the federal income tax and from the income tax of the state in which they are issued, although municipal bonds issued for certain purposes may not be tax exempt. A mortgage bond is a bond backed by a pool of mortgages on a real estate asset such as a house. A corporate bond is a bond issued by a corporation. It is a bond that a corporation issues to raise money effectively in order to expand its business

Under the regulations of the IRS, a tax exempt entity: Must provide a private benefit to those institutions operating or affiliated with the entity. Must limit the benefit to any private individual. Must provide a benefit to the public. Can minimize penalties if it limits private benefits to less than 50%.

...Must provide benefit to public

Determining whether the help desk function is effective and whether projects are well managed are examples of measuring an information system department's: Strategic competency. Political competency. Vendor competency. Operational competency.

...Operational competency.

Short-range planning is enhanced if a strategic plan has been adopted because: Potential program can be eliminated easily if not part of the strategic plan. Use of space has already been determined. A frame of reference is already in place. Operational problems can be quickly resolved.

...Operational problems can be quickly resolved.

The cultural climate of an organization affects its recruiting procedure because: It reduces employee turnover and absenteeism. Organizations seek applicants whose attitudes, values and goals are consistent with those of the organization. Applicants who cannot support a given culture will be unwilling to work for that organization. Applicants look only to organizations that portray a positive cultural climate.

...Organizations seek applicants whose attitudes, values and goals are consistent with those of the organization.

The role of a not-for-profit healthcare organization's governing board includes all of the following except: Delineate clinical privileges. Ensuring that quality healthcare is delivered. Overseeing the day to day operations. Setting broad institutional policy.

...Overseeing the day to day operations.

A food service director is assigned responsibility for environmental services. This is an Example of: Redundant management. Matrix management. Oversight management. Service line management.

...Oversight management

Network of hospitals, physicians and other healthcare providers that provide services for a negotiated fee are called: HMOs. PSOs. PPOs. MSOs.

...PPO

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

...Pareto analysis.

A healthcare executive is serving on the board of a community mental health center. The mental health center board is evaluating proposals for inpatient psychiatric services. Proposals were received from the executive's facility and several other facilities. The healthcare executive should: Participate in the discussion and the vote if the benefits to the community outweigh possible conflicts of interest. Not participate in the discussion or the vote. Declare a potential conflict-of-interest and excuse himself or herself from participating in both the discussion and the vote. Participate in the discussion but not vote on the proposals.

...Participate in the discussion but not vote on the proposals.

Which of the following management styles allows the highest subordinate freedom and lowest personal authority? Autocratic. Participative. Democratic. Laissez-faire.

...Participative.

What is the correct order, from bottom to top, of Maslow's Hierarchy of Needs? Physiological, safety, esteem, belonging, self-actualization. Safety, physiological, belonging, esteem, self-actualization. Physiological, safety, belonging, esteem, self-actualization. Safety, esteem, physiological, belonging, esteem, self-actualization.

...Physiological, safety, belonging, esteem, self-actualization "PSBES"= "Please stop breaking everyone's stuff"

The real value of financial statements lies in the fact they can be used to help: Predict the firm's future financial condition. Compute total margin versus periodic gain. Relate the industry average to net profit/loss over time. Understand that a large portion of a hospitals net income may come from non- operating gains

...Predict the firm's future financial condition.

Which of the following courts is often given jurisdiction to hear cases involving such matters as surgery for an incompetent person or the involuntary commitment of a mentally ill person? Family court. Juvenile court. Appellate court. Probate court.

...Probate Court

Bundled pricing (paying a single fee for all services) for such services as total hip replacement or coronary artery bypass surgery affects physician- hospital relationships by: Reducing the need to devote administrative effort to measuring outcomes and performance indicators. Putting the physician and hospital at each other's throat fighting over the distribution of the fee Promoting efforts to collaborate and integrate efforts to provide more efficient care. Guaranteeing that only top quality physicians will be allowed to participate in such programs.

...Promoting efforts to collaborate and integrate efforts to provide more efficient care.

The major purpose of a code of ethics for members of a healthcare executives association is to: Provide guidance to members in their own professional conducts. Increase public understanding of the professional association. Provide a framework for disciplining members when necessary. Provide a framework for annually evaluating professional performance.

...Provide guidance to members in their own professional conducts. "The purpose of the Code of Ethics of the American College of Healthcare Executives is to serve as a standard of conduct for members. It contains standards of ethical behavior for healthcare executives in their professional relationships. These relationships include colleagues, patients or others served; members of the healthcare executive's organization and other organizations; the community; and society as a whole. The Code of Ethics also incorporates standards of ethical behavior governing individual behavior, particularly when that conduct directly relates to the role and identity of the healthcare executive."

A successful healthcare organization usually has a unique and well- articulated company philosophy that presents a clear picture of the organization's objectives, norms and values. Employee motivation to support this philosophy would be greatest when the company: Maintains a program that provides employees with a wide variety of social, cultural and recreational activities. Emphasizes financial rewards, including strong employee benefits. Provides a training program that is well communicated, understood by employees and enforced by executive management. Continues a major effort to articulate employee rights in such areas as grievances, affirmative action and human rights issues.

...Provides a training program that is well communicated, understood by employees and enforced by executive management.

In a sound human resources program, the primary purpose of the job classification system is to: Develop position descriptions for employees. Establish a total wage and salary administration program. Rank jobs by kind and level of work performed. Define an effective organizational structure.

...Rank jobs by kind and level of work performed.

Which of the following is a key responsibility of a governing board? Recruit and select the CEO. Operationalize the organization's strategic plan. Assist the CEO with evaluation of the rest of the management team. Develop a physician recruitment plan.

...Recruit and select the CEO.

The method referred to as value analysis is used in inventory control activities to: Make adequate substitutions for requisitioned items. Reduce the quantity of items issued to the various departments. Reduce cost without impairing functional efficiency. Relate quantity and quality of items.

...Reduce cost without impairing functional efficiency. Inventory management is important to provide patients with the high quality supplies at the least possible cost.

Accident rates among personnel continue to rise and are distributed among all departments. What would be your best initial action in finding a comprehensive solution to this problem? Form a safety committee of key personnel to review reports of all accidents and make recommendations for corrections. Require each department head to analyze his/her department's accidents in order to determine the causes and find methods of correction. Institute a safety education program by departments. Recommend that the personnel committee formulate an effective accident- prevention program.

