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Flashcards in Acute Care Facilities Deck (40)
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1
Q

Number of Registered Hospitals

A

5,600+

2
Q

Vertical vs. Horizontal Integration

A
Vertical
- Hospitals (facilities), INSURANCE, and Physicians
- Multi-hospital expansion can happen
Horizontal
- Hospitals and Physicians
- Multi-hospital expansion can happen
3
Q

Levels of Care

A

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
Q

Community Hospital

A

Open to the general public and Non-federal

5
Q

For Profit vs. Not For Profit

A
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
Q

Specialty Hospital

A

Any facility that is restricted in admissions

7
Q

ALOS

A

Average Length Of Stay

- 5.2 days is the national average

8
Q

C Suite

A
CEO
COO
CFO (can either report to the CEO or the COO)
CNO and other Asst.
Clinical and service department
9
Q

Job of CEO

A

Take care of the Board, Community, and Medical Staff

10
Q

Parts of Reimbursement

A

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

11
Q

Prospective vs. Retrospective

A

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
Q

CPB and Process of it

A

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
Q

CBO

A

Congressional Budget Office

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

14
Q

CAH

A

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
Q

Disproportionate Share Hospital

A
  1. Can qualify for Cost Plus Basis

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

16
Q

Recuse

A

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

17
Q

Fiduciary

A

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

18
Q

Goal of Board of Directors

A
  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
Q

Bylaws

A

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

20
Q

OIG

A

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
Q

Governance

A

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
Q

Management

A
  1. Ongoing or continual

2. Day to day activities

23
Q

Executive Committee

A

Chair - Vice chair - CEO

24
Q

CQI

A

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

25
Q

What does the board want to know?

A
  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
Q

Income Statement Facts

A

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

27
Q

Balance sheet Fact

A

Tells you the net worth of your company

28
Q

Operating Line of Credit

A
  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
Q

Average % profitability

A

-.7%

30
Q

Advocacy Groups

A

For profit - Federation of American Hospitals (FAH)

Not for Profit - American Hospital Association (AHA)

31
Q

Acute Care Definition

A

The treatment of injury and/or Illness

32
Q

Acute vs. Critical Care

A
  1. Acute is primary/ secondary

2. Critical care occurs with anything above secondary care

33
Q

Triage

A

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

34
Q

How does the state grade facilities?

A

It uses Conditions of Participation to grade or grade a Facility

35
Q

Deemed Status

A

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

36
Q

CMS

A

Centers For Medicare and Medicaid Services

37
Q

Who Medicare covers and the Parts

A
65+  and disabled
A - Reimburses acute care hospital inpatients
B - Physicians and or outpatient
C - Medicare supplemental 
D - Drugs
38
Q

AHCA

A

American Health Care Association

39
Q

AUPHA

A

Association for University Programs in Health Administration

40
Q

ACHE

A

American College of Healthcare Executives