The non-profit advocacy group for pediatric hospitals in the US. National Association of Children’s Hospitals and Related Institutions.
minimally invasive surgery
Use of fiber optics, guide images, microwaves and other technologies to do surgery rather than cutting large sections of tissue.
Ambulatory Surgery Center, normally costs 50% less than an inpatient hospital procedure because they practice line by line billing.
Department of Health and Human Services.
Laparotomy performed with a laparoscope that makes a small incision to examine the abdominal cavity (esp. ovaries and Fallopian tubes).
Inspection of body organs or cavities using a lighted scope that may be inserted through an existing opening or through a small incision.
Method to remove cataracts in which an ultrasonic needle probe breaks up the lens, which is then aspirated.
A minimally invasive operation to repair a damaged joint.
natural orifice surgery
Abdominal surgery where the entrance wound is through either the stomach or through the vagina.
single payer system
Government run healthcare system. Healthcare system is made up of a) cost, b) access and c) quality.
Taking raw materials and processing them until they become a useable good.
evidence based medicine
Used EMR’s to compile statistics to determine the “best practice.”
The % of goods and services used in hospitals that have been negotiated with the GPO’s.
“Standard’ type of health insurance individuals can purchase, provides comprehensive major medical benefits and allows insured individuals to choose any physician or hospital when seeking medical care.
Preferred Provider Organization. A prepaid health insurance plan in which providers agree to deliver services for discount fees; patients can go to any provider, but using nonparticipating providers results in higher costs to the patient. Part of managed care.
Health Maintenance Organization. A prepaid health insurance plan in which patients receive health care from designated providers. Part of managed care.
national insurance costs
The average US family pays $14,000 a year for insurance coverage with 3/4 being paid by the employer and 1/4 being plaid by the employee.
Patient Protection and Affordable Care Act
This is the health care reform law. Focuses on reform of the private health insurance market; providing better coverage for those with pre-existing conditions; improving prescription drug coverage in Medicare.
corporate structure of hospitals
1)Department Heads; 2) Medical Executive Committee; 3) Board.
accountable care organization
A term used in the Patient Protection and Affordable Care Act to define an ideal healthcare organization able to have very low costs caused by successful capitalization on medical goods and services.
A civil law established by following earlier judicial decisions.
Laws enacted by a state or federal legislature that in certain cases can overwrite common law.
A rule issued by the president that has the force of law.
Wrongs against a particular person or organization.
Any wrongdoing for which an action for damages may be brought.
Less resources to recruit, compensate, and develop workforce.
declining supply of workers
Shortage of skilled workers.
increasing population need
Increased volumes of patients and workload for HSO.
external pressure on HSO’s
HR must ensure high performance in HSO.
National Labor Relations Act
1935 law that provides bargaining units and collective bargaining in hospitals and health service organizations.
Fair Labor Standards Act
1938 law regulating minimum wage, overtime pay, and minimum worker ages.
Equal Pay Act
1963 law prohibits discrepancies in pay between men and women.
Civil Rights Act
1964 law that prohibits discrimination based on gender, race, or religion.
Age Discrimination in Employment Act
1967 law that prohibits discrimination of employees 40 years and up.
Occupational Safety and Health Act
1970 law that requires employers to maintain a safe workplace and adhere to standards specific to healthcare employers.
1973 law that protects rights of handicapped.
Employee Retirement Income Security Act
1973 that grants protection to employees for retirement benefits to which they are entitled.
Pregnancy Discrimination Act
1978 law stating that pregnancy is considered a medical condition and prohibits exclusion of pregnancy in benefits and leave policies.
Consolidated Omnibus Budget Reconciliation Act: 1986 law that gives benefits like health coverage for a limited time due to various circumstances like termination, layoff, death, reduction of hours per week, and divorce.
Immigration Reform and Control Act
1986 law that establishes penalties for employees who knowingly hire illegal aliens.
Worker Adjustment and Retraining Notification Act
1986 law that requires employers who will make a mass layoff or plant closing to give 60 days advance notice to affected employees.
Americans with Disabilities Act
1990 law that gives people with disabilities access to public services and requires employers to provide reasonable accommodation for applicants and employees.
Family Medical and Leave Act
1993 law that permits employees in organizations to take up to 12 weeks of unpaid leave each year for family or medical reasons.
Health Insurance Portability and Accountability Act
2003 law that guarantees employees protection from outside access to personal health info and limits employers’ ability to use employee health info under health insurance plans
Ability to critically analyze and solve complex problems.
