Week 6 Strategic/Fiscal Planning and Healthcare Reform (5 Questions) Flashcards Preview

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Flashcards in Week 6 Strategic/Fiscal Planning and Healthcare Reform (5 Questions) Deck (42)
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1
Q

The future of health care

  • Patient centered _____ _____ allows for more t_____, less ____ based care, more c____, more e____, patient p____
A
  • medical homes

transparency, hospital, community, education, portals

2
Q

Barriers to PCMH =

A

= health care reform, rapidly changing technology, point of care testing, increasing gov regulation of healthcare, reduced provider autonomy

3
Q

Influences of PCMH =

A

= rapidly changing technology, point of care testing, telehealth and internet, growing elderly population, other changing demographics, nursing shortages in acute area

4
Q

Healthcare Reimbursement

A

*

5
Q

Incremental Budgeting =

  • No incentive for efficiency - is easiest but?
A

= facility budgets for current year are based on a certain % increase over previous year

  • least valuable
6
Q

Fee for Service Reimbursement =

A

= based on costs incurred to perform the health care service PLUS a profit

  • no ceiling, so more service = more monay (volume not value)
7
Q

Diagnosis Related Groups (DRG’s) =

A

= gov. regulations to justify need for services and to monitor quality

  • doesn’t count for unexpected costs and can drastically reduce length of stay (bad if not ready to go home yet)
8
Q

Prospective Payment System (PPS) =

A

= switch to payment according to DRG as opposed to actual costs incurred

9
Q

Managed Care =

Concern =

A

= focuses on prevention, need for services, de-emphasis on inpatient care, and use of clinical practice guidelines or critical pathways to ensure care is best practice

= evaluation for need for services is done by INSURANCE COMPANY staff who aren’t qualified/too far removed from situation
- also might result in UNDERTREATMENT -> (capitations)

10
Q

Managed Care Organizations (2)

A

Health Maintenance Organization (HMO)

Preferred Provider Organization (PPO)

11
Q

Health Maintenance Organization (HMO)

2

A

MEDICARE

MEDICAID

12
Q

HMO advantages (1) =

HMO disadvantages (2) =

A

= cheaper

= restrictive (limited choice of network of providers), harder to navigate (if need to see someone, need a referral even if person is within HMO)

Point of Service (POS), Exclusive Provider Organization (EPO)

13
Q

PPO advantages =

PPO disadvantages =

A

= freedom to select provider within organization regardless of specialization you need, bigger network

= expensive

14
Q

Criticisms of HMOs =

A

= loss of hcp-pt relationship, limited choice, lower level of continuity of care, reduced HCP autonomy, longer wait times, consumer confusion about many rules to be followed

15
Q

Managed Care Organizations receive reimbursement for Medicare - eligible pts based on formula established by center for medicare/medicaid services (CMS)

They look at what factors?

A

Age
Gender
Geographic region
Average cost per pt at given age

(gov gives itself a 5% discount and gives rest to MCO)

16
Q

Patient Protection and Affordable Care Act =

A

= comprehensive insurance reforms, budled payments, accountable care organizations, hospital value-based purchasing, medical home, heath insurance marketplaces

HOSPITALS THAT ARE DOING WELL GET BETTER REIMBURSEMENT

17
Q

Planning =

A

= deciding in advance what to do, who will do it, how and when it needs to be done

(PROACTIVE, requires FLEXIBILITY and ENERGY, MANAGEMENT SKILLS)

18
Q

Strategic Planning =

A

= examines an organizations PURPOSE, MISSION, PHILOSOPHY, and GOALS in context of its EXTERNAL ENVIRONMENT

19
Q

Planning Hierarchy

A
Mission/Vision/Philosophy 
Goals 
Objectives 
Policies 
Procedures 
Rules
20
Q

Why plans fail ->

A
  • false assumptions
  • not knowing overall goal
  • not enough alternatives
  • inadequate time or other resource
  • low motivation
  • sound strategies not used
  • inadequate delegation of authority
  • not recognizing organization goals and needs
  • planning too narrow in scope
21
Q

Instead of Strategic planning we want to move toward?

A

Proactive Planning

22
Q

Proactive Planning =

  • Reactive Planning =
  • Inactivism =
  • Preactive Planning =
A

= (INTERACTIVE planning), considers PAST, PRESENT, and FUTURE and attempts to plan future of org rather than react to it, dynamic and adaptive

= occurs after a problem exists
= seeks status quo
= utilize technology to accelerate change; future-oriented

23
Q

SWOT =

A

Strengths
Weaknesses
Opportunities
Threats

24
Q

Strengths -
Weaknesses -
Opportunities -
Threats -

A
  • INTERNAL attributes that help org. reach objectives
  • INTERNAL attributes that challenge org in reaching objectives
  • EXTERNAL conditions that promote achievement of org. objectives
  • EXTERNAL conditions that challenge or threaten achievement of org. objectives
25
Q

Fiscal Planning =

A

= not intuitive, a learned skill critical to nurse managers bc incr emphasis on finance/ “big business” of health care

26
Q

Cost containment =

A

= effective and efficient delivery of services WHILE generating needed revenues for continued organizational productivity

27
Q

Cost effectiveness =

A

= producing good results FOR THE AMOUNT OF MONEY SPECT (getting your money’s worth)

  • takes into account factors anticipated length of service, need for such a service, and availability of alternatives
28
Q

Critical Pathways =

A

= strategy for assessing, implementing, and evaluating the COST EFFECTIVENESS of pt care

Predetermined course of progress that pts should make after admission for a SPECIFIC DIAGNOSIS or after SPECIFIC SURGERY

29
Q

Responsibility accounting =

A

= each of an organizations REVENUES, EXPENSES, ASSETS, and LIABILITIES is someone’s responsibility -> person with most direct control or influence on any of these financial elements should be held accountable for them (usually leader/manager); unit manager can best monitor and eval all aspects of unit’s budget control

30
Q

Budget =

A

= a plan that uses numerical data to predict the activities of an org. over a period of time

2) maximizes use of resources to meet short and long term goals
3) mechanism of planning and control and for promoting unit’s needs and contributions

31
Q

Types of Budgets (3)

A

Personnel
Operating
Capital

32
Q

Personnel budget =

A

= wages, overtime, bonuses of employees

33
Q

Operating budget =

A

= revenue and expenses rt pt care

Supplies are 2nd largest part of budget

34
Q

Capital budget =

A

= big things/changes/construction - unexpected things accounted for in budget

35
Q

Methods of Budgeting (4)

A

1) Incremental Budgeting
2) Flexible Budgeting
3) Performance Budgeting
4) Zero-based budgeting

36
Q

Incremental budgeting =

A

= EASIEST, bump up budget based on what it was last year and and this year’s INFLATION RATE

37
Q

Incremental budgeting is good for what types of organizations?

A

Stable organizations that haven’t changed much over last 3-4 yrs

38
Q

Flexible budgeting =

ex)

good for nurse ______

A

= takes into account how things change throughout year by looking at HISTORICAL TRENDS

ex) low pt census during christmas

managers

39
Q

Performance budgeting =

A

= thinks about how budget performed last time, compares to now, and analyzes difference; critically thinking about what changes were and seeing if they need to be made again

good for nurse managers

40
Q

Zero-based budgeting =

good for what type of organizations?

A

= brand new unit from scratch

Brand new

41
Q

Nursing Care Hours/Per Patient Day formula =

A

= nursing hours worked in 24 hours/ patient census

42
Q

Who is counted is nursing care hours?

A

RNs, LPNs, PCTs, and Secretaries count