Healthcare
Jamie Phillips, FACHE
Vice President, Operations
Nationwide Children’s Hospital
Highlights
 Healthcare
• 24 questions for 14% of exam
• 8 knowledge areas
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
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
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
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
Healthcare
Traditional healthcare delivery system is a
“sickness system”
• Focused on clinical interventions
• Treated patients after they presented to the
healthcare system
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.
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
Healthcare
Understand the continuum of care:
• Acute
• Curative care
• Long-term rehabilitative/custodial care
• Palliative care
• Outpatient/ambulatory
• Inpatient/institutional
Healthcare
Settings of outpatient care
•
home
•
physician offices
•
clinic-based settings
•
outpatient departments of a hospital
•
emergency departments of a hospital
Healthcare
Implications of types of inpatient care
• Service complexity
• Specialization
• Medical staff membership
• Ownership
• Breadths of ancillary services
• Level of acuity
Healthcare
Alternatives site of care
• Satellite facilities
• Joint venture partnerships with physicians
• Freestanding facilities
• Sub acute care
• Post-acute care
Healthcare
Horizontal vs. vertical integration
Vertical – expanding services up and down the
continuum of care
Horizontal – increasing and integrating points
of care
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?
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.
Healthcare
Ready for some test questions?
Healthcare
Test Questions
An efficient Formulary and Therapeutics Committee in many
hospitals evaluates all of the following except?
1.
2.
3.
4.
Symptoms of adverse reactions.
Patients’ current medication effectiveness.
Contraindications.
Specific drugs in terms of appropriateness to caseload.
Healthcare
Test Questions
Which of the following would represent the most common
cause of adverse drug events?
1.
2.
3.
4.
Lack of standardization.
Lack of knowledge of drug.
Preparation errors.
Transcription errors.
Healthcare
Test Questions
Participating providers in the federal Medicare program must:
1.
2.
3.
4.
Be accredited by the Joint Commission.
Serve Medicaid beneficiaries.
Meet the Conditions of Participation.
Be in compliance with state Certificate of Need laws.
Healthcare
Test Questions
Which physician organization is responsible for accrediting
residency training programs?
1.
2.
3.
4.
ACGME
AAMC
CAT
BPQA
Healthcare
Test 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?
1.
2.
3.
4.
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.
Healthcare
Test Questions
Communication Health Intranet Networks (CHIN’s) were
developed for what purpose?
1.
2.
3.
4.
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.
Healthcare
Test 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?
1.
2.
3.
4.
African American.
Asian.
Latino.
White.
Healthcare
Test Questions
Which of the following limitations would cause a hospital OB
unit to see no change in volume over a four year period?
1.
2.
3.
4.
Organizational.
Market.
Financial.
Clinical.
Healthcare
Test Questions
The overall goal of the HIPAA Act of 1996 is:
1.
2.
3.
4.
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.
Healthcare
Test Questions
The four important aspects of clinical support services are
technical quality, patient satisfaction, continuity of
integration and:
1.
2.
3.
4.
Cost-benefit analysis.
Outcome.
Appropriateness.
Health promotion.
Healthcare
Test Questions
Medicare Conditions of Participation for hospitals require that
a prescribing practitioner authenticate a verbal order
within ____, if not defined by the state.
1.
2.
3.
4.
24 hours.
48 hours.
7 days.
30 days.
Healthcare
Test Questions
What is true about the relationship between acute care
hospitals and long-term care organizations?
1.
2.
3.
4.
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.
Healthcare
Test Questions
Under HIPAA, Congress required the Secretary of HHS to
adopt standards to:
1.
2.
3.
4.
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.
Healthcare
Test Questions
The principle goal of a Health Services Organization’s
medical /hospital model is:
1.
2.
3.
4.
Security.
Disease treatment.
Quality of life.
Comfort.
Healthcare
Test Questions
Which of the following regulations exempted self-funded
employer-sponsored health insurance plans from state
insurance regulations?
1.
2.
3.
4.
BBA.
TEFRA.
COBRA.
ERISA.