...Require each department head to analyze his/her department's accidents in order to determine the causes and find methods of correction. This question addresses sentinel events

The main role of the board is: Selecting the CEO. Overseeing operations. Setting institutional policy. Running the institution in the absence of the CEO.

...Selecting the CEO.

As an internal control method, a budget is most commonly used to: Allow managers to control expenditures in the current year and to justify increases in future budgets. Provide feedback concerning operational expenditures to the governing authority and to allow management to satisfy the governing authority's requirements of accountability. Serve as a numerical specification of plans and to function as a standard of control against which results can be compared. Allow management to monitor operational expenditures and to justify future requests for decreased or increased expenditures to rate-setting agencies.

...Serve as a numerical specification of plans and to function as a standard of control against which results can be compared. " Budgeting is the process of converting the operating plan into monetary terms. Budgets are an important way for managers to exert control function. It is a control standard against which superiors can measure performance of subordinates"

After a marketing research problem has been identified, the researcher's next step is to: Conduct a literature search. Conduct focus groups and collect data. Specify information needs. Design a data-collection instrument.

...Specify information needs. Market Research involves gathering information about a market size and trends. Marketing Research Process: 1. Define the problem 2. Determine the research design 3.Identify data type and data sources 4. Design data collection forms & questionnaires 5. Determine sample size and plan 6. Collect the Data 7. Analyze & interpret the data 8. Prepare the research report.

In the field of healthcare services, which of the following trends has significantly increased the need to develop more comprehensive and more systematic credentialing processes in healthcare facilities? The increased number of independent healthcare practitioners. The expansion of governmental regulations covering the operation of healthcare facilities. The growth of ambulatory healthcare services. The growth of liability of healthcare facilities for malpractice by health practitioners.

...The growth of ambulatory healthcare services.

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

...The heads of the operating divisions, with the CEO collating.

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

...The information requested consists of psychotherapy notes.

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

...The process by which short-range objectives and actions are established and implemented in accordance with the strategic plan.

Most products and services enter a period of decline. Unless compelling reasons prevail, continuing a declining product or service is costly because: Increased turnover of personnel will occur. Continuation will set an undesirable precedent concerned with maintaining the status quo. The program will consume a disproportionate amount of management time and delay the search for a replacement. The organization will be perceived as being insensitive to the marketplace.

...The program will consume a disproportionate amount of management time and delay the search for a replacement.

Which of the following is the least serious limitation to decision analysis? Oversimplifying the problem. Inadequate data. The decision maker's values. The statistical model.

...The statistical model.

Controlling the costs of accounts receivable is heavily affected by: The time or length of the payment cycle. The dollar amount of credit granted to individuals. The total dollar amount of receivables carried on the books. Working capital management

...The time or length of the payment cycle.

Which statement best describes the status of health organizations under antitrust law? The medical staff appointments are exempt from antitrust litigation. They are subject to antitrust law relative to price fixing and boycotts. They are exempt from most antitrust principles because they are "charitable." They are subject to antitrust law, just as any other industry is.

...They are subject to antitrust law, just as any other industry is.

Hospitals that were acquired by hospital systems generally have which characteristic? They operate at a net gain. They incur higher debt levels. They are located in markets with a smaller number of HMOs. They are younger, not-for-profit hospitals with higher occupied bed

...They incur higher debt levels.

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

...To provide a community-based hub for sharing health information.

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

...To standardize the sharing of clinical and administrative information.

An important management principle that should guide the development of information systems in healthcare organizations is to: Treat information as an essential organizational resource. Delegate all decisions about information technology to technical specialists. Employ consultants to set priorities for systems to be developed. Always buy the newest system available to avoid technical obsolescence.

...Treat information as an essential organizational resource.

If the amount of charity care increased from one reporting period to the next, which of the following would occur? Provision for bad debts would increase. Unrestricted net assets would increase. Unrestricted net assets would neither, increase or decrease. Unrestricted net assets would decrease

...Unrestricted net assets would decrease

Behaviorally anchored rating scales (BARS) for specific jobs can be: Used to identify components of job behaviors. Developed in a short period of time. Used for evaluation but not for employee development. Subjective on some scale items.

...Used to identify components of job behaviors.

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

...White

If the average daily census on an inpatient medical surgical unit is 19, and the productive hours per patient day target is 7.2, and the productive percentage calculation is 8.5, how many fulltime equivalents (FTEs) should be budgeted for the productive core staffing? 24. 26. 30. 35.

24 How to Calculate FTEs Definitions: FTE stands for full time equivalent. An FTE is the equivalent of one person working full time: 8 hrs./day X 5 days/week X 52 weeks/year = 2080 hours/year Examples: 1 person working full time = 1 FTE 2 people each working 4 hours per day, 5 days per week = 1 FTE Tips: FTEs does NOT mean number of employees. An FTE value stays the same over time (except when you adjust your usual staffing pattern). Do not multiply it by days, weeks, or months. How to Do It: 1. If you know your total number of labor hours for one year: Divide by 2080. This is your FTEs. Example: Your department's total labor hours as reported to payroll for Jan. - Dec. 1998 were 13,104. 13,104 ÷ 2080 = 6.3 FTEs.

Memorial Hospital offers a screening test as a public service for $0.50 per test. Variable costs per unit are $0.32. Fixed costs are $43,200 per month for the department performing the test. It is the only test done by this special department. The break-even point in tests is: 240,000 tests. 172,000 tests. 135,000 tests. 86,400 tests.

240,000 tests. ... Total Cost per unit=0.50 Variable Cost= 0.32 Total Cost = Fixed cost +Variable cost Fixed cost=0.5-0.32 Fixed cost= 0.18 per unit. Total Units=Total fixed cost/ Fixed cost=$43,2000/$0.18=240,000 Total units need to be made to cover fixed cost= 240,000 Breakeven point is the money needed to cover fixed cost without getting any profits.

Mission statements: 1) Are frequently changed in response to environmental issues and marketing trends. 2) Do not require formal board action when revised. 3) Require financial parameters. 4) Identify in broad terms the purposes for which an organization exists.

A mission statement describes what an organization does, what its purpose is, or why it exists. The correct statement is "d".

What is generally prohibited by Stark II Laws? A hospital paying a physician for admissions. A physician receiving payment from another physician for a referral. A physician referring a patient to a service owned by the physician. A hospital referring a patient to its own home health agency.

A physician referring a patient to a service owned by the physician.

