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

The future of health care

- Patient centered _____ _____ allows for more t_____, less ____ based care, more c____, more e____, patient p____

- medical homes
transparency, hospital, community, education, portals

2

Barriers to PCMH =

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

3

Influences of PCMH =

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

4

Healthcare Reimbursement

*

5

Incremental Budgeting =

- No incentive for efficiency - is easiest but?

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

- least valuable

6

Fee for Service Reimbursement =

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

- no ceiling, so more service = more monay (volume not value)

7

Diagnosis Related Groups (DRG's) =

= 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

Prospective Payment System (PPS) =

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

9

Managed Care =

Concern =

= 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

Managed Care Organizations (2)

Health Maintenance Organization (HMO)
Preferred Provider Organization (PPO)

11

Health Maintenance Organization (HMO)

(2)

MEDICARE

MEDICAID

12

HMO advantages (1) =

HMO disadvantages (2) =

= 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

PPO advantages =

PPO disadvantages =

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

= expensive

14

Criticisms of HMOs =

= 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

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?

Age
Gender
Geographic region
Average cost per pt at given age

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

16

Patient Protection and Affordable Care Act =

= 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

Planning =

= 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

Strategic Planning =

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

19

Planning Hierarchy

Mission/Vision/Philosophy
Goals
Objectives
Policies
Procedures
Rules

20

Why plans fail ->

- 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

Instead of Strategic planning we want to move toward?

Proactive Planning

22

Proactive Planning =

- Reactive Planning =
- Inactivism =
- Preactive Planning =

= (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

SWOT =

Strengths
Weaknesses
Opportunities
Threats

24

Strengths -
Weaknesses -
Opportunities -
Threats -

- 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

Fiscal Planning =

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

26

Cost containment =

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

27

Cost effectiveness =

= 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

Critical Pathways =

= 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

Responsibility accounting =

= 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

Budget =

= 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