Questions and Answers of Introduction To Healthcare Quality Management

How would you rate the quality of the medical care you’ve received? (Please circle one.)? l01
How would you rate the quality of the customer service you’ve received? (Please circle one.)(poor) 0 - 1 - 2 - 3 - 4 - 5 - 6 - 7 - 8 - 9 - 10 (perfect)? l01
What did you like best about this visit?? l01
What did you like least about this visit?? l01
Please suggest one or more ways we could make things better.? l01
For any healthcare activity, three performance factors can be measured: structure, process, and outcome. Identify one structure measure, one process measure, and one outcome measure that could be
For each measure you selected to evaluate the hospital admission process, describe the measure in fundamental terms. What are the numerator and denominator? If the measure does not require a
Suppose the manager of the hospital registration area wants to gather data to report performance results for the measures you have chosen. What data source could be used to gather information for the
In your opinion, what is the one greatest barrier to ensuring the quality of data used for performance measurement purposes? Support your opinion with literature references.? l01
Query the NQMC (www.qualitymeasures.ahrq.gov) and identify five evidence-based performance measures related to prescribing the correct medications for patients. The measures should focus on choosing
The Joint Commission Quality Check website (www.qualitycheck.org) provides performance ratings for accredited organizations. Go to this site and look up the hospitals ranked high in performance on
Explore the CMS Hospital Compare website and review the data for each measurement category. Which performance measures in these categories are most important to consumers of healthcare services?
The Centers for Medicare & Medicaid Services (CMS) Hospital Compare website(www.hospitalcompare.hhs.gov) allows you to compare performance at hospitals throughout the United States. Go to this site
Does our physical environment differ from that of the study unit?
Are the patients in the study population similar or dissimilar to our patient population?
The researchers reported the number of patient falls per 1,000 patient days.Do we use the same reporting methodology? Do we count the number of patients who have fallen, or do we count the number of
How reliably did caregivers in the study unit report patient falls? If they did not report falls consistently, would the number of patient falls have been higher if the caregivers had reported more
What is the study unit’s definition of patient fall? Do we define patient fall the same way?
Horizontal bar charts are often used when the labels along the x-axis are too long to fit under vertical columns or when a large number of bars are displayed.
The width of the bars within a bar graph is not relevant, but it should be consistent.
The height of the bar represents the frequency of incidences for that category.In Exhibit 4.9, the heights of the bars represent the average computer response times at each hospital.
Bar graphs are an excellent way to show performance results from a snapshot of time.
Should action be taken? What kind of action?
Do the data reveal a trend?
What is current performance?
explain how comparative performance data are used for assessment purposes.?
identify common techniques for establishing performance expectations, lop5
describe the role of performance targets in evaluating performance, lop5
apply methods of interpreting healthcare performance measurement data, lop5
identify common ways of reporting measurement data to facilitate performance assessment, lop5
State the purpose of the pro forma financial analysis in management of an organization or project.
Use financial evidence to define the pro forma objectives.
Describe feasible financial actions that can be taken to achieve defined objectives.
Discuss barriers and supports for achieving defined financial objectives.
Describe financial interrelationships and their impact on strategy.
You have been asked to give an in-service to all practice professionals about the need for pro forma analysis. List at least three critical points you want to make during this in-service and the
The practice is interviewing financial consultants to assist them in building pro formas required by the bank before a loan for an electronic medical records system can be approved. Suggest two
The consultant has delivered the pro formas to the practice. Describe at least one additional analysis that you will suggest using the pro formas, and outline the steps you suggest to accomplish this
The practice investors have requested a meeting with the practice owners to discuss the financial strategy of the practice for the next year. You have been asked to discuss the return on investment
A practice owner has suggested that the practice borrows the money to purchase the electronic medical records system proposed for the next year. The practice currently uses no debt, so its
Define the terms macro-finance and micro-finance.
Discuss why healthcare providers need to know basic principles of financial economics.
Understand why government healthcare systems in the United States always have a political as well as administrative dimension.
Discuss the concept of states’ rights and its implications for government healthcare systems.
Understand the evolving social compact in U.S. society in regards to healthcare financing.
Discuss the resource allocation issues inherent in the societal goal of health and healthcare.
What is the main difference between macro-finance and microfinance concepts? Conduct some independent research and find an example or an application of each concept.