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

Acquiring a long-term care facility. Vertical Integration: i. Can be two entities at different stages of producing services or can be several stages of production iii. Establishing Ambulatory and family practice for health promotion activities=forward integration (means that you're moving toward the consumer) iv. Backward Integration= long-term care facilities & rehab center c. Health systems can be vertical or horizontal, which means that health systems are linked by contract and not by ownership i. Managed care organizations are example of virtual vertical integrated system→ contract with acute care services, rehab, ambulatory services, and drug prescription services ii. Some MCO's own nothing....not even the office in which business is conducted but only contract with the services and coordinate the services provided. d. Highly integrated systems of healthcare delivery are defined as vertical integration and having 3 stages of health services delivery, one system-wide contract with a payer. i. Typically include one acute care hospital, physician component such as physician hospital organization or group practice, and another stage of care such a skilled nursing home facility, home health agency or surgical center ii. Has contract with one system-wide payor such as employer or employee coalition, managed care organization, or government entity.

What type of problem arises when a healthcare executive knowingly allows the organization to continue double billing? An ethical problem for the healthcare executive, but may not be grounds for dismissal if organizational policy is not clearly stated. An actual conflict of interest, even absent a direct economic benefit to the healthcare executive. An ethical problem for the employee if the healthcare executive receives direct economic benefit. An ethical problem if it clearly violates state or federal law.

An actual conflict of interest, even absent a direct economic benefit to the healthcare executive....

The governing body of a healthcare institution meets its responsibility for the quality of patient care by: 1) delegating accountability for patient care to the committee appointed by the governing body, which provides a formal administrative liaison between the governing body, the administration, and the medical/professional staff. 2) delegating to the chief executive officer the responsibility for developing criteria for making certain that an effective medical/professional audit is carried out. 3) establishing, maintaining and supporting through the medical/professional staff and management staff an ongoing program of review and evaluation of patient/client care and action on findings. 4) establishing an effective system for utilization review, medical/professional audit activities, and credentialing of the medical/professional staff.

Answer 3 is the correct response. Answers 1 and 2 can be immediately disqualified because responsibility is not met through delegating. Answer 4 can be eliminated because it only addresses some of the activities that could be used in meeting quality assurance requirements. Answer 3 is much more inclusive. Key words are establishing, maintaining, and supporting. Also, answer 3 is the only response that suggests follow-up on the program through review, evaluation, and action on the findings.

Which of the following are parts of the dimensions of the strategic balanced scorecard? Financial performance. New technology. Competitor activity. Board/management team.

Financial Performance Balanced Scorecard Perspectives include: Financial Perspective Business Process Perspective Customer Perspective Learning & growth perspective

One approach for measuring technical quality of clinical support services is: Patient satisfaction scores. Degree of continuity of care. Appropriateness testing. Process review.

Appropriateness testing.

Which of the following is the best way to assign costs in responsibility management? Allow each department manager to be responsible for a different type of fixed cost. Allow each department manager to choose the cost that he/she prefers to control. Assign costs to the department manager who is responsible for making decisions about those costs. Assign costs equally to all managers thus allowing equal responsibility for costs.

Assign costs to the department manager who is responsible for making decisions about those costs.

When evaluating capital budgeting performance, what is the best indicator of operating leverage? Debt to capitalization ratio. Expense ratio. Average age of plant. Depreciation ratio.

Average Age of plant

For the routine service cost center, an increase in the number of patient days over the budgeted number of patient days will result in: A higher average cost per patient day. A lower average cost per patient day. An increase in the budgeted fixed costs for the routine service cost center. No change in the average cost per patient day.

B. lower average cost per patient day Look for explanation

If a CEO wanted to look at a "snapshot" of the financial condition of the healthcare organization, he/she would review which of the following? Income Statement. Balance Sheet. Retained Earnings Statement. Investment Portfolio

Balance Sheet. Income statement is the "ruler" because it measures performance Balance sheet is the "camera snapshot" because it gives the financial conditions over a certain point in time. Retained earnings is income earned by the organization by operations minus dividends.

In the healthcare field, the accountability of management is best measured by the:? Balance maintained between service quality and operational efficiency. Results shown on the annual expense and income statement. Balance maintained between physician satisfaction and patient needs. Degree to which management's needs are met.

Balance maintained between service quality and operational efficiency.

Resource allocation in health services organizations involves balancing the needs of organization, staff, and patients. However, the essential primary focus on patients can be met only if the: Strategic planning process has been effective and thorough. Mission and vision statements are appropriate to the task. Organizational culture makes a basic commitment to it. Basic needs of the organization and staff are addressed first.

Basic needs of the organization and staff are addressed first.

The purpose of the ACHE Ethics Committee is to review and recommend action on ethical violations to which group? Executive Committee. Board of Governors. Council of Regents. Membership Committee.

Board of Governors.

In a healthcare organization, who has ultimate fiduciary responsibility? Chief financial officer Board of directors. Medical staff officers. Senior management.

Board of directors.

Which of the following best describes a healthcare organization's recognized service reputation that has been earned over the long-term within its market? Soft assets. Market share. Brand equity. Community perception.

Brand Equity

One method for evaluating relative value of different jobs is: Broad banding. Gant charting. Scalability. Benchmarking.

Broadbanding 6 methods of evaluating a job value: 1. Ranking 2. Job Classification 3. Point System 4. Market Pricing 5. Broad-banding 6. Factor Comparison

Research in behavioral science has consistently found that once basic needs are met, staff is motivated most: By an incentive payment program. Only by a significant increase in salary. By factors such as being kept informed. When performance sets them apart from the group.

By factors such as being kept informed. HR Book= " For empowerment to thrive and grow, organizations must encourage participation, innovation, access to information, accountability, and a culture that is open and receptive to change. To support empowerment, organization must share with the workforce information, knowledge, power to act, and rewards"

Many hospitals develop affiliations with college-based nursing education programs to: ? Improve the image of the hospital in the community. Improve access to qualified graduates. Provide financial support to higher education. Gain the services of low-cost trainees.

Improve access to qualified graduates.

What in the revenue cycle process is a major impediment to prompt payment? Payment receipt and posting. Claims submission. Poor financial counseling. Claim denial.

Claims Denial

A patient files a complaint relating to a negative hospital experience. The proper handling of this patient's complaint is to: Cite organizational policy. Side against the organization. Minimize the complaint. Clarify the problem.

Clarify the problem.

