FACHE Board of Governors Exam
Study Group
Knowledge Area: Healthcare
Brian Sweeney, RN, FACHE
Vice President for Clinical and Support Services
Thomas Jefferson University Hospitals
Exam Overview
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Test blueprint – www.ache.org
Section weight on test – 17%
Questions – 34
Description – “This area includes a broad
range of organizations and professions
involved in the delivery of healthcare.
Included are managed care models,
healthcare trends, and ancillary services.”
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Elements of Knowledge
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Healthcare and Medical Terminology
Healthcare Trends
Healthcare Funding and Structures
Services Across Continuum of Care
Levels of Service
Types of Healthcare Providers
Ancillary Services
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Elements of Knowledge
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Support Services
Integration of Healthcare Sectors
Clinician Roles and Criteria
Evidence Based Management
Staff and Functional Role Perspectives
Patient Perspectives
Interrelationship of Access, Quality, and Cost
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Medical Terminology
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Health
• WHO definition – state of complete physical,
mental, and social well-being and not merely the
absence of disease or infirmity
• Blum’s model – 4 inputs: environment, lifestyle,
heredity, and medical care
• Medical model – absence of illness or disease
• Holistic model – spiritual, physical, mental, and
social elements are necessary for well being
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Definitions
• Activities of daily living – eating, bathing,
dressing, toileting, continence, out of bed
• Acute condition – severe, short, treatable
• Chronic condition – exacerbates over time and
may never go away or wax and wane
• Ambulatory care – non-inpatient services
• Continuum of care – longitudinal coordination
across different providers
• Primary care – main provider and referrer
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Definitions
• Population health – outcomes of group of managed
individuals
• Incidence – new cases in time period
• Prevalence – cases at point in time
• ICD-9-CM – classification of morbidity and mortality
• DRG – Medicare classification for reimbursement
• CPT – coding system for procedures
• Shared governance – staff engaged in leading
operations
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Healthcare Trends
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Macroeconomics
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Global recession
18.2% of GDP is healthcare
Baby boomers increasing
Medicare insolvency
Uninsured growing
Employer benefit cost skyrocketing – can’t be
competitive with other nations
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Industry Trends
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Reduction in acute care beds – excess
Declining hospital operating margins
Shift from inpatient to outpatient care
Increased focus on population health
Transformation to pay for performance
Purchasers of services driving changes
Consumers slow to engage
Pricing transparency
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Industry Trends
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Increasing competition
Increasing physician and staff shortages
Deployment of evidence based medicine
Technology changing rapidly
Specialty and niche providers growing
Physician employment
Leading causes of death – heart disease,
stroke, and cancer
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Question
What population factor is currently having the
greatest impact on healthcare organizations?
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b.
c.
d.
Ethnic composition
Economic status
Geographic distribution
Age cohort
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Question
What age group will consume the greatest per
capita healthcare resources in the 21st century?
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b.
c.
d.
75 years and over
65-74 years
45-64 years
0-1 year
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Healthcare Funding and
Structures
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Payers
• Government
– Medicare
• A - hospital
• B – medical/physician office visits
• D – outpatient prescription drugs
– Medicaid – state and CHIP
• Commercial insurance/managed care
• Fee for service/individual
• Employer role
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Managed Care
• Original focus - cost control
– Primary care gate keeper
– Preferred network providers
• Co-payments/deductibles
– Provider risk sharing/incentives
– Provider report cards
• Hospital response - consolidation for leverage
• Consumer response - dissatisfaction
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Managed Care Models
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HMO (Health Maintenance Organization)
PHO (Physician-Hospital Organization)
IPA (Independent Physicians Association)
PPO (Preferred Provider Organization)
POS (Point of Service) Plan
Question
Consumer report card development and distribution has become
a high priority for managed care organizations because:
a. Measurements of performance have now become wellestablished, standardized, and accepted by all parties
b. Purchasers are pressuring for disclosure of meaningful
performance information for use by buyers and consumers
c. Consumers in healthcare are now well-organized, and
managed care organizations feel a need to satisfy them
d. Physicians are increasingly encouraging their patients to
evaluate managed care organizations based on these report
cards
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Question
The agency normally responsible for regulation of
the financial solvency and subscriber regulations of
HMOs is the:
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b.
c.
d.