Healthcare
Test Questions
The single most important way patients can help prevent
medical errors from affecting them is to:
1.
2.
3.
4.
Interact with their caregivers.
Research medical error rates among organizations.
Read and understand consent forms.
Chose large, reputable healthcare providers.
Healthcare
Test Questions
In a hospital setting, a critical pathway is beet described as
1.
2.
3.
4.
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.
Healthcare
Test Questions
Under a capitated payment system, the risk sharing
arrangements involve which parties?
1.
2.
3.
4.
Insurers and patients.
Physicians and purchasers.
Hospitals and patients.
Hospitals and patients.
Management
& Business
Highlights
 Management
• 19 questions for 11% of exam
• 6 knowledge areas
 Business
• 20 questions for 12% of exam
• 7 knowledge areas
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
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
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
Management &
Business
The five management functions:
1. Planning
2. Organizing
3. Controlling
4. Directing
5. Staffing
All are connected by decision making – problem
solving
Management &
Business
Managing vs Leading
Managing –
caretaking
maintaining status quo
transactional
Leading –
visionary
dynamic
transformational
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
Management &
Business
Mintzberg’s research – managerial roles
• Interpersonal
– Figurehead
– influencer
• Informational
– Monitor
– spokesperson
• Decisional
– Entrepreneur
– negotiator
Management &
Business
Managerial competencies
• Conceptual
• Technical managerial/clinical
• Interpersonal/collaborative
• Political
• Commercial
• Governance
• others
Management &
Business
Management’s authority or power
• Legitimate (formal)
• Reward
• Coercive
• Expert
• Referent
Understand the risks and benefits of each
Management &
Business
Leader traits and skills
• Assertive
• Cooperative
• Decisive
• Dependable
• Intelligent
• Conceptually skilled
• Creative
• Persuasive
Management &
Business
Leadership styles (Likert)
• Autocratic
• Benevolent
• Consultative
• Participative/democratic
Management &
Business
Designing Formal Organizations
• Genesis in the planning function
• Authority and responsibility relationships
• Departmentation
• Coordination and relationships of components
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
Management &
Business
“Organization” within an organization
• Formal structure and formal organization
• Informal organization – dynamic behavior and
activity patterns
• Combination of both the formal and the informal
are the actual organization
Management &
Business
Strategic Planning & Operational Planning
• Strategic planning addresses the longer-term
direction and goals selected by the governance
and management
• Operational planning focuses on the direction
and activities of individual units and departments
of the organization. The operational plan must
be coordinated with and is subordinate to the
strategic plan
Management &
Business
Contingency planning
• Anticipating the unknown
• Mitigating the potential negative implications
• Turning the unknowns into economic or
competitive advantages
• External disasters
• Internal disasters
Management &
Business
Managers as Negotiators
• Know the art of negotiating
• Conflict in negotiations
– how resources are to be divided
– resolving psychological dynamics and
satisfying the personal motivation of those
involved
Management &
Business
Resolving Disputes
• Alternative dispute resolution (ADR)
– binding finding and nonbinding arbitration
– mediation
– mini-trials
– neutral fact
• Legal action
Management &
Business
Need more in-depth resources?
Haimann’s Healthcare Management, 7th ed by Rose T. Dunn, FACHE
Healthcare Strategic Planning: Approaches for the 21st Century by Alan M.
Zuckerman, FACHE, FAAHC
Health Service Management: Readings and Commentary, 7th Ed., by
Anthony R. Kovner, Ph.D. and Duncan Neuhaser, Ph.D.
The Leader’s Change Handbook, by Jay A. Conger, Gretchen M.
Spreitzer, and Edward E. Lawler III
Leadership for the Future: Core Competencies in Healthcare, by Austin
Ross, LFACHE; Frederic J. Wenzel and Joseph W. Mitlyng
Managing Health Services Organizations and Systems by Beafort B.
