Acute Care Facilities

Question 1

Number of Registered Hospitals

Answer 1

5,600+

Question 2

Vertical vs. Horizontal Integration

Answer 2

Vertical
- Hospitals (facilities), INSURANCE, and Physicians
- Multi-hospital expansion can happen
Horizontal
- Hospitals and Physicians
- Multi-hospital expansion can happen

Question 3

Levels of Care

Answer 3

Primary - Doctors office and ER’s
Secondary - Everything between
Tertiary - Highly specialized, one on one care
- (i.e. Intensive Care Unit)
Quaternary - Teaching facilities

Question 4

Community Hospital

Answer 4

Open to the general public and Non-federal

Question 5

For Profit vs. Not For Profit

Answer 5

For Profit (1/3)
- Pay dividends to stockholders
      -The board declares a dividend by separating dividends from RE
Not for Profit (2/3)
- CB (Community Benefits)
- Tax exemption
- Uncompensated care
   □ Charity Care
   □ Difference between Medicaid and Billed charges
	- Retail Price

Question 6

Specialty Hospital

Answer 6

Any facility that is restricted in admissions

Question 7

ALOS

Answer 7

Average Length Of Stay

- 5.2 days is the national average

Question 8

C Suite

Answer 8

CEO
COO
CFO (can either report to the CEO or the COO)
CNO and other Asst.
Clinical and service department

Question 9

Job of CEO

Answer 9

Take care of the Board, Community, and Medical Staff

Question 10

Parts of Reimbursement

Answer 10

CMS 50%
Private/Commercial Insurance 40%
Out of Pocket 10%

Question 11

Prospective vs. Retrospective

Answer 11

Prospective - there are predetermined rates that have already been set such as in CMS
Retrospective - The facility basically gives the insurance company the bill with a list of the charges and it’s either paid in full, part, or none at all

Question 12

CPB and Process of it

Answer 12

Cost Plus Basis

1. Find % of your Expense that was from Medicare
   
   • This includes both operating and Capital expenses
2. File a Cost Report
3. Receive Prospective Interim Payments
   
   • You are prepaid each quarter based on the passed year’s report

Question 13

CBO

Answer 13

Congressional Budget Office

- The committee that determines the funds that you get is the Ways and Means Committee

Question 14

CAH

Answer 14

Critical Access Hospital

1. Certified to receive Cost Plus Basis Medicare payments
   
   • All costs are covered plus at least 1%
2. Must have less than 25 beds and must be rural
3. Must be located at least 35 miles from any other hospitals
4. Can have Swing Beds
   
   • You can use the beds for either short or long term care without penalty

Question 15

Disproportionate Share Hospital

Answer 15

1. Can qualify for Cost Plus Basis

2. It must treat a higher % of CMS than the national average

Question 16

Recuse

Answer 16

To remove yourself from the group due to possible conflict of interest

Question 17

Fiduciary

Answer 17

A fiduciary is responsible for managing the assets of another person, or of a group of people

Question 18

Goal of Board of Directors

Answer 18

1. Declare the mission and vision of the facility
2. Declare Policies and Procedures
   
   • i.e. only qualified physicians can be members of the medical staff

Question 19

Bylaws

Answer 19

A rule made by a company or society to control the actions of its members

Question 20

OIG

Answer 20

The Office of Inspector General

1. There to assure that all laws are fallowed
2. One there for every cabinet position in the government

Question 21

Governance

Answer 21

Governance

1. Episodic
   
   • Can only transact business when in session
2. Must have a Quorum
   
   • A majority or uneven number of people in the group so that they can rule in one direction or another

Question 22

Management

Answer 22

1. Ongoing or continual

2. Day to day activities

Question 23

Executive Committee

Answer 23

Chair - Vice chair - CEO

Question 24

CQI

Answer 24

Continual Quality Improvement. Looks at Quality of Care. Is lead by President of Medical Staff

Question 25

What does the board want to know?

Answer 25

1. If you were profitable 2. Volume of patient services - Total inpatient days - Total outpatient visits - Compare budget to actual to variance 3. Productivity - Productivity = Units of Service ÷ FTE's ???

Question 26

Income Statement Facts

Answer 26

Net Income = Retained Earnings - RE aren't liquid Net income ÷ Net Revenue = Profit Margin

Question 27

Balance sheet Fact

Answer 27

Tells you the net worth of your company

Question 28

Operating Line of Credit

Answer 28

1. Established with local bank 2. You can flex into and out of for short term needs 3. Must be paid off as quickly as possible

Question 29

Average % profitability

Answer 29

-.7%

Question 30

Advocacy Groups

Answer 30

For profit - Federation of American Hospitals (FAH) | Not for Profit - American Hospital Association (AHA)

Question 31

Acute Care Definition

Answer 31

The treatment of injury and/or Illness

Question 32

Acute vs. Critical Care

Answer 32

1. Acute is primary/ secondary | 2. Critical care occurs with anything above secondary care

Question 33

Triage

Answer 33

The assignment of degrees of urgency to an illness or wound that determines the order to treat patients

Question 34

How does the state grade facilities?

Answer 34

It uses Conditions of Participation to grade or grade a Facility

Question 35

Deemed Status

Answer 35

If they have already been approved by the JC then the CMS doesn’t need grade them to

Question 36

CMS

Answer 36

Centers For Medicare and Medicaid Services

Question 37

Who Medicare covers and the Parts

Answer 37

``` 65+ and disabled A - Reimburses acute care hospital inpatients B - Physicians and or outpatient C - Medicare supplemental D - Drugs ```

Question 38

AHCA

Answer 38

American Health Care Association

Question 39

AUPHA

Answer 39

Association for University Programs in Health Administration

Question 40

ACHE

Answer 40

American College of Healthcare Executives