Which of the following health maintenance organization models exerts maximum control over physician providers? Closed panel. Open panel. Network. Point of service.

Closed HMO Point-of-service (POS)= HMO's that exert minimum to no control over their physician providers because they allow enrollees to seek care from providers not on contract wit the HMO (ie, out of network). Although HMO reimburses the provider's fees, the HMO requires enrollees to pay out-of-network providers larger deductibles and coinsurance, as well as higher premiums to the HMO, for using out-of-network providers. Network HMOs: i. Can be either Closed panel or open panel. Relies on groups of primary care physicans and reimburses physicians groups on capacitation. Primary care groups are responsible for referring and reimbursing referrals t specialty physicians.

The primary components of a healthcare organization's mission statement include: Community served and time frame. Community served and services provided. Services provided and financial results. Services provided and patient care quality.

Community served and services provided.

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

Concurrent review. As pre-certification and concurrent review of cases grew, utilization management spun out of utilization review. The difference is utilization management is prospective and intends to manage health care cases efficiently and cost effectively before and during health care administration. Utilization review is more retrospective considering whether health care was appropriately applied after it was administered. The basic techniques in utilization management: Demand Management= the process of working to lower the demand for services, outside the specific chronic conditions. Concurrent Review= used to maximize use of inpatient facility and to aid in discharging planning for use of alternative resources Retrospective review= claims reviews examined for mistakes and pattern reviews to study cost and clinical outcomes Case Management= examines catostrophic cases (transplants, neonates) Disease Management

This act prohibits employer from discharging an employee because of his or her earning are subject to garnishment and limits the amount of wages that can be withheld fro garnishment

Consumer Credit Protection Act

Which of the following leadership actions most clearly supports organizational transformation toward total quality management? Convening and chairing the Quality Council. Changing the name of the quality department from QA to CQI. Requiring all direct reports to attend an introductory course in TQM. Hiring a customer service representative.

Convening and chairing Quality Council Search explanation

According to the ACHE's Ethical Policy Statement in Creating an Ethical Environment for Employees, the organization should: Ensure maximum utilization of an employee's skills and abilities. Create a working environment that provides freedom from coercion. Develop a committee that addresses employee diversity and compliance. Provide sensitivity training to new employees at orientation.

Create a working environment that provides freedom from coercion. Healthcare executives have ethical and professional obligations to the employees they manage that encompass but are not limited to: Creating a work environment that promotes ethical conduct; Providing a work environment that encourages a free expression of ethical concerns and provides mechanisms for discussing and addressing such concerns; Promoting a healthy work environment which includes freedom from harassment, sexual and other, and coercion of any kind, especially to perform illegal or unethical acts; Promoting a culture of inclusivity that seeks to prevent discrimination on the basis of race, ethnicity, religion, gender, sexual orientation, age or disability; Providing a work environment that promotes the proper use of employees' knowledge and skills; and Providing a safe and healthy work environment.

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

Critical Pathways: A document that focuses on efficiency and describes a standard set of activities to be performed for a defined category of patients. Clinical pathways, also known as care pathways, critical pathways, integrated care pathways, or care maps, are one of the main tools used to manage the quality in healthcare concerning the standardization of care processes. Choice C= Functions protocols. key words are standardize clinical activities. B= key words are "consistent provision of appropriate clinical practice"=Patient management guidelines. Alternatives that can be mixed up: Choice B describes patient management guidelines (Systematically developed statements to assist practitioner and patient decisions on the appropriate healthcare for specific clinical circumstances.) 1. Protocols= consensus statements on the right act in a given set of circumstances. They are used to integrate the caregiver's diagnoses with the patient's plan-of-care goals and the specific actions of the treatment. 2. Functional Protocols= how procedures or sets of activities should be carried out elements of care; contribute to patient safety by eliminating unnecessary or inappropriate procedures. Functional protocols ensure quality and safety by standardizing care processes 3. Patient management protocols= Guide care of similar patients; define the normal steps or processes in the care of clinically related group of patients at a specific institution. They specify the functional components of care, outcomes quality goals, and the cost. They are communicated among caregivers, thereby increasing efficiency and reducing the chance of error.

You have been assigned to develop a marketing strategy for your organization. The most important issue to consider is that the marketing strategy be: Broad-based. Customer-centered. Accessible on the Internet. Short-term oriented.

Customer-centered. The purpose of marketing and its strategy is to identify, evaluate, and respond to changes in stakeholder needs

The reimbursement method that was first adopted by Medicare and later by most third party payers is known as: ICD-9. RBRVS. RUG. DRG.

DRG DRG= Prospective so provides risks and incentives to control costs. Resource Utilization Groups=RUGs are mutually exclusive categories that reflect levels of resource need in long-term care settings (nursing homes) to facilitate Medicaid & Medicare payment

Information systems management security is concerned with the policies and procedures for ensuring the security of: Data. Software. Hardware. Firmware.

Data

One feature that distinguishes nonintegrated healthcare organizations from integrated organizations is a: Regional community vision. Widely accepted brand identity. Seamless continuum of care. Define market image.

Define market image.

What are the three basic categories of quantitative performance measures used in conventional accounting systems? Market share, customer satisfaction, and quality. Demand, sales, and cost. Demand, cost, and output/productivity. Services rendered, market share, and access.

Demand, cost, and output/productivity.

Demand-based Assessment

Demand-based Assessment : Workforce planning strategy that studies utilization. In healthcare, demand and supply are not balanced because price is not easily determined by supplier or the purchaser. So utilization is the best indicator of demand for services

The primary stimuli that causes educational programs to be made available to and required of staff are the: Legal demands resulting from medical malpractice. Regulations issued by governments at all levels. Demands and expectations of stakeholders. Increasingly stringent expectations of consumers.

Demands and expectations of stakeholders.

An organization's long-term competitive position is substantially dependent on its credit rating. Which of the following is a direct benefit of an excellent credit rating? Increased market share. Improved quality of clinical care. Improved cost of capital. Increase in community rating.

Improved cost of capital.

Which technique would provide the most beneficial information to a healthcare organization about customer satisfaction? Direct mail surveys. Mall intercepts. Focus groups. Competitor analyses.

Direct Mail surveys

The internal rate of return measures the: Number of years to recover the original investment. Discounted future cash flows. Discount rate at which the net present value is zero. Discount rate that the firm uses in computing the cost of capital.

