Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Leadership > Ch 9 and 10 Terms > Flashcards

Ch 9 and 10 Terms Flashcards

1
Q

Time Management

A

making optimal use of available time

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Volume

A

an amount of something

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Value-based purchasing (VBP)

A

a payment methodology that rewards quality of care through payment incentives and transparency. In VBP, value can be broadly considered to be a function of quality, efficiency, safety, and cos

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Bundled Payment

A

a payment structure in which different health-care providers who are treating a patient for the same or related conditions are paid an overall sum for taking care of that condition rather than being paid for each individual treatment, test, or procedure

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Accountable care organizations (ACOs)

A

groups of providers and suppliers of service who work together to better coordinate care for Medicare patients (does not include Medicare Advantage) across care settings

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Medical Home

A

also called the patient-centered medical home (PCMH); a partnership between the patient, family, and primary provider in cooperation with specialists and support from the community, the medical home relies on a team of providers to integrate all aspects of health care, including physical health, behavioral health, access to community-based social services, and the management of chronic conditions; care is designed around patient needs and aims to improve access to care, increase care coordination, and improve quality while simultaneously reducing costs; integrates all aspects of health care through well-developed health information technology including electronic health records

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Cost Containment

A

controlling expenses within preplanned budgetary constraints

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Cost-effective

A

producing good results for the amount of money spent, such that an item is considered worth the cost; does not necessarily mean inexpensive

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Responsibility Accounting

A

each category of an organization’s revenues—expenses, assets, and liabilities—is someone’s responsibility

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Forecasting

A

looking to the future to anticipate how things will be

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Budget

A

a financial plan that includes estimated expenses as well as income for a period of time

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Controllable expenses

A

expenses that can be controlled or varied

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Noncontrollable expenses

A

expenses that cannot be controlled or varied

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Acuity Index

A

weighted statistical measurement that refers to severity of illness of patients for a given time. Patients are classified according to acuity of illness, usually in one of four categories. The acuity index is determined by taking a total of acuities and then dividing by the number of patients.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Affordable care act

A

officially known as the Patient Protection and Affordable Care Act, this act passed in March 2010 to assure that all Americans have access to affordable health insurance by reducing the barriers to obtaining health coverage as well as accessing needed health-care services.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Assets

A

financial resources that a health-care organization receives, such as accounts receivable

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Case Mix

A

Case mix: type of patients served by an institution. A hospital’s case mix is usually defined in such patient-related variables as acuity levels, diagnosis, personal characteristics, and patterns of treatment.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Cost-Benefit Ratio

A

Cost–benefit ratio: numerical relationship between the value of an activity or procedure in terms of benefits and the value of the activity’s or procedure’s cost. The cost–benefit ratio is expressed as a fraction.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Cost-Center

A

Cost center: smallest functional unit for which cost control and accountability can be assigned. A nursing unit is usually considered a cost center, but there may be other cost centers within a unit

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Diagnosis-related Group

A

Diagnosis-related groups: predetermined payment schedules reflecting historical costs for the treatment of specific patient conditions

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

Direct Costs

A

Direct costs: costs that can be attributed to a specific source, such as medications and treatments; costs that are clearly identifiable with goods or service

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

Free-for-service- system

A

Fee-for-service system: a reimbursement system under which insurance companies retrospectively reimburse health-care providers according to the services provided

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

Fixed budget

A

Fixed budget: style of budgeting that is based on a fixed, annual level of volume, such as number of patient-days or tests performed, to arrive at an annual budget total

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

For profit organization

A

For-profit organization: organization in which the providers of funds have an ownership interest in the organization. These providers own stocks in the for-profit organization and earn dividends based on what is left when the cost of goods and of carrying on the business is subtracted from the amount of money taken in.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

Full time equivalent

A

For-profit organization: organization in which the providers of funds have an ownership interest in the organization. These providers own stocks in the for-profit organization and earn dividends based on what is left when the cost of goods and of carrying on the business is subtracted from the amount of money taken in.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

