Healthcare

1. Healthcare Jamie Phillips, FACHE Vice President, Operations Nationwide Children’s Hospital

2. Highlights • Healthcare • 24 questions for 14% of exam • 8 knowledge areas

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

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

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

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

7. Healthcare Traditional healthcare delivery system is a “sickness system” • Focused on clinical interventions • Treated patients after they presented to the healthcare system

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

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

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

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

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

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

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

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

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

17. Healthcare Ready for some test questions?

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

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

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

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

22. HealthcareTest Questions According to CMS Conditions of Participation, under what circumstances, if any, is it permissible to deny a patient access to his/her medical record? • The information requested consists of psychotherapy notes. • The request comes from the 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/her records.

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

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

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

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

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

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

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

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

31. HealthcareTest Questions The principle goal of a Health Services Organization’s medical /hospital model is: • Security. • Disease treatment. • Quality of life. • Comfort.

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

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

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

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

36. Management & Business

37. Highlights • Management • 19 questions for 11% of exam • 6 knowledge areas • Business • 20 questions for 12% of exam • 7 knowledge areas

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

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

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

41. Management & Business The five management functions: • Planning • Organizing • Controlling • Directing • Staffing All are connected by decision making – problem solving

42. Management & Business Managing vs Leading Managing – caretaking maintaining status quo transactional Leading – visionary dynamic transformational

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

44. Management & Business Mintzberg’s research – managerial roles • Interpersonal • Figurehead • influencer • Informational • Monitor • spokesperson • Decisional • Entrepreneur • negotiator

45. Management & Business Managerial competencies • Conceptual • Technical managerial/clinical • Interpersonal/collaborative • Political • Commercial • Governance • others

46. Management & Business Management’s authority or power • Legitimate (formal) • Reward • Coercive • Expert • Referent Understand the risks and benefits of each

47. Management & Business Leader traits and skills • Assertive • Cooperative • Decisive • Dependable • Intelligent • Conceptually skilled • Creative • Persuasive

48. Management & Business Leadership styles (Likert) • Autocratic • Benevolent • Consultative • Participative/democratic

49. Management & Business Designing Formal Organizations • Genesis in the planning function • Authority and responsibility relationships • Departmentation • Coordination and relationships of components

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