Discount rate at which the net present value is zero. IRR is the minimum return needed to break even on an investment. NPV equaling zero means capital expenditure is generating discounted cash flows just sufficient to repay the original investment (C) Choice A describes payback period, the number of years needed for cash flows to recover the original investment.

The principal goal of a Health Service Organization's medical/hospital model is Security. Disease treatment. Quality of life. Comfort.

Disease Treatment

Which of the following is an Example of direct costs? Utility bills. Parking operations. Dept service. Drug prescriptions.

Drug prescriptions. Direct Costs are a measure of departmental performance. Direct cost are costs that can be traced back to a department. Drug prescriptions can be traced to pharmacy.

This act requires that all organizations that are getting federal grants must certify that they are providing drug-free work environment

Drug-free Workplace Act of 1988

The primary purpose of generally accepted accounting principles (GAAP) in healthcare settings is to: Provide regulators with increased access to high quality financial statements of organizations within their jurisdiction. Ensure that financial information that is reported to outsiders is consistent across businesses and presented in a manner that facilitates interpretation and judgments. Allow interested individuals a rapid means of collecting financial data about hospitals and managed care organizations. Facilitate the training of accountants and other finance professionals in the fundamentals of hospital and health services accounting.

Ensure that financial information that is reported to outsiders is consistent across businesses and presented in a manner that facilitates interpretation and judgments.

Who is exempt from protection from the Polygraph Protection ACt?

Exemptions for Polygraph Protections ACT: 1. Federal contractors (national security agent, FBI) 2. Employees suspected of involvement resulting in economic loss to employer 3. Prospective employees engaged in dispensing of controlled substances.

The only law that mandates a particular type of payment for time not worked. FMLA EMTALA ADA CMS

FMLA= correct answer *** Part-time worker & Elected officials are not eligible for FMLA The Family and Medical Leave Act of 1993 (FMLA) is a United States federal law requiring covered employers to provide employees job-protected and unpaid leave for qualified medical and family reasons. Qualified medical and family reasons include: personal or family illness, family military leave, pregnancy, adoption, or the foster care placement of a child.

Which of the following combines data from a balance sheet and an income statement to create a single number that facilitates easy interpretation? Financial ratio analysis. Acid test ratio. Operating margin ratio. Cash flow analysis.

Financial ratio analysis. Acid Test= stringent test that indicates whether a firm has enough short-term assets to cover its immediate liabilities without selling inventory. Operating Margin Ratio= A ratio used to measure a company's pricing strategy and operating efficiency. Cash Flow Analysis =a type of financial analysis that compares the timing and amount of cash inflows with the timing and amount of cash outflows. A firm's cash flow position can greatly affect its ability to remain in business. These effects may not be apparent from a cost-benefit analysis.

The Statement of Cash Flows is typically organized into three sections: Cash Flow From Operations; Cash Flow From Investing Activities; and Cash Flow From: Bad Debt Recovery. Regulatory Recapture. Financing Activities. Donations & Foundation Support.

Financing Activities

When discharging a patient from a hospital, the institution can be held liable: For providing post-discharge medications for ongoing care. If the patient uses public transportation after discharge and is involved in an accident resulting in injuries. For abandoning the patient if the patient is in need of further medical care. When patients are transferred to a less costly setting where adequate care can be provided

For abandoning the patient if the patient is in need of further medical care.

When a specialist within the organization provides a directive or states an opinion, there is recognition of that individual as an expert in the field. This is an Example of what type of authority? Positional. Functional. Personal. Charismatic.

Functional. Organizational authority has three important underlying principles: Authority is based on the organizational position, and anyone in the same position has the same authority. Authority is accepted by subordinates. Subordinates comply because they believe that managers have a legitimate right to issue orders. Authority flows down the vertical hierarchy. Positions at the top of the hierarchy are vested with more formal authority than are positions at the bottom. Three types of Authority are: 1. Line Authority, Staff Authority, & Functional Authority. 1: Line Authority: It is the power to give orders to subordinates. Line managers are responsible for attaining the organizational goals as efficiently as possible. Production and sales managers typically exercise line authority 2: Staff Authority: Power to give advice, support, and service to line departments. Staff managers do not command others. Examples of staff authority are found in personnel, purchasing, engineering, and finance. 3: Functional Authority: Staff's ability to initiate actions within a given area of expertise. Functional Authority allows decisions to be implemented directly by the staff. In an organization functional authority can be found in accounting, labor etc areas.

Which of the following would be a discrete measure in continuous improvement? Gender. Weight. Height. Temperature.

Gender...

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

Hospitals and insurers.

The five major functions of marketing are: Identifying markets, promoting the organization, recruitment of providers, managing external relationships, patient selection. Identifying markets, health promotion, managing external relationships, patient selection, attracting capable workers. Identifying markets, promoting the organization, managing external relationship, convincing patients to select the organization, attracting capable workers. Identifying markets, promoting the organization, managing external relationships, strategic planning, physician recruitment.

Identifying markets, promoting the organization, managing external relationship, convincing patients to select the organization, attracting capable workers. White Book" 6 Marketing functions= attracting associates, managing stakeholder relationship, influencing potential customers, developing brand and media relationships, identifying customers & markets, and listening to stakeholder needs.

Where should charity care be shown in a healthcare organization's financial statement? In the balance sheet. In the statement of operations. In the statement of changes in net assets. In the notes to the financial statements.

In the notes to the financial statements.

Which statement about short-term debt reduces liquidity? Increased use of short-term debt reduces liquidity Short-term debt provides greater certainty about interest costs over time The interest rates for short-term debt are typically higher than interest rates for long-term debt. An organization that relies on short-term debt replaces the need for working capital.

Increased use of short term debt reduce liquidity

Healthcare organizations require the filing of annual disclosure statements on the part of board members and officers. This policy is intended to address: Inurement. Theft. Exploitation. Incompetence.

Inurement

The point-of-service product is the fastest growing managed care product in the contemporary marketplace because:? It allows consumers to place a direct value on how important provider choice is to them. The product is less costly for Managed Care Organizations (MCOs), employers, and employees. Managed Care Organization (MCO) utilization management systems are so well developed that they can affod to let people go out of the network without any increase in costs. Primary care physicians prefer to have their patients seek specialty care without referrals.

It allows consumers to place a direct value on how important provider choice is to them.

In general, it is believed that when preliminary research findings show that an experimental therapy is effective, the experimental therapy should be provided to the control group because: That is part of the standard contract for all research protocols. It is unethical to deny someone potentially beneficial therapies. The Nuremberg Code, widely used in the United States, requires it. Researchers have an unwritten code that makes it mandatory.

