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Medicare A

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covers most medically necessary hospital, skilled nursing facility, home health and hospice care. It is free if you have worked and paid Social Security taxes for at least 40 calendar quarters (10 years); you will pay a monthly premium if you have worked and paid taxes for less time.

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Medicare B

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covers most medically necessary doctors' services, preventive care, durable medical equipment, hospital outpatient services, laboratory tests, x-rays, mental health care, and some home health and ambulance services. You pay a monthly premium for this coverage.

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Medicare C

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is the part of Medicare policy that allows private health insurance companies to provide Medicare benefits. These Medicare private health plans, such as HMOs and PPOs, are known as Medicare Advantage plans. If you want, you can choose to get your Medicare coverage through a Medicare Advantage plan instead of Original Medicare.

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Medicare D

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is the part of Medicare that provides outpatient prescription drug coverage. Part D is provided only through private insurance companies that have contracts with the government—it is never provided directly by the government

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SCHIP

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State Childrens Health Insurance program. A pragram created by the federal government to provide a "safety net" and preventive-care level of health coverage for children, funded through a combination of federal and state funds and administered by the states, through Medicaid in conformance with federal requirements.

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POS

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Point of service plan that is an open access plan similar to an HMO that provides limited coverage for self referral outside network

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PPO

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An entity that "acts as a broker btn the purchaser of care and the provider... Consumers have th3 option of using preferred providers within the plan or not

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HMO

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A prepaid organized delivery system where the organization and the primary care physicians assume some financial risk for the care provided to its enrolled members

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DRG

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Diagnosis-related Groups: created by Medicare in 1983 as an attempt to contain health care costs. A hospital receives a set amount of money for a patient with a certain diagnosis.

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Changes in health care that impacted ot

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Title 18 social security act 1965 expanded OT practice for older adults

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Strategic planning process

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The process of establishing and organizational mission and formulating goals, corporate strategy, marketing objectives, marketing strategies and marketing plans. An OT looks towards future, analizes current service delivery environment and understanding their employing organization

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SWOT analysis

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A planning exercise in which managers identify organizational strengths (S) and weaknesses (W) and environmental opportunities (O) and threats (T).

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Mission statement

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A broad description of a firm's objectives and the scope of activities it plans to undertake; attempts to answer two main questions: What type of business is it? What does it need to do to accomplish its goals and objectives?

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Vision statement

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A statement representing what the organization wants to become and where it wants to be in the future.

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Business letter vs business memo

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Business letters are intended for external audiences and memos are for internal audiences

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Netiquette

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A combination of the words "network" and "etiquette" the informal code of Internet conduct.

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Marketing

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An organizational function and a set of processes for creating, communicating, and delivering value to customers and for managing customer relationships in ways that benefit the organization and its stakeholders.

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Indemnity policies

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long-term care policies that specify daily coverage amounts for various kinds of care

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Managed care

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A system of health care that combines delivery and payment; and influences utilization of services, by employing management techniques designed to promote the delivery of cost-effective health care.

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Utilization review

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Audit of health-care use and charges to identify which benefits are used and to make certain that care is necessary and costs are in line

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Least restrictive managed care to most restrictive

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POS- PPO- HMO(INDEPENDENT)- HMO(NETWORK MODEL)- HMO(GROUP)- HMO(STÀFF)

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Trends in occupational therapy

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Increase in school system, decrease in hospital, mental health and increase in private practice

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Top emerging practice areas

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Ergonomics, driver rehab, design and home modification, low vision services, assistive devices, wellness,welfare to work

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Future trends in OT

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Baby boomers, increase in chronic conditions, military personnel,

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Management

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Achieving the goals of an organization through planning, organizing, leading, and controlling organizational resources including people, money and time.

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Supervision

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-active process of directing, guiding, and influencing the outcome of an individual's performance of an activity

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Leadership

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Ability of an individual to influence a group or another individual toward the achievement of goals and results.

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4 functions of a manager

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Planning- goals and deadlines Organizing- charts, developing and managing patterns of coordination Directing- instruction, guidance, standards, policy, procedure, mentoring and coaching

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Requisite managerial authority

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The level of control and discretion,that a manager must have to fairly held responsible for th3 outcome of work groups

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Strategic planning

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APURPOSE, ASPIRÀTION, GOALS AND ACTIVITIES A managerial decision process that matches an organization's resources and capabilities to its market opportunities for long-term growth and survival.

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dual pyràmid

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refers to two lines of authority in a medical institution?