Expertise or ability to perform a specific work task.
interpersonal/human relation skills
Enables a manager to communicate with and work well with other individuals.
functional organizational structure
Most common organizational structure; pyramid shaped; used in larger organizations; deep vertical structures; strict chain of command ensures that communication and assignment and evaluation of tasks are carried out; used most frequently in HSO’s.
matrix management method
Administrative structure; dual authority system where individuals are assigned to complete specific work tasks; advantages are improved coordination and communication, also increases flexibility of organization to carry out work.
product/service line management
Organized around selected services to control service delivery; Advantages are resource control, accountability, enhanced clinical quality of service.
environment for HSO’s
Entities and influences outside of the organization’s boundaries.
Organizations which are affected by, and also affect, their environment.
Transaction between 2+ organizations where something of value is exchanged and both gain value.
input/output management model
Management acquires inputs, uses inputs to provide services, and creates outputs.
Persons appointed to positions of authority who enable others to do their work effectively, who have responsibility for resource utilization, and who are accountable for work results.
Those that supervise other employees.
Those that carry out work and advise their bosses.
6 management functions
1) Planning; 2) Organizing; 3) Staffing; 4) Controlling; 5) Decision-Making; 6) Directing
Establishing authority and responsibility management.
Acquiring and retaining human resources.
Initiating action in the organization by leading, motivating, and communicating.
Monitoring, adjusting, and improving aggregate performance.
Evaluating alternatives and making choices.
Include core tasks, routine add-ons, and specialty add-ons.
domains of management
1) Self; 2)Team/Work Unit; 3)Organization
Ingrained patterns of shared beliefs, values and behaviors, with associated symbols and rituals, that are acquired over time by members.
Deals directly with the patients such as a hospital, nursing home, physician practice, and assisted living facilities.
Supports the care of individuals through products and services made available to direct care settings. Ex) Consulting firms, associations, pharmaceutical companies, and medical suppliers.
Percentage of expenditures in healthcare that go to pay the workforce.
The most basic/important item in business relationships.
Worst provision for the employee in a contract.
at will contract w/ or w/o restrictive covenant
What is the best deal for employer in a contract?
contract with money/stability and free agency
What is the best deal for you in a contract?
patients and skills
As a physician what are your bargaining tools in a contract?
Restriction on free agency.
Tells us what the whole deal is.
How we’re going to resolve disputes.
maximum notice possible and severance
What provisions are best for you in a termination without cause?
fairness and consistency
What are the 2 key principles in hiring?
Good place to start on how to set up your practice: 1) Executive summary; 2) Mission statement; 3) Ownership/management; 4) Market analysis; 5) Financing; 6) Projected patient base/referral sources; 7) Services; 8) Location; 9) Assets; 10) Operational plan; 11) Human Resources; 12) Marketing
reimbursements for physician services
These must be credentialed!
joint several liability
Risk is that if one person screws up, all in the partnership are liable.
LLP-limited liability partnership
Risk is that liability is limited individually.
What is the most important factor in choosing a location for your practice?
statute of frauds
What says that leases/realty agreements must be in writing?
What is the sales maximum to be eligible for an SBA loan?
What on your record is very bad for credentialing criteria?
audits and penalties
In your insurance, what does regulatory liability cover the costs of?
Protects directors and officers in corporations.
Can unemployment or worker’s comp be waived?
In regards to suppliers and equipment what is most important?
How many years must patient records be kept?
4 philosophies: 1) Avoidance; 2) Reduction of effect–or risks; 3) Transfer; 4) Acceptance.
Main goal = reducing waste reduces risk to practice. Achieve high quality, defect-free medicine.
The worst waste in healthcare.
key LEAN principles
The patient comes first. Care must be of the highest quality. Promote efficiency. ID/remove practice/treatment defects. Maximize business safety. Organize all elements of practice. Eliminate all waste.
less waiting time for patients
What is the most important possible LEAN benefit?
What is the biggest risk in a practice?
Leveled production, no bottlenecks or waste.
The safety element/be watchful for all defects.
5 S theory
How many million people are uninsured?
Focus on design, operations, control and optimization of processes through the aid of systemic efforts.
world class leadership
What is MOST critical to LEAN?
What is everyone’s job in a practice?
Who does arbitration favor?
How many million people are underinsured?
Affordable Health Choices Act
Same as house bill but more emphasis on prevention and wellness.
The Care Triad
Number of thousands of patients who die each year from medical errors.
Hill Burton Act
Instigated after WWII: most community hospitals est. as a result of this act, provided funds for community hospitals.
(#1) CEO, Chief Executive officer, COO, owners, VP’s of finance, marketing.
(#2) Largest category–they lead and follow at the same time, comprised mostly of dept. heads.
first line managers
(#3) Supervisors who organize how will things get done, using resources.