Find a recent example of the debate between states and the federal government in regard to healthcare. This could be a court case involving states’ rights or an administrative action between a
You have learned that in the United States, power belongs to the people, who choose to allow government to act on their behalf.Find an example of another type of shared power between people and their
Give an example of and discuss the allocation dilemmas that occur as a result of the government’s need to support either health or healthcare. For example, if the government chooses to support
The Constitution states that the people have a right to change the government if they are not satisfied with it. This implies that people must be generally satisfied with systems instituted by the
What do you recommend as the basis for the new health strategy in Tekram. Discuss the reasons for your recommendation and the policy evidence from the literature that supports these
State at least one goal and two objectives that are critical to your strategy. Your goal should be SMART (specific, measurable, attainable, realistic, and timely).Tekram is an island nation in the
Make at least one recommendation on how to build support for your strategy.Tekram is an island nation in the South Pacific. The climate is tropical and the nation is self-governing after a period of
Discuss at least three methods that the ministry should use to implement your support-building recommendation.Tekram is an island nation in the South Pacific. The climate is tropical and the nation
Suggest one alternative to the present social insurance scheme, and provide a rationale for the feasibility of this alternative.Tekram is an island nation in the South Pacific. The climate is
Explain the concept of risk in relation to health insurance.
Describe the basic actuarial formula and explain its use.
Define experience and community rating.
Describe the budget approach to health insurance.
Discuss the two major types of risk control strategies in health insurance.
The promise of genomic medicine is that the uncertainty surrounding individual health risks will be greatly reduced. By understanding each individual’s genetic map, the risks of certain chronic
A state legislator has suggested that the community-rating method be required for all insurers writing health-insurance policies in her state. She belongs to a political party that does not accept
Congratulations! You have just accepted a position as the clinical advisor for a medium-sized health insurance company. You have decided your first priority is to gain control of the costs in your
You are a member of a healthcare team visiting a developing country in Africa. You are told that healthcare is a right for all people in the country and that the ministry of health is responsible for
The cost of adopting electronic medical records has been shown to be prohibitively high for single-physician and small rural group practices. Discuss the benefits—from the insurer’s
Discuss the basic financial incentives in the U.S. healthcare market.
Define healthcare financial management strategies as a response to market incentives.
Explain the linkage between healthcare financial management and operations management.
Define the major parts of an organizational financial plan.
Describe the characteristics of a perfectly competitive market and give one actual example of how healthcare markets differ from those that are perfectly competitive.
Define each of the four main healthcare market incentives and give a recent actual example of each incentive from the context of the payer and the provider.
Select one major public or private payer for healthcare services and list all the conditions that the primary care provider must meet to qualify for reimbursement.
List and define all the components that should be included in a reimbursement analysis from the perspective of a primary healthcare provider. Give one actual or theoretical example of each component.
Define the information required to understand the cost of a routine primary healthcare visit.
Select either long- or short-term financial planning as your focus, give one real-world example of a planning strategy used in your focus area, and discuss the information that would be needed to
Discuss goal setting in the U.S. healthcare system.
Define the relationship between goals and financial strategy.
Discuss the regulatory challenges that impact goal setting and financial strategy in the U.S. healthcare system.
Discuss selected U.S. healthcare system strategic financing dilemmas.
Describe the essential difference between goal setting in public and private health-insurance systems.
Explain the relationship between goals, strategic objectives, and financial strategy using an example from either public or private health-insurance organizations.
Debate at least one potential strategic dilemma confronting a health insurer. Provide at least one tentative solution to resolve the dilemma.
Differentiate the roles of the public-sector regulator and the private-sector strategic planner in immunization policy and service delivery.
Outline a provider position paper in response to one of the three strategic dilemmas discussed in this chapter. Your position paper outline may be focused at either the state or federal level. The
Define the main characteristics of cost behavior in ambulatory care practices.
Discuss the two types of cost analysis.
Compare and contrast four types of costing systems currently useful to ambulatory care practices.
Describe the organizational and policy uses of cost data.
Review the list of practice expenses provided (see page 70) and classify each as fixed, semi-variable, or variable. Give a brief rationale for your classification decision.
You have been asked to conduct a cost-finding analysis for your practice. One of the first activities you undertake is the classification of costs into direct and indirect categories. Explain how you
Define and give an example of step-down cost allocation as part of your definition. Discuss the strengths and challenges in activitybased costing or step-down cost allocation.
Select one of the costing systems reviewed in this chapter and discuss in detail how this system could be applied to an ambulatory practice. Your discussion should consider (1) the data required to
You have been asked to participate in the Physician Practice Information Survey. The other partners in your practice do not understand why the practice should take the time to participate. Give a
Discuss the main points to be considered in a revenue management plan.
Explain the strategies necessary for revenue account management.
Define revenue optimization objectives and revenue account evaluation.
Outline the strategies for revenue account negotiation based on practice revenue requirements.
Explain the relationship between the reimbursement plan and operational revenue management.
Outline the main strategies that might be used to match the receivables cycle with the payables cycle.

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