It is unethical to deny someone potentially beneficial therapies.

The primary function of an extended-care unit is to provide: Post-acute care services in a rehabilitation-oriented environment. Self-care facilities for ambulatory patients. Additional facilities for geriatric cases. More intensive nursing care for chronically ill patients.

Post-acute care services in a rehabilitation-oriented environment

Which of the following techniques would play a central role in an organization being able to demonstrate equal employment compliance? Job questionnaires. EEOC postings in the human resource department. A job analysis procedure. An established complaint process.

Job analysis= correct answer EEOC postings in the human resource department.= not correct answer. "Simply having set of policies is not a substantial defense (Fried-source)" A healthcare organization's best defense against lawsuits is creating and following a set of policies that are nondiscriminatory in nature which includes disseminating organizational policies. Job Analysis helps employees to meet their legal duties under the equal employment opportunity law. Employment decisions that involve either job applicants or employees and that have vague and non-job related criteria are being challenged successfully. Job analysis is surrounded by legal constraints because it serves a basis for selection decisions, compensation, performance appraisals and training.

An analysis of proposed capital investment typically includes all of the following except: Cost of capital Cash flow projections Liquidity ratio. Risk assessment.

Liquidity ratio.... BOG Reference Manual: " Inputs required to determine the rate of return on capital investment decisions include: 1) Cash Flows 2) Economic life 3) Discount rate (cost of capital) 4) Impact of taxations and/or cost-based reimbursement

The critical link that brings patients and providers together is: Marketing. Advertising. Strategic planning. External analysis.

Marketing

According to the ACHE's Code of Ethics, one way that healthcare executives can avoid or minimize the negative implications of conflict of interest is to: A.Develop a public relations plan to address potential conflict-of-interest scenarios. B. Not participate in the specific decision where conflict may exist. C. Ensure members submit annual lists of major activities and holdings for inspections. D.Make the conflict known to those in superior positions.

Make the conflict known to those in superior positions....D is the only one that is stated in the ACHE code of ethics. B& C are correct but not stated in ACHE code of ethics. ACHE Code of Ethics= "Disclose financial and other conflicts of interest"

The volume that would be realized if each prospective consumer were to purchase a specified amount of a particular service during a defined future time frame is called: A sales forecast. A market forecast. Operational capacity. Market potential.

Market potential....Correct The key words are "Volume" & Future time frame. The market size is defined through the market volume and the market potential. The market volume exhibits the totality of all realized sales volume of a special market. The volume is dependent on the quantity of consumers and their demand. Market potential defines the upper limit of the total demand for a product and takes potential clients into consideration. Market potential is measured by sales volume or sale price. Market Forecast=projects the future numbers, characteristics, and trends in your target market.

The Capital Asset Pricing Model (CAPM), an equilibrium model, describes the relationship between which of the following? Market risk and required rate of return. Expected rate of return and actual rate of return. Price and market risk. Expected rate of return and required rate of return.

Market risk and required rate of return.= correct The CAPM is a model for pricing an individual security or portfolio. It used to determine a theoretically appropriate required rate of return of an asset

One reason healthcare entities should document their credentialing procedures is to: Meet federal compliance mandates. Maximize medical staff understanding of the process. Minimize inconsistency and liability. Assist with practitioner auditing.

Minimize inconsistency and liability.

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

Provide for standard data elements and code sets.

Governance challenges faced by fully integrated healthcare delivery systems are more complex than those faced by nonasset merged multi- hospital systems because: The components of integrated systems function in a highly interdependent manner. Multi-hospital systems usually have been in existence for a long time. Multi-hospital systems often have an independent governance structure. Boards of multi-hospital systems have a different board selection process.

Multi-hospital systems usually have been in existence for a long time.

Which concept of profitability analysis listed below is correct? Internal Rate of Return (IRR) measures a project's percentage of cash flow. Net Present Value (NPV) is a profitability measure that uses discounted cash flow. Modified Internal Rate of Return (MIRR) is a less accurate measure than a project's actual rate of return. Profitability Return Rate (PRR) provides the most accurate measure.

Net Present Value (NPV) is a profitability measure that uses discounted cash flow.

On a balance sheet, what does the difference between total current assets and total current liabilities indicate? Cash on hand. Net working capital. Liquid assets. Equity.

Net Working Capital The variables of the net working capital formula are the same as those used in the current ratio. The current ratio formula instead divides current assets by current liabilities.

Which of the following is an output-related performance measure? Provider productivity. Board satisfaction. Customer loyalty index. Paid nursing hours.

Provider productivity. need to think about definition of productivity

Large gifts to not-for-profit (tax-exempt) health services organizations do not suggest a conflict of interest, whereas a large gift to a manager of such an organization is likely to be ethically unacceptable. The difference is that: Managers fail in their duty of loyalty to the organization by accepting gifts. Organizations are ethically neutral entities in the eyes of the public and law. Gifts to the organization benefit both the patients and the general public. No direct individual relationship is established by giving to the organization.

No direct individual relationship is established by giving to the organization.

Managers who use their authority to greatly enhance their salaries, benefits, and accoutrements of office may be causing a disbenefit to patients. This personal aggrandizement is known as self dealing and can: Be seen most commonly in for-profit HMOs. Occur only in for-profit organizations. Occur in any health service organization. Be seen only in non-health services field charities.

Occur in any health service organization

Under generally accepted accounting standards, bad debts are reported as a/an: Operating expense. Deduction from net revenue. Contractual allowance. Deduction from gross revenue.

Operating expense....

Which of the following must be included when determining a capital project's incremental cash flow? Opportunity costs. Cash inflows. Inflation. Internal rate of return.

Opportunity costs. The difference in return between a chosen investment and one that is necessarily passed up.

Which of the following third-party reimbursement methods provides the largest financial incentive for the provider to reduce cost? Charge-based Cost-based Prospective payment Per diem

Prospective payment ...

Under the Emergency Medical Treatment and Active Labor Act (EMTALA): Benefits only those who are uninsured and unable to pay. Originated due to concerns of patient dumping. Excludes women in active labor. Does not require facility to forward medical records to the second facility.

Originated due to concerns of patient dumping.