Responsibilities include: planning rather than executing, relations with governing board, external relations, leadership, ceremonial functions.
Responsibilities include: mostly internal and execution, delivers short-term expectations for cost, demand, quality, patient satisfaction, employee satisfaction; link between strategy/performance; can be chief medical officers or chief nursing officers.
(Chief Financial Officer) Responsiblities include: finance, accounting, protections of assets, reimbursement job.
(Chief Information Officer) Responsibilities include: information services and planning, medical records, technology, computers, electronic records.
(Chief Medical Officer) Responsibilities include: medical staff relations, medical education, physician recruitment, top manager that takes care of all staff issues.
(Chief Nursing Officer) Responsibilities include: nursing, staff planning, recruitment, inpatient care, top nurse plans.
Activities that anticipate and prevent problems.
Activities aimed at fixing structural and functional arrangements.
measurement and control systems
Collect data and reward specific behaviors is a way to determine performance.
Belief that the average employee hates work, avoids work and tries to get by with doing as little as possible.
Belief that most employees consider work natural and that most are eager to do the right thing, seek responsibility under the proper conditions, exercise self-control and do not need to be constantly reminded to do their work.
formal authority theory
Originates at the top of the organizational hierarchy and is delegated downward from superiors to subordinates.
acceptance authority theory
Addresses the role of subordinates in managerial authority in bottom up-approach.
Design, Measure, Assess, Improve, Redesign
Fair Labor Standards Act of 1938
Minimum wage, overtime pay and record keeping.
Employee Polygraph Protection Act
Prohibits use of polygraph by most private employers.
Health insurance coverage.
Nursing Relief for Disadvantaged Areas Act
Permits temporary employment of illegal aliens/foreign Registered Nurses.
People left to do their work—minimal amount of supervision—most useful in an organization of professionals.
Process affecting the inner needs or drives that arouse, move, energize, direct, channel and sustain human behavior.
State of mind and emotion affecting the attitudes, feelings, and sentiments of individuals and groups towards their work, environment administration, and colleagues.
Process that checks performance against standards–ensures that performance is consistent with plans and that the organizational and departmental goals and objectives are achieved.
Information on how the system is doing is obtained by the supervisor or the sensor who then monitors the system by comparing the actual results with the desired performance.
Manager initially prepares the 12 month budget as he/she would in a traditional budget—when the first month of the new budget ends the manager projects that month’s budget for the following year and so on.
This budget is prepared with a range of activity levels so that adjustments can be made throughout the year if changes in activity levels occur.
Involves projections for the following year based on current expenditures and the previous annual budget.
Couples with the rolling or flexible budget—the base is treated as though it were already authorized and requires no review—adjustment amounts become the manager’s new budget.
Used by many corporations–ignores the previous years budget–every activity submitted for funding must be justified of each budget item from the ground up.
A legal wrong or an act of omission of acting that results in injury to another.
respondent superior doctrine
The institution–employer–is legally responsible for the negligent or wrongful acts or omission of the employee even though the facility itself is committed no wrong; the negligence of the employee is imputed to, or placed on the employer.
Offer a means to explain and justify actions and service as guides for making moral decisions and thus influence behavior.
National Committee on Vital and Health Statistics
Government agency that has led the development of basic data sets for health records and computer databases.
minimum data set
Purpose is to recommend common data elements to be collected in health records.
Data that are collected on large populations of individuals and stored in databases.
Uniform Hospital Discharge Data Set
The inpatient data set that has been incorporated into federal law and is required for Medicare reporting.
performance improvement programs
Both HEDIS and the Joint Commission’s ORYX program are designed to collect data to be used for:
National Health Information Network
A network of networks.
Health Insurance Portability and Accountability Act of 1996
The federal law that directed the Secretary of Health and Human Services to develop healthcare standards governing electronic data interchange and data security.
Most healthcare information standards have been implemented by:
A critical early step in designing an EHR is to develop a(n) ___ in which the characteristics of each data element are defined.
According to this, ethnicity should be recorded as either: Hispanic, non-Hispanic, or unknown.
reason for encounter
While the focus of inpatient data collection is on the principal diagnosis, the focus of outpatient data collection is on:
MDS Version 2.0
In long term care, the resident’s care plan is based on data collected in the:
Reimbursement for home health services in dependent of data collected from:
Comparison of the performance of health plans.
A standard that allows data to be transferred across the Internet.
harmonization of standards from multiple sources
As many private and public standards groups promulgate health informatics standards, the Office of the National Coordinator of Health Information Technology has been given responsibility for: