Questions and Answers of Introduction To Healthcare Quality Management

Research the balance billing regulations for one major payer.Include regulatory requirements, the penalties if regulations are not followed, and the revenue implications for the practice.
Research the strategies used by practice managers to optimize revenue management. You may want to interview a local practice manager to understand the practical implications of optimal revenue
List three main payer negotiation strategies and the evidence that you would use to support negotiations.
Define the relationship between strategic planning and budgeting.
List the main types of budgets and the steps for constructing them.
Analyze an existing expense budget and identify potential budget categories.
Explain the use of budget categories in constructing the chart of accounts.
Discuss the analysis of budget performance in the context of the goals of the firm.
As a new practice administrator in an existing practice, describe the steps you will take to become familiar with the budgeting process.
You discover that the practice does not use RVUs because 60 percent of its revenue is capitated. Design a brief staff in-service to explain the reasons that RVUs are important despite the flat
You are one month away from the end of the fiscal year and are discussing the annual budget cycle with your accounting firm.You have noticed that some of the accounts listed in the chart of accounts
In reviewing the latest variance report you noticed a large negative variance in technology costs that is completely offset by a large positive variance in labor costs. What steps would you recommend
You are working in a practice that is 100 percent owned by a capitated payer, and you receive a flat monthly payment to take care of the 50,000 patients registered to your practice. You have only a
Define the term capital structure.
Discuss the implications of capital structure for the patient care practice.
Analyze the effect of taxes on capital structure.
Define the effect of risk on capital structure.
Discuss capital structure planning in the context of a patient care practice.
You have decided to open a primary care practice in New York City focused on serving the Medicaid population. List three initial questions you need to consider to plan your capital structure.
You decide that you will accept a high level of debt to open your practice. List at least two potential risks the practice will face due to this capitalization decision.
Three of the four partners in this incorporated practice have more than $150,000 in student loan debt. Discuss at least two implications the practice faces from this level of personal indebtedness.
One of the partners was employed by another primary care practice in the city for the last five years. Discuss one major start-up financial consideration for this partner joining the practice.
At your first start-up partners’ meeting, one of the nurse practitioners said he did not want to be involved in making a capital structure recommendation. He wanted to leave it to the financial
State the purpose of each of the four basic financial statements.
Explain how the balance sheet is related to the income and expense statement.
Define the elements of the cash flow statement and identify its relationship to the balance sheet.
Explain the relationship of financial statements to financial ratios.
You have been offered a partnership in a local healthcare practice in a suburb of a large city. You decide to review the practice’s financial situation after hearing rumors that they are not doing
The practice has a profit-sharing plan in place for partners. Which report is the most important to determine the profit that has been earned by the practice? List at least three questions you will
You have heard rumors that the practice is “cash poor.” What report will you examine to evaluate its cash position, and what categories does this report analyze? For each category, describe at
The practice’s partners also have a 20-percent share in retained earnings as part of their salary package. What are retained earnings, and how do they differ from other sources of equity? Because
You notice that the practice seems to be in a favorable financial position, according to its balance sheet. But its sources of cash are largely from financing activities, such as short-term loans.
Explain the use of ratio analysis in comparing an organization’s financial performance to internal and external benchmarks.
Define liquidity, solvency, and profitability ratios and state their purposes in financial analysis of an organization.
Discuss the relationship between key ratios and the practice’s financial performance with regard to return on assets and return on equity.
You are considering accepting a partnership in a primary care practice.You have been provided with a set of financial reports that include the balance sheet, the income and expense statement, and the
Conduct a DuPont analysis using the financial statement presented in Chapter
Based on this analysis, would you recommend that the practice assume more debt? Why or why not?
You wish to compare the financial performance of your nurse practitioner-owned primary care practice, which is focused on health promotion. Which NAICS code will you use for this practice and why?
Define the concept of peer grouping for the purposes of financial analysis. Propose at least three questions that would guide your selection of an appropriate peer group.
Describe the steps necessary to develop financial plans and budgets for projects.
Discuss one example of an integrated project management strategy.
Develop an integrated project management plan and define the project team.
Define a project financial plan using financial performance indicators.
The state health department has issued a call for proposals to design and implement a diabetes education plan for adolescent women on Medicaid. The diabetes educator who is a part-time consultant to
Congratulations! Your practice was awarded the diabetes education project and the educator has been designated as the principal investigator. Outline three critical questions that you would like to
You are meeting with the practice financial management team to design the project’s financial framework. What financial management approach will you recommend and why?177
Identify one major risk-management strategy that you will recommend to the financial management team.
The diabetes educator has requested the involvement of the consulting endocrinologist to provide personalized care planning for adolescent women who cannot control their blood glucose levels.The
Define project financial flows based on the integrated project plan.
Compare and contrast the main methods of project valuation.
Define the steps in the net present value analysis of projects.
Discuss the impact of the discount rate in project evaluation.
Evaluate project decisions based on project valuation analysis.
Your practice is considering a project focused on improving healthcare services for the homeless. You presently serve insured middle-class clients who work at the local university, and you contract
The project analysis shows that project start-up costs will be relatively high at $120,000 because additional staff will need to be hired to provide care in a nearby public housing project. Revenue
The community where your practice is located strongly supports the homeless clinic, and your environmental analysis shows that both the university and a for-profit company would be willing to
Outline the project financial evaluation strategy for the project implementation phase based on your revised net present value analysis and factoring in the expected in-kind and financial support of
It is clear that the external environmental factors are critical to the project’s success. Discuss at least three environmental factors that you will monitor on a regular basis, and provide both a
Discuss the relationship between finance and population health.