ACHE's Ethical Policy Statement on Ethical Issues Related to Downsizing recommends that healthcare executives should consider providing which of the following when downsizing? Financial aid. Child care. Family counseling Out-placement assistance

Out-placement assistance Explore and evaluate best practices from similar organizations which could be helpful in designing and implementing a workforce reduction plan; best practices can be identified by conducting a thorough literature review, attending seminars and speaking with colleagues; Develop a workforce reduction plan that effectively describes its rationale, objectives, implementation process, timeline and impact assessment techniques; Support, if possible, through retraining and redeployment, employees whose positions have been eliminated. Also, consider outplacement assistance, appropriate severance policies and continued service through the organization's employee assistance program, if possible; and Address the needs of remaining staff by demonstrating sensitivity to their potential feelings of loss, anger and survivor guilt. Also address their anxiety about the possibility of further reductions and uncertainty regarding changes in workload, work redesign and similar concerns.

Which is the Shewhart process for performance improvement? Plan, check, do, act. Plan, do, check, act. Analyze, formulate, implement, evaluate. Analyze, implement, control, evaluate.

Plan, Do, Check, Act

A manager who seeks input from others prior to making a decision is engaging in which leadership style? Autocratic. Participative. Democratic. Laissez-faire.

Participative. Autocratic leaders make decisions without consulting their team members, even if their input would be useful. This can be appropriate when you need to make decisions quickly, when there's no need for team input, and when team agreement isn't necessary for a successful outcome. However, this style can be demoralizing, and it can lead to high levels of absenteeism and staff turnover. Democratic leaders make the final decisions, but they include team members in the decision-making process. They encourage creativity, and people are often highly engaged in projects and decisions. As a result, team members tend to have high job satisfaction and high productivity. This is not good for quick decision Laissez-faire leaders give their team members a lot of freedom in how they do their work, and how they set their deadlines. They provide support with resources and advice if needed, but otherwise they don't get involved. This autonomy can lead to high job satisfaction, but it can be damaging if team members don't manage their time well, or if they don't have the knowledge, skills, or self motivation to do their work effectively. (Laissez-faire leadership can also occur when managers don't have control over their work and their people.) A charismatic leadership style resembles transformational leadership: both types of leaders inspire and motivate their team members. The difference lies in their intent. Transformational leaders want to transform their teams and organizations, while leaders who rely on charisma often focus on themselves and their own ambitions, and they may not want to change anything. Charismatic leaders might believe that they can do no wrong, even when others warn them about the path that they're on. This feeling of invincibility can severely damage a team or an organization, as was shown in the 2008 financial crisis.

Define Population Based Estimating

Population based estimating: Workforce planning strategy that rests on the presumed appropriate or normative ratios of personnel and professionals to populations. This method is weak because it shows wide variations in ratio points.

What is an important advantage of physician participation in Independent Practice Associations (IPAs) versus other affiliation arrangements with HMOs? IPA arrangements normally pay physicians better than staff or group model arrangements. Physicians participating in IPAs can limit their dependence on any single HMO. IPA arrangements avoid the serious tensions that arise between primary care and specialty physicians. IPAs rarely use utilization management mechanisms like primary care gatekeeping and preadmission certification.

Physicians participating in IPAs can limit their dependence on any single HMO. Open Panel HMO has two types: IPA and Direct Contract Model. Open Panel HMO's participating physicians are not employed by the HMO. Two types of Closed Panel HMO are: Staff Model and Group Model.

The CEO of a 125-bed hospital realizes that her hospital is surrounded by three similar institutions and determines that her institution has no competitive advantage. Which strategy should she pursue? Target many market segments based on demographics. Prioritize market segments and heavily promote to key groups. Advertise broadly to increase general awareness. Recruit more physicians to admit to the institution.

Prioritize market segments and heavily promote to key groups.

Which of the following analyses is used for workforce planning and forecasting? Qualifications inventory analysis. Job analysis. Productivity analysis. Ratio analysis.

Productivity analysis.= Correct Answer. Job Analysis is not correct because it is part of Workforce development. Workforce development is recruitment, selection, training, and diversity & cultural competency. Workforce planning: 1. Develops forecasts of the number of persons required in each skill by year for the next 3-5 years. 2. Includes succession planning for key managerial positions 3. Projects available human resources, including attritions and additions. The workforce plan should be developed from forecasts of activity from the service plan. Service plan is developed from the epidemiological need of the community and long-range financial plan. Forecasting used judgmental methods such as estimates, rules of thumb, Delphi technique, simulations models, regression analysis, staffing ratios, and productivity ratios.

The thrust of antitrust legislation as applied to the healthcare field is to: Contain costs. Contain rising costs of independent single unit hospital. Monitor the scope of health services provided in a given area. Protect the public's economic interest.

Protect the public's economic interest.

5. Consumer "report card" development and distribution has become a high priority for managed care organizations because:? Measurements of performance have now become well established, standardized, and accepted by all parties. Purchasers are pressuring for disclosure of meaningful performance information for use by buyers and consumers. Consumers in healthcare are now well organized, and managed care organizations feel a need to satisfy them. Physicians are increasingly encouraging their patients to evaluate managed care organizations based on these report cards.

Purchasers are pressuring for disclosure of meaningful performance information for use by buyers and consumers

Which of the following is a unit of measure commonly used to determine physicians' clinical productivity? RVU CMS IPO CPU

RVU =relative value units...

According to the ACHE Code of Ethics, what action can the Ethics Committee take against an affiliate after a grievance procedure has been initiated? Fine the affiliate. Report the violation to the affiliate's employer. Issue a written reprimand to the affiliate. Recommend expulsion of the affiliate.

Recommend expulsion of the affiliate. ACHE Ethics Actions The following are possible outcomes of grievance procedures: Determination that the grievance complaint is invalid. Dismissal of the grievance complaint. Consultation: an educational communication with the respondent. Censure: a stern reprimand based on the outcome of the grievance procedure which does not suspend or terminate membership. Suspension of membership, which may be for a specified minimum period of time or may be contingent on specified criteria. Expulsion.

The critical-incidents technique of employee performance appraisal requires raters to: Select statements that fit the performance characteristics of individuals. Select the highest and lowest performing employee in a work unit. Record the degree to which specified behaviors are performed. Record behaviors of employees that are related to both good and poor performance.

Record the degree to which specified behaviors are performed.

A key role for any governing board is: Establishing the budget. Working cooperatively with individual physicians. Representing the community. Recruiting and evaluating the chief executive officer.

Recruiting and evaluating the chief executive officer.