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Product line

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Personnel ar3 organized according to the service they provide rather than function

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Communication

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Dual-P--- Is facilitated Product L-- between disciplines harder

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Planning

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Dual P-- professional development and clinical supervision is facilitated, program planning harder Product L-- program planning facilitated but planning functions with in disciplines is harder

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Budgeting

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Dual P-- within disciplines tracking and planning costs facilitated Hard for interdisciplinary Product L-- opposite

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Staffing

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Dual P-- need to communicate with other managers is harder Product L-- coverage is harder for vacancies and leaves

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CQI, program evàl and outcomes

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Dual P-- discipline specific processes is easier Product L-- discipline specific elements requir3 extra effort

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Professional development

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Dual P-- development of discipline specific skills related to assessments and interventions is facilatated by ease of access Product L-- Dev. Of interdisciplinary skills related to the needs of population or program development

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OT staffing related activities

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Human resource planning Recruitment Hiring Orientation Training and development Separation

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Top down approach

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Management style in which decisions are made in the upper levels without the input and participation of staff from throughout the organization

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Key concepts in strategic planning

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Mission Vision Stakeholder participation Environmental analysis Swot analysis Identification of possible scenarios Prioritize and selection of strategic goals Determination of eval criteria

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Linking strategic planning to evidence based planning

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Str. Planning needs to ensure that decisions and outcomes are based on considerations of all available data

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Environmental and SWOT analysis

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Internal and external factors

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Environmental assessments

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"Evaluation of all forces and changes affecting the organization's ability to conduct business effectively within the market".

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Marketing2

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Activity for creating, communicating, delivering, and exchanging offerings that benefit the organization, its stakeholders and society at large

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Marketing research

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Analyzing markets to determine challenges and opportunities, and finding the information needed to make good decisions.

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Organizational assessment

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":An organizations' evaluation of its effectiveness relative to the client population, the community,and the health care system"

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Outcome marketing

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The use of evidence-based service or product outcomes to promote the results of processes or efforts.

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Packaging

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"The way in which a product is presented and delivered to the consumer. Colour, shape, size and different materials will generally be used to help market the product."

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People

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Internal and external to a business who are responsible for every element of implementing the marketing strategies

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Place

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Physical or virtual location where a service is obtained or a product is purchased

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Positioning

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Communication of the ways a service or product is a better value than similar services or products in the marketplace

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Price

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Money charged

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Product

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Anything used or consumed to satisfy a markets need or want

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Promotion

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Methods of communicating w customers about services and products

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Marketing mix

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A unique blend of product, place, promotion, and pricing strategies designed to produce mutually satisfying exchanges with a target market.

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Additional 3 P's

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Positioning, packaging and people

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Marketing management

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The art and science of choosing target markets and getting, keeping, and growing customers through creating, delivering, and communicating superior customer value.

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Classic purchase model

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Awareness, consideration and purchase

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4 steps in marketing management

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Analysis, planning, implementation and monitoring

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2 analytic approaches to marketing analysis

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Organizational and environmental assessments

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Orgànizational

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Addresses the internal and external SWOT factors within the organization

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Environmental

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Evaluates the forces and çhanges outside of organization and relationship between the organization and the target market

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Planning in marketing management

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Company description Mission statement Target market description Description of products and services offered ID competition Objectives Strategies Action plan

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Implementation

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Organized process of carrying out plan. Identify people and experience ID short and long term goals ID budget Select marketing mix Create timeline

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Monitoring

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Are you using evidence based approaches? When was last time market plan changed? Do you have clear and specific goals? Is budget right? Are your internal, external and DR refe4al programs working together? How do you measure response and return on investment? Does marketing message highlight advantages or uniqueness

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Marketing success

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Is dependent on 2 elements... 1- Reaching your specific marketing goals, which include sound financial or reimbursement models 2- pursuing service or practice growth opportunities

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Kotler's marketing success 4 basic growth opportunity frameworks

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1- selling more current products to current customers 2- selling new products to current customers 3- selling more current products to new customers 4- selling new products to new customers

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Marketing for occupational therapy services and products

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Outcome marketing which is the use of evidence based service or product outcomes or measurements to promote the results of processes or efforts

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Conflict resolution

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Reduction or resolution of a conflict.

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Collectivistic culture

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A culture that focuses on ensuring that group needs are met

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Conflict

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A struggle of opposing forces

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Emotional intelligence

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The ability to perceive, understand, manage, and use emotions wisely

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Individualistic culture

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Focuses on the self as an autonomous individual; successful pursuit of individual goals is valued.

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Negotiation

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A process in which parties attempt to settle their dispute informally, with or without attorneys to represent them.

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2 core principles of conflict resolution

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Negotiation Focusing on mutually beneficial goals

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Individualistic western cultures

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norm of speaking directly is honored, a more contentious approach

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Collectivistic eastern culture

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minimizing confrontation, values the maintenance of positive workplace relationships by minimizing conflict

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Strategies for conflict resolution

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1- active communication 2- use "I" statements 3- authentic listening 4- mutual problem solving 5- win-win resolutions 6- remain positive 7- control emotions 8- respond to ideas not person 9- aim for resolution 10- one topic at a time 11- observe non verbal communication

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