Longest, Jr., Jonathon S. Rakich, and Kurt J. Darr, J.D., Sc.D, FACHE
Mastering the Negotiation Process: A Practical Guide for the Healthcare
Executive, by Christopher L. Laubach
*The Well-Managed Healthcare Organization, 5th Ed, by John R. Griffith
FACHE and Kenneth R. White, Ph.D., FACHE
Management &
Business
Ready for some test questions?
Management & Business
Test Questions
Hospitals pursuing strategic alliances are faced with issues
of vertical integration. One example of vertical
integration is:
1.
2.
3.
4.
Acquiring a long-term care facility.
Creating a “super” physician-hospital organization.
Developing a system of local hospitals.
Outsourcing laboratory services.
Management & Business
Test Questions
The concept of demand management consists of:
1.
2.
3.
4.
Concurrent review.
Risk assessment.
Disease management.
Chart review.
Management & Business
Test Questions
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? (186)
1.
2.
3.
4.
Strategic Planning.
Trend Analysis.
Situational Analysis.
Survey Research.
Management & Business
Test Questions
Which of the following is not an example of a marketing
function?
1.
2.
3.
4.
Promoting the organization.
Convincing patients to select the organization.
Managing external relationships.
Reviewing organizational costs.
Management & Business
Test Questions
The arrival of women for obstetrical deliveries or patient flow
in an emergency department can best be analyzed
through the use of which technique?
1.
2.
3.
4.
Pert Charting.
Stochastic Modeling.
Gant Charting.
Monte Carlo Simulation.
Management & Business
Test Questions
All of the following are essential components of strategic
planning except:
1.
2.
3.
4.
The corporate mission statement.
Timetables for activity completion.
Competitive analysis.
Assessment of the external environment.
Management & Business
Test Questions
Operational planning can be correctly defined as:
1.
2.
3.
4.
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.
Management & Business
Test Questions
Which of the following statements best defines increased
productivity?
1. 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.
2. An increase in productivity occurs when an increase
occurs in the volume or number of units of service
rendered.
3. An increase in productivity occurs when a reduction
occurs in the ratio of hours worked to the number of
units of service rendered.
4. An increase in productivity occurs when an increase
occurs in the revenue from a given number of full-time
equivalent employees.
Management & Business
Test Questions
Materials management can best be defined as a system of
effective:
1.
2.
3.
4.
Purchasing of materials at the lowest possible cost.
Distribution of materials on a scheduled basis.
Allocation of materials.
Control of inventories.
Management & Business
Test Questions
Before submission of the annual business plan to the
governing authority, the plan should be developed by:
1.
2.
3.
4.
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.
Management & Business
Test Questions
From a marketing viewpoint, the development of the
standards of practice, clinical pathways, clinical
guidelines and protocols can all be viewed as efforts to
deal with which unique aspect of delivering services:
1.
2.
3.
4.
Inseparability.
Intangibility.
Heterogeneity.
Perishability.
Management & Business
Test Questions
The master site plan (or master facility plan) for a healthcare
organization:
1. Describes future facility needs (either renovation or new
construction) necessary to meet strategic and
operational needs.
2. Provides detailed design documents for all construction
programs along with specific costs for each project.
3. Must be prepared by an outside planning or architectural
firm to ensure sufficient objectivity.
4. Is necessary to ensure that the organization complies
with certificate of need and other regulatory
requirements.
Management & Business
Test Questions
A master patient index (MPI) can best be described as:
1.
2.
3.
4.
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.
Management & Business
Test Questions
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:
1.
2.
3.
4.
A run chart.
A frequency table.
Pareto analysis.
Deming cycle.
Management & Business
Test Questions
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
Management & Business
Test Questions
• To guard against the loss of assets, an administrator
should do which of the following?
a. Encourage off-site storage of equipment
b. Allow service directors to determine the frequency of
asset inventories
c. Implement detailed procedures, risk control and annual
outside audits
Management & Business
Test Questions
• 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:
a.Specific nursing unit or specialty area
b.Specific period
c.Common geographic market
d.Specific facility
Management & Business
Test Questions
What is the first effect of demographic trends on a health
service organization’s strategic planning process?
1.
2.
3.
4.
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.