Which of the following balance sheet items would differ between a for-profit and a not-for-profit healthcare organization? Retained earnings. Plant, property, and equipment. Real estate. Investments.

Retained earnings Look up how nonprofit balance sheet differ from for-profits

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

Reviewing organizational costs. Marketing Functions include: 1. Identifying and segment customer & associate markets 2. Listen to stakeholder needs 3. Develop brand and media relations 4. Influence potential customers 5. Attract and motivate associates 6. Manage other stakeholder relationships.

Which one of the following conditions must be met for human subjects to be used in a medical research program? No suitable animal model exists for use instead of people. The research program has been approved by the medical staff. The research program has been approved by the governing authority. Risk should be clearly explained in understandable language to each individual subject.

Risk should be clearly explained in understandable language to each individual subject.

The agency normally responsible for regulation of the financial solvency and subscriber regulations of HMOs is the:? U.S. Department of Health and Human Services. State insurance commission/department. Medicaid agency/department. Department of Taxation.

State insurance commission/department.

What is the first stage in the strategic planning process? Board retreat. Situation analysis Mission statement development. Action planning.

Situational Analysis= Correct Situation analysis refers to a collection of methods that managers use to analyze an organization's internal and external environment to understand the organization's capabilities, customers, and business environment. Situational Analysis is another name for SWOT or Environmental Assessment . Mission Statement Development is too narrow of an answer. Action planning is the last stage of the strategic planning process. Board retreat is not relevant. 4 Stages of the Strategic Planning Process. Stage 1: Environmental Assessment: 1. Organizational review, including mission, values, & philosphy 2. External assessment of the market structure and dynamics 3. Internal assessment of distinctive characteristics 4. Evaluation of competitive position, including advantages & disadvantages. Stage2: Organizational Direction: ➢ Main activity= Develop future strategic profile of the organization by examining alternative futures, mission, vision, values, and key strategies. Stage 3: Strategy Formulation: ➢ Main purpose= determine what future direction is possible and desirable. ➢ Determine the future scope of services and position of the organization. Stage 4: Action Planning: ➢ Activities include resource allocation, schedule planning, setting priorities to ensure implementation of plan

One of the major elements of an information system strategic plan includes the: Request for proposals from vendors Specifications for computer program documentation. Specifications for computer hardware maintenance. Software development plan.

Software development plan.

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

Specific period DRG is one of the types of prospectives payments. Medicare pays a fixed amount for each episode of treatment based on the DRG

Which of the following does not accurately describe patient management guidelines? Patient management guidelines: Are developed and managed by physicians. Include economy, patient satisfaction, and pharmacology. Are the most extensive development in clinical expectations. Specify actions which deliberately constrain doctors' judgments based on individual patients.

Specify actions which deliberately constrain doctors' judgments based on individual patients.

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

Stochastic Modeling.= correct answer A method of financial modeling in which one or more variables within the model are random. Stochastic modeling is for the purpose of estimating the probability of outcomes within a forecast to predict what conditions might be like under different situations. The random variables are usually constrained by historical data, such as past market returns. A Gantt chart is a visual representation of a project schedule. A type of bar chart, a Gantt charts show the start and finish dates of the different required elements of a project. Henry Laurence Gantt, an American mechanical engineer, is recognized for developing the Gantt chart. A PERT chart is a graph that represents all of the tasks necessary to a project's completion, and the order in which they must be completed along with the corresponding time requirements. Monte Carlo Simulations= A problem solving technique used to approximate the probability of certain outcomes by running multiple trial runs, called simulations, using random variables.

Which financial statement is updated daily to reflect changes in assets or composition of financing? The flash report. The balance sheet. The statement of operations. The statement of cash flows

The balance sheet.

The applicability of continuous improvement in healthcare organizations assumes: An upper limit of improvement. The physician's perspective is dominant. An organizational commitment. The elimination of outliers.

The elimination of outliers.

A well-designed grievance system begins with: 1) An emphasis on sanctions. 2) Sound employment policies. 3) Rewards for whistleblowing. 4) Effective employee assistance programs.

The key words are "begins with". Employment policies must be in place before a grievance system can be developed. The correct answer is "b".

Controlling the costs of accounts receivable is heavily affected by: The time or length of the payment cycle. The dollar amount of credit granted to individuals. The total dollar amount of receivables carried on the books. Working capital management.

The time or length of the payment cycle. Accounts receivables is the money due to the organization from patients and third parties for services that the organization has already provided. Revenue cycle management is focused on increasing the cash flow coming into the organization and decreasing the cash flow going out of the organization. Accounts receivables is a liability and an indicator of the organization's efficiency is collection. The length of the payment cycle is affected by the Board's policy on how aggressively to collect and Management's collection procedures. If the payment cycle is short, then the organization is collecting money from patients efficiently.

Training-output Estimate

Training-output Estimate: Most common method for anticipating supply of practitioners for workforce planning. It draws on data from training programs, such number of enrollees, the number of anticipated graduates, and the trends in the application submissions.

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

Trend Analysis. Key word is patterns.

Which of the following is not required for managing strategic adaptation? Development of integrated continuums of care. Development of successful hospital-physician partnerships. Vertical and horizontal integration with out-of-area providers. Programs of strategic leadership development for board members, managers, physicians, and nurse leaders.

Vertical and horizontal integration with out-of-area providers.

The most important responsibility of the CIO in a healthcare organization is: 1) Evaluating computer hardware, software and intra-and interdepartmental communications. 2) Supporting the executive team with effective strategic planning and management information. 3) Developing request for proposals (RFP) for computer software. 4) Supervising systems analysts and computer programmers to ensure that they are meeting the organization's needs.

We are asked for the most important responsibility. As a member of the executive team, the most correct answer is "b".

Which position is included in the NRLB Bargaining rules? Physician independent contractor Nurse supervisors Pharmacists. Certified accountants

pharmacists Most employees in the private sector are covered under the NLRA. The law does not cover government employees, agricultural laborers, independent contractors, and supervisors (with limited exceptions). Exclusions: Confidential employees such as company accountants. employed by Federal, state, or local government employed as agricultural laborers employed in the domestic service of any person or family in a home employed by a parent or spouse employed as an independent contractor employed as a supervisor (supervisors who have been discriminated against for refusing to violate the NLRA may be covered) employed by an employer subject to the Railway Labor Act, such as railroads and airlines employed by any other person who is not an employer as defined in the NLRA