resource mgmt module 2

Question 1

four most common budgeting methods

Answer 1

• incremental
• zero based
• flexible
• performance

Question 2

zero-based budgeting

Answer 2

• must rejustify their needs every budgeting cycle
• start at 0 each year
• no expense would be assumed to be absolutely necessary

Question 3

key components of decision packages in zero-based budgeting

Answer 3

• listing of all current and proposed objectives or activities in the dept
• alternate plans for carrying out these activities
• costs for each alternate
• adv and disdain of continuing or discontinuing an activity

Question 4

flexible budget

Answer 4

• automatically calculates what the expenses should be, given the volume
• works well in most healthcare organizations
• goes up and down depending of the volume

Question 5

performance budget

Answer 5

• emphasizes outcomes and results instead of activities or outputs
• mgr would budget as needed to achieve a specific outcome and would evaluate the budgetary success

Question 6

clinical pathway

Answer 6

• predetermined courses of pt progress after admission for a specific dx or surgery
• standardized predictions of pt progress
• standardizes care according to evidenced based practice

Question 7

advantages of clinical pathway

Answer 7

• leads to improved pt outcomes

- provides some means of standardizing care

Question 8

disadvantages of clinical pathway

Answer 8

difficulties accounting for and accepting what are often justifiable differentiations between unique puts who have deviated

Question 9

fee for service (FFS)

Answer 9

• type of reimbursement
• based on costs incurred to provide the service plus profit
• no ceiling placed on the total ant that could be charged

Question 10

Medicare

Answer 10

• for 65+

- those with catastrophic or chronic illness

Question 11

Medicaid

Answer 11

low income children and adults

Question 12

Medicare part A

Answer 12

hospital insurance

Question 13

Medicare part B

Answer 13

outpatient care

Question 14

Medicare part C

Answer 14

• medicare advantage

- allows more choices for participating in managed care plans

Question 15

Medicare part D

Answer 15

prescription drugs

Question 16

DRGs

Answer 16

predetermined payment schedules that reflected historical costs for tx of specific pt conditions

Question 17

why do hospitals use the ICD

Answer 17

to comply with HIPPA

Question 18

outlier

Answer 18

the extra cost of providing care for the pt can be justified

Question 19

responsibility of the nurse leader

Answer 19

• to recognize when cost containment is impinging on pt safety and to take appropriate action
• to guarantee at least a minimum standard of care

Question 20

Balanced Budget Act (BBA)

Answer 20

-contains numerous cost containment measures

Question 21

two ways the BBA provided savings

Answer 21

• limiting the growth rates for hospital and physician payments
• restructuring the payment methods for rehab hospitals, HHA, SNF, and outpt services

Question 22

managed care

Answer 22

• a system that attempts to integrate efficiency of care, access and cost of care
• PCPs are “gate keepers” with a focus on prevention

Question 23

utilization review

Answer 23

process used by insurance companies/hospitals

• to assess the need for medicare care
• to assure that payment will be provided for the care

Question 24

capitation

Answer 24

• when providers receive a fixed monthly payment regardless of services used by the pt during the month
• cost of care is less than the amt = provider profits

Question 25

HMO

Answer 25

a corporate body funded by insurance premiums

Question 26

staff HMO

Answer 26

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

Question 27

IPA HMO

Answer 27

- HMO contracts with a group a physicians thru an intermediary to provide services for members - there is a middle man

Question 28

group HMO

Answer 28

HMO contracts directly with one independent physician group

Question 29

network HMO

Answer 29

HMO contracts with multiple individual physician group practices

Question 30

purpose of a gate keeper

Answer 30

- PCP | - prevent hospitalization

Question 31

POS

Answer 31

- HMO | - pt has the option to select a provider outside the network, but pays a higher premium as well as copayment

Question 32

EPO

Answer 32

- HMO | - enrollees must seek care from the designated HMO provider or pay all of the cost out of pocket

Question 33

Affordable Care Act

Answer 33

- new pt bill of rights | - medicare beneficiaries to get preventative services for free and discounts on brand name drugs

Question 34

bundled payments

Answer 34

has 4 broadly defined models that gives flexibility to work together to coordinate care for pts over the course of a single episode of illness

Question 35

retrospective payment

Answer 35

target payment amt for a defined episode of care

Question 36

prospective payment

Answer 36

a single payment is made to a hospital that would encompass all services furnished during an inpt stay

Question 37

accountable care organizations

Answer 37

delivery of seamless high quality care in an environment that is truly pt centered and where pts and providers are partners in decision making

Question 38

hospital value-based purchasing

Answer 38

- paid inpt acute care services looks at both quality and quantity of care and services provided - based on a system of rewards/consequences for the providers

Question 39

health insurance marketplaces

Answer 39

- also called exchanges - created for those without access health insurance thru a job - cannot turn down clients for preexisting conditions