Acute Care Facilities Flashcards Preview

Managing Healthcare Provider Org. > Acute Care Facilities > Flashcards

Flashcards in Acute Care Facilities Deck (40):
1

Number of Registered Hospitals

5,600+

2

Vertical vs. Horizontal Integration

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

3

Levels of Care

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

4

Community Hospital

Open to the general public and Non-federal

5

For Profit vs. Not For Profit

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

6

Specialty Hospital

Any facility that is restricted in admissions

7

ALOS

Average Length Of Stay
- 5.2 days is the national average

8

C Suite

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

9

Job of CEO

Take care of the Board, Community, and Medical Staff

10

Parts of Reimbursement

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

11

Prospective vs. Retrospective

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

12

CPB and Process of it

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

13

CBO

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

14

CAH

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

15

Disproportionate Share Hospital

1. Can qualify for Cost Plus Basis
2. It must treat a higher % of CMS than the national average

16

Recuse

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

17

Fiduciary

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

18

Goal of Board of Directors

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

19

Bylaws

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

20

OIG

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

21

Governance

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

22

Management

1. Ongoing or continual
2. Day to day activities

23

Executive Committee

Chair - Vice chair - CEO

24

CQI

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

25

What does the board want to know?

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 ???

26

Income Statement Facts

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

27

Balance sheet Fact

Tells you the net worth of your company

28

Operating Line of Credit

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

29

Average % profitability

-.7%

30

Advocacy Groups

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

31

Acute Care Definition

The treatment of injury and/or Illness

32

Acute vs. Critical Care

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

33

Triage

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

34

How does the state grade facilities?

It uses Conditions of Participation to grade or grade a Facility

35

Deemed Status

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

36

CMS

Centers For Medicare and Medicaid Services

37

Who Medicare covers and the Parts

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

38

AHCA

American Health Care Association

39

AUPHA

Association for University Programs in Health Administration

40

ACHE

American College of Healthcare Executives