Identify the emerging trends that will affect healthcare financing.
Define the role of macro- and micro-financing in responding to emerging trends in healthcare.
You have been asked to make a presentation to the local chamber of commerce on population health. Outline three major points you will make about population health. For each point discuss its actual
Identify one additional development that affects healthcare financing in the United States that you would include in the list of trends.Provide evidence to support the health-financing effect and the
Your healthcare practice is located in a county that intends to eliminate all after-school sports and music programs for middle school students, due to lack of funding. Outline the points that you
The rate of premature births to teenage mothers in your state has doubled in the last ten years. Identify one initiative that you would support to decrease this troubling trend and support your
You have been asked to serve on an advisory group to improve population health in your state. The group’s first project will be to investigate the determinants of health for people and prioritize
Define the key stakeholders in all health-financing models.
Discuss the role of the major stakeholders in healthcare financing.
Define the essential features of the major financing models: social insurance, private insurance, or out-of-pocket household payment.
Analyze the financial flows in each of the major financing models.
Assess the risks and benefits inherent in selected healthcare financing approaches.
Explain and give examples of the role of the household in U.S.healthcare financing.
You have been asked to survey the main stakeholders in a small state to ascertain their opinions about healthcare costs. List five stakeholder groups you will include and provide a rationale for
Explain the concept of social insurance and give an example of a social health insurance system either in the United States or in another country. Include a general description of the funds flow in
Analyze the health savings account approach to financing healthcare.Include in your analysis the following: definition of the HSA, tax treatment of HSA accounts, incentives to establish an HSA, and
Evaluate one healthcare financing system in the United States. It can be a state-level system, a federal system, a private system, or a blended system. Discuss at least three financial strengths and
Look at the 10 principles of servant leadership (Box 2.3). How do these principles fit within your approach to work? Do you employ any of them in your day‐to‐day activities?
Think about your personal values and take some time to make a list them. Are the things you listed similar to the values offered in Box 3.7?
If you can, approach a person who you feel is a clinical leader. Explain to them that you see them as a clinical leader and ask them how they feel. Were they shocked, surprised, delighted? How did
What are your experiences of leadership development from your undergraduate or formative healthcare education? Do you feel well prepared and instructed in leadership theories and techniques? Ask some
Draw a ‘mind map’ with the word ‘leadership’ in the centre. You could start the map here and build or add to it as you progress through the book or over the trajectory of your studies.
Who are your leaders? Who might you direct an alien or stranger to if they asked you to take them to your leader? Would these be the same people if you were asked to take them to your ‘clinical
Having considered these theories of leadership, do any of them feel as if they ‘fit’ the clinical environment you work within, in terms of explaining what you understand leadership to be about?
Using a general internet search engine, look for ‘leadership styles’. See what comes up. Identify any styles that you feel will help you and note down the positive and negative aspects of each,
Transformational leadership is associated with leaders who lead change as a definitive aspect of their role. Think about the characteristics of a transformational leader. Can you reflect on times
Authentic leadership, servant leadership, compassionate leadership and congruent leadership are all types of values‐based leadership theories (James et al. 2021). Read James’s article and think
Discuss your values list with a professional colleague. Find out if they have similar values, what their values are or how they might express them.
Reflect on the relationships you have had with a past or present ‘leader’. Think about the kind of working relationship you have had with them and what thought (if any) you have put into your
Undertake the Followership Style Questionnaire in this chapter. What are your thoughts about the result? Have you ever been taught about followership? Yes or No. Why do you think this is?
Does your organisation encourage the participation of followers? Do you feel that you have ‘power’ as a follower? If not, how could you use some of the change models offered in Chapter 7 to
Who would you identify as the most effective followers in your ward/clinic/team or clinical area? Are these the same people you might identify as leaders or potential leaders?
Think about your formative healthcare education. What did you learn about management? Was this adequate? Do you think that there are other matters or topics that health professionals should learn
Think about a leader (from your work, from history, politics, or any walk of life) whom you admire, look up to or have been inspired by. Write a short summary about what it is or was about them that
Are clinical leadership, management and profession-specific leadership different? Think for a moment about these three concepts and how they relate to your professional position. Is there something
In researching the difference between leadership and management in the health service, trying to undertake both roles (leadership and management in the one position) was found often to lead to
If culture is people focused, what impact do you think technology is having on our relationships and our organisational culture? Talk to some of your senior colleagues and ask them how much impact
Bradshaw (2016) wrote a very interesting article about the hidden presence of M. Simone Roach’s model of caring, which seems to have been the ‘unwritten’ precursor to the 6Cs. Bradshaw is of
Listen to the songs ‘The times they are a-changin’ by Bob Dylan (1967), ‘Changes’ (1971) by David Bowie and ‘Revolution’ by the Beatles (1968). Are the times always ‘a-changin’ or was
Draw up your own version of the FFA model. Think of a problem you want to address. It can be personal or work related. Begin by listing the driving then restraining forces that have an impact on the

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