Health maintenance organization

A

Health maintenance organizations (HMOs): prepaid organizations that provide health care to voluntarily enrolled members in return for a preset amount of money on a per-person, per-month basis; also includes a licensed health plan that places at least some of the providers at risk for medical expenses as well as health plans that use designated (usually primary care) physicians as gatekeepers (although some HMOs do not). Common types of HMOs include staff, independent practice association, group, and network.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

Hours per patient day

A

Hours per patient-day (HPPD): hours of nursing care provided per patient per day by various levels of nursing personnel. HPPD are determined by dividing total production hours by the number of patients.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

International Classification of Disease codes

A

coding used to report the severity and treatment of patient diseases, illnesses, and injuries to determine appropriate reimbursement

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

Indirect costs

A

costs that cannot be directly attributed to a specific area. These are hidden costs and are usually spread among different departments.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

Managed care

A

term used to describe a variety of health-care plans designed to integrate efficiency of care, access, and cost of care

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

Medicaid

A

a federal-state cooperative health insurance plan for the financially indigent

32
Q

Not-for-profit organization

A

this type of organization is financed by funds that come from several sources, but the providers of these funds do not have an ownership interest.

33
Q

Operating expenses

A

costs required to maintain the day-to-day activities of a business or institution

34
Q

Preferred criteria for hiring

A

the most desired criteria for hiring decisions

35
Q

Third-party payment system

A

a system of health-care financing in which providers deliver services to patients, and a third party, or intermediary, usually an insurance company or a government agency, pays the bill

36
Q

Turnover ratio

A

rate at which employees leave their jobs for reasons other than death or retirement. The rate is calculated by dividing the number of employees leaving by the number of workers employed in the unit during the year and then multiplying by 100.

37
Q

Fiscal-year budget

A

typically a 12-month accounting period that may or may not coincide with the calendar year

38
Q

Perpetual budget

A

a budget generally done on a continual basis each month so that 12 months of future budget data are always available

39
Q

Personnel budget

A

budgeted expenses to cover the cost of personnel; includes actual worked time (also called productive time or salary expense) and time the organization pays the employee for not working (nonproductive or benefit time), such as cost of benefits, new employee orientation, employee turnover, sick and holiday time, and education time

40
Q

Labor intensive

A

costs that are disproportionately related to manpower

41
Q

Staffing mix

A

ratio of RNs, licensed vocational nurses/licensed professional nurses, and unlicensed workers

42
Q

Standard

A

a predetermined level of excellence that serves as a guide for practice

43
Q

Nursing care hours (NCH) per patient-day (PPD)

A

the total number of nursing care hours worked in a 24-hour period, divided by the patient census for that 24-hour period

44
Q

Worked time:

A

productive time or salary expense (excludes benefit and nonproductive time)

45
Q

Operating budget

A

budgetary expenses that change in response to the volume of service

46
Q

Capital budget

A

expenses to cover major purchases (e.g., real estate) and acquisitions (e.g., magnetic resonance imaging [MRI] equipment); composed of long- and short-term components

47
Q

Zero-based budgeting

A

requires a rejustification of program or needs every budgeting cycle. The use of a decision package to set funding priorities is a key feature of zero-based budgeting.

48
Q

Decision package

A

a tool used in zero-based budgeting to set funding priorities

49
Q

Flexible budgets

A

budgets that flex up and down over the year depending on volume

50
Q

Performance budgeting

A

a budgeting strategy that emphasizes outcomes and results instead of activities or outputs

51
Q

Critical pathways

A

also called clinical pathways; predetermined courses of progress that patients should be making after admission for a specific diagnosis or after a specific surgery

52
Q

Variance analysis

A

an examination of the factors leading to deviation from a critical pathway

53
Q

Medicare

A

nationwide health insurance program authorized under Title 18 of the Social Security Act that provides benefits to people aged 65 years or older. Medicare coverage also is available to certain groups of people with catastrophic or chronic illness, such as patients with renal failure requiring hemodialysis, regardless of age.