State insurance commission
U.S. Department of Commerce
U.S. Department of Health and Human Services
Department of Taxation
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Services Across Continuum of Care
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Prevention and Non-Acute Care
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Primary prevention – reduce odds disease develops
Secondary prevention – early diagnosis/treatment
Public health role
Primary care physicians
Federally qualified health centers – targets
medically underserved
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Ambulatory Care
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Physician practices
Multi-specialty centers
Lab
Imaging
Infusion centers
Ambulatory surgery centers (ASC)
Emergency departments
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Acute Care
• The hospital remains the institutional center
of the U.S. healthcare system
• 2 major agencies that count and classify
hospitals:
– AHA (Amer Hosp Assn)
– NCHS (Natl Ctr for Health Stats)
• Hill-Burton Act – 1946: drove growth through
grants and loans
Acute Care
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Community hospitals
Teaching hospitals
Religious-affiliated hospital
Academic medical centers
Specialty hospitals
Critical access hospitals - <25 beds, >35 miles
from other hospital, Medicare pays costs
Hospital Ownership
• Private
– Non-profit
• Community benefit requirements – charity care
• Form 990
• For-profit – investor owned
• Public – federal, state, county
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Post Acute and Sub-acute
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Assisted living
Long term care
Home health
Hospice and palliative care
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Question
Investor-owned healthcare systems are usually distinct from
nonprofit systems because:
a. Investor owned healthcare systems provide no
uncompensated care
b. Members of the medical staff of investor-owned
healthcare systems may use any healthcare facility
owned by the corporation
c. Investor-owned healthcare systems consolidate balance
sheets
d. Local boards have governing authority
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Question
The primary reason for the decision to move
from a freestanding voluntary facility to an
investor-owned healthcare organization is:
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b.
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d.
Economy of scale
Access to the equity market
Access to patients
Improved visibility in the community
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Integration of Healthcare Sectors
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Healthcare Systems
• Organizational models
– Integrated delivery system
– Vertical integration – same services
– Horizontal integration – different services
• Ownership models
– Alliances/networks
– Joint ventures
– Mergers/acquisitions
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Question
Which one of the following characteristics
differentiates an integrated delivery system from
a network or alliance?
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b.
c.
d.
The geographic distribution of its members
The corporate structure
Vertical integration
Horizontal integration
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Question
The principal advantage for an inpatient facility to
affiliate with a geriatric care program is that such an
arrangement:
a. Provides for the continuum of care for patients
b. Permits patients to receive care in the home
settings
c. Requires less skilled personnel to provide care
d. Is less costly to the patient
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Ancillary Services
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Ancillary Services
• Diagnostic
– Lab
– Radiology – ultrasound, MRI, IR
– Cardiac catheterization lab
• Therapeutic
– Anesthesia
- Radiation therapy
– Respiratory
- Social services
– Pharmacy
– Blood bank
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Support Services
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Support Services
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Plant operations
Security
Environmental services
Patient transportation
Nutrition and dietetics
Patient services
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Question
Effective facilities maintenance depends on:
a. Life-cycle planning of equipment
b. An up-to-date inventory of equipment parts for
replacement
c. A periodic update on a preventative
maintenance schedule
d. Maintaining facilities on a preventive schedule
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Question
The method referred to as value analysis is used in
inventory control activities to:
a. Make adequate substitutions for requisitioned items
b. Reduce the quantity of items issued to the various
departments
c. Reduce costs without impairing functional efficiencies
d. Relate quantity and quality of items
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Clinician Roles and Criteria
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Physicians
• Education
– Medical school – MD, DO
– Residency and fellowship
• Credentialing – hospital function (medical staff office)
– Knowledge, skill, ability
– Licensure – State Boards of Medicine
– National practitioner database
• Types
– Primary care
– Specialists – medical/surgical
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Physician Organization
- Have their own medical staff organization
- Focus: clinical quality, patient safety, compliance
- Bylaws, rules, and regs approved by hospital board
- Specific procedures for election of officers
- Officers have authority to enforce rules of physician
members
- Officers delineate privileges of medical staff
- Officers may recommend disciplinary actions
Nurses
• Florence Nightingale – founder of modern nursing
• Educational programs – diploma, associates,
bachelors, masters
• State licensure
• Scope of services
• Magnet designation - ANCC
• Shared governance model
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Other Roles
• Allied health professionals – healthcare
related professions and personnel who assist,
facilitate, and complement the work of
physician
• Physician extenders – NP/PA
– Credentialed
– Under direct supervision of physician
Key Elements of Patient Care
Models
• Nursing – primary/team based
• Multidisciplinary
• Interdisciplinary plan of care (IPOC)
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Question
Planning for a patient’s discharge should begin
at what point in the hospitalization?
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b.
c.
d.
After the physician writes the discharge order
On the day of discharge
On admission
One day after admission
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Question
Your board of trustees has voted to terminate
the privileges of a physician. Which of the
following organizations must you inform?
a.
b.
c.
d.
American Medical Association
Local medical society
National Practitioner Database
The Joint Commission
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Question
Magnet hospital designation includes an
organizational commitment to all of the
following except:
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b.
c.
d.
Professional autonomy over practice
Nursing control over practice environment
Competitive benefits for all nurses
Effective communication between physicians,
administrators, and nurses
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Evidenced Based Management
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Key Elements
• Guide clinical decision making based on know
facts
• Published research
• Best practices
• Benchmarking
• National, state, or professional association
standards
• Health informatics
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References
• Delivering Health Care in America, Second Edition, by Leiyu Shi and
Douglas A. Singh
• Essentials of Managed Health Care, Fourth Edition, 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, Fourth Edition, by Robert M. Sloane, FACHE; Beverly LeBov
Sloane; and Richard K. Harder
• Understanding the U.S. Health Services System, Second Edition, by
Phoebe Lindsey Barton, Ph.D.
• The Well-Managed Healthcare Organization, by John R. Griffith and
Kenneth R. White.
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