CPHQ Prep (NAHQ Material) Complete Solution, Over 300 Questions And Answers

CPHQ Prep (NAHQ Material) Complete Solution, Over 300 Questions And Answers Leaders Cope with change by developing vision and aligning subsytems Managers Cope with complexity through planning and budgeting Quality Roles for the Board of Directors/Governing body Setting policy, financial and strategic direction, quality of care, goals and objectives What are the subsystems of the organization and the principles of leadership Structure, People, Renewal, Reward, Resources, Culture Mission Organizations purpose or reason for existence; why are we here? Vision Organizations statement of its goals for the future Core values Define an organizations attitudes and help direct vision Organizations direction is built on ________ and guided by ________ mission; vision Definition/explanation of a goal broad general statement specifying a purpose or desired outcome Definition/explanation of an objective specific statements that detail how goals will be achieved through specific and measurable actions SMART Acronym Specific, measurable, attainable, relevant, time bound The following is an example of what? Place 100% of veterans in permanent housing, which includes moves to HUD-VASH program and moves from VA SSVF into permanent housing by September 30th annually Objective Voice of the customer (VOC) is a process conducted at the start of any new product, process or service design initiative to understand better the customer wants and needs Four aspects of the VOC Customer needs, a hierarchical structure, priorities, customer perceptions of performance (the product is a list of needs, wants and desires of the customer of a process output) How to construct VOC research identify customers of a process output, develop a list of questions to ask customers about the process, refine the list to use with the process review and improvement Hoshin Planning a Japanese term that means policy deployment - it is used to ensure that the vision being set forth by top management is being translated into planning objectives and actions Four perspectives of measurement for a balanced scorecard Financial, Customer, Internal Business processes, Learning and Growth Financial Scorecard term How do we look to providers or financial resources Customer scorecard term How do our customers see us Internal business processes scorecard term at what must we excel Learning and growth scorecard term can we continue to improve and create value for our customers Steps for creating reward systems in company culture 1. Determine priorities, values and behaviors 2. Identify criteria for recognition 3. establish a budget 4. determine accountability for recognition 5. obtain feedback through performance appraisal 6. modify program based on feedback 7. give rewards based on the program Population Health definition outcomes for a group of individuals What does PHM involve PHM involves gaining an understanding of clinical and other characteristics (e.g. SES, geography) of population/subpopulation and associated risks Transition of care definition/example a care transition occurs when a patient moves from one healthcare provider or setting to another. According to the joint commission, 80% of serious medical errors involve _______ during the __________ miscommunication; transition of care Handoffs defined as a transfer and acceptance of patient care responsibility achieved through effective communication What should handoffs include? patient history, heart rhythm, infections, complications, needs for restraints etc to achieve successful handoffs, organizations should 1. demonstrate leaderships commitment to successful handoffs 2. standardize critical content to be communicated to the sender during a handoff, both verbally and in written form 3. cover everything needed to safely care for the patient in a timely fashion recommendations for improving transitions of care 1. improve communication during transitions between providers patients and caregivers 2. implement EMRs that include standardized medication reconciliation elements 3. establish points of accountability for sending and receiving care, particularly for hospitals and nursing home providers 4. expand the role of pharmacists in transitions of care 5. develop performance measures to encourage better transitions of care episodes of care all care a patient receives in the courses of treatment for a specific illness, condition or medical event sharing vital signs and care with the care providers on the next shift is an example of what handoff a cardiac specialist called in to provide a consultation on cardiac issues with a surgical patient is an example of what episode of care a hospital sharing patient information on hospital stay with home health service is an example of what transition of care provide patient information to a dietitian consulted about a patient who is losing weight after a procedure is an example of what episode of care Fee for service reimbursements providers receive payment for each service provided managed healthcare A system of healthcare delivery that tries to manage the cost, quality and access of healthcare traditional retrospective payment pays providers after services have been provided Managed Care Reimbursement Third party payers mange cost of healthcare and episodes of care Episode-of-care reimbursement Providers receive one lump sum for all the services they provide related to a condition or disease Capitation third party payer reimburses providers a fixed per capita amount for a period (PMPM or Per Member Per Month) prospective payment payment rates established in advance for a specified time period; predetermined rates based on average levels of resource use (DRG) Pay for performance provides bonus to healthcare providers if they meet or exceed agreed upon quality or performance measures. This may also reward improvement in performance over time Patient Protection and Affordable Care Act (PPCA) 1. requires virtually every citizen to obtain health insurance 2. establishes a five year Medicare voluntary pilot program for integrating care across hospitals, physicians and post acute providers during an episode of care Value-based purchasing PPACA establishes value based purchasing program for Medicare to pay hospitals based on performance compared to quality measures. Accountable Care Organization (ACO) An organization of healthcare providers accountable for the quality, cost, and overall care of Medicare beneficiaries who are assigned and enrolled in the traditional fee-for-service program What two items can reduce Medicare payments to hospitals? Hospital acquired conditions (HACs) or Preventable Readmissions (HRRP) PPACA Goals 1. give more individuals to affordable, quality health insurance 2. reduce the growth in health care spending in the country 3. expand the affordability, quality and availability of private and public health insurance through consumer protections. Health Maintenance Organization (HMO) Members need to receive most or all care from a network provide and select a PCP responsible for managing and coordinating all healthcare Preferred Provider Organization (PPO) Health plan contracts with a network of preferred providers from which to choose and members do not need to select a PCP and do not need referrals to see other network providers. Exclusive Provider Organization (EPO) services limited to medically necessary or preventative care and the medical care must come exclusively from network providers or the EPO won't pay What is utilization management criteria used for to decide whether a patient is admitted to an inpatient, outpatient or observation setting Pre-admission review a certification that takes place before services are provided. The reviewer determines whether admission to the facility is reasonable and medically necessary Concurrent review A review of the health record while the patient is still hospitalized or under treatment retrospective reveiw performed after discharge authorizations are performed to ensure payers that the payment is appropriate Length of stay for UM review a basic attempt to control costs; it is essentially the number of days that a patient should stay in a facility for a specific diagnosis. Case Management a collaborative process of assessment, planning, facilitation, care coordination, evaluation, and advocacy for options and services to meet an individual's and family's comprehensive health needs through communication and available resources to promote quality, cost-effective outcomes. Clinical pathways multidisciplinary plan that schedules clinical interventions over an anticipated time frame for high risk, high volume, high cost types of cases evidence based research Basis for sound clinical practice guidelines and recommendations Goal of clinical pathways and guidelines