54
Q

Medicaid

A

a federal-state cooperative health insurance plan for the financially indigent

55
Q

Outlier

A

Outlier: the cost of providing care for that patient justifies extra payment.

56
Q

Clinical practice guidelines

A

standardized clinical guidelines that provide diagnosis-based, step-by-step interventions for providers to follow in an effort to promote high-quality care while controlling resource utilization and costs

57
Q

Selective contracting

A

providers agree to lower reimbursement levels in exchange for patient population contracts

58
Q

Utilization review

A

process used by insurance companies to assess the need for medical care and to assure that payment will be provided for the care; typically includes precertification or preauthorization for elective treatments, concurrent review, and, if necessary, retrospective review for emergency cases

59
Q

Gatekeeper

A

a primary care provider, often in the setting of a managed care organization, who coordinates patient care and provides referrals to specialists, hospitals, laboratories, and other medical services

60
Q

Capitation

A

a prospective payment system that pays health plans or providers a fixed amount per enrollee per month for a defined set of health services, regardless of how many (if any) services are used

61
Q

Health maintenance organizations (HMOs)

A

prepaid organizations that provide health care to voluntarily enrolled members in return for a preset amount of money on a per-person, per-month basis; also includes a licensed health plan that places at least some of the providers at risk for medical expenses as well as health plans that use designated (usually primary care) physicians as gatekeepers (although some HMOs do not). Common types of HMOs include staff, independent practice association, group, and network.

62
Q

Staff HMO

A

physician providers are salaried by the HMO and under direct control of the HMO.

63
Q

Network HMOs

A

the HMO contracts with multiple independent physician group practices

64
Q

Exclusive provider organization

A

enrollees in this type of insurance plan must seek care from the designated health maintenance organization provider or pay all of the cost out of pocket

65
Q

Copayment

A

in health-care circles, the amount of money enrollees pay out of their pocket at the time a service is provided

66
Q

Medical savings account

A

an insurance plan that combines high-deductible medical insurance protection with a tax-deferred savings account

67
Q

Medical savings account

A

an insurance plan that combines high-deductible medical insurance protection with a tax-deferred savings account

68
Q

Moral hazard

A

the risk that an insured person will overuse services just because the insurance will pay the costs

69
Q

Health Insurance Portability and Accountability Act (HIPAA)

A

federal act passed in 1996 directed at protecting the privacy of health information and improving the portability and continuity of health insurance coverage

70
Q

Medical savings account

A

an insurance plan that combines high-deductible medical insurance protection with a tax-deferred savings account

71
Q

Value-based purchasing (VBP)

A

a payment methodology that rewards quality of care through payment incentives and transparency. In VBP, value can be broadly considered to be a function of quality, efficiency, safety, and cost.

72
Q

Bundled care

A

the bundling or grouping of patient care services; providers working together to coordinate care for patients over the course of a single episode of an illness

73
Q

Medicare Shared Savings Program

A

a Medicare incentive program that rewards accountable care organizations that lower growth in health-care costs while meeting performance standards on quality of care and putting patients first

74
Q

Medical home

A

also called the patient-centered medical home (PCMH); a partnership between the patient, family, and primary provider in cooperation with specialists and support from the community, the medical home relies on a team of providers to integrate all aspects of health care, including physical health, behavioral health, access to community-based social services, and the management of chronic conditions; care is designed around patient needs and aims to improve access to care, increase care coordination, and improve quality while simultaneously reducing costs; integrates all aspects of health care through well-developed health information technology including electronic health records

75
Q

Health insurance marketplaces

A

also called exchanges; part of the Affordable Care Act; online insurance supermalls created for individuals without access to health insurance through a job or for small businesses who wish to buy affordable and qualified health benefit plans in a competitive insurance marketplace

Leadership (5 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions