Week 3 Lecture 1

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Across
  1. 1. method of classifying patients. Different criteria are used for different systems. In nursing, patients are usually classified according to acuity of illness.
  2. 3. costs that can be controlled or that vary. An example would be the number of personnel employed, the level of skill required, wage levels, and quality of materials.
  3. 4. a hospital payment system with predetermined reimbursement ratio for services given
  4. 5. (DRGs) rate-setting PPS used by Medicare to determine payment rates for an inpatient hospital stay based on admission diagnosis. Each DRG represents a case type for which Medicare provides a flat dollar amount of reimbursement. This set rate may be higher or lower than the cost of treating the patient in a particular hospital.
  5. 6. rate at which dollars are received and dispersed
  6. 8. term used to describe a variety of health-care plans designed to contain the cost of health-care services delivered to members while maintaining the quality of care
  7. 13. nationwide health insurance program authorized under Title 18 of the Social Security Act that provides benefits to people aged 65 years or older.
  8. 14. a payment structure in which different health-care providers who are treating a patient for the same or related conditions are paid an overall sum for taking care of that condition rather than being paid for each individual treatment, test, or procedure. In doing so, providers are rewarded for coordinating care, preventing complications and errors, and reducing unnecessary or duplicative tests and treatments (HealthCare.gov, n.d., para. 1).
  9. 21. a payment methodology that rewards quality of care through payment incentives
  10. 22. groups of providers and suppliers of service who work together to better coordinate care for Medicare patients across care settings
  11. 23. total amount of regular time, overtime, and temporary time. This also may be referred to as actual hours.
  12. 25. costs that cannot be directly attributed to a specific area. These are hidden costs and are usually spread among different departments. Housekeeping services are considered indirect costs.
  13. 27. in nursing, workloads are usually the same as patient-days. For some areas, however, workload units might refer to the number of procedures, tests, patient visits, injections, and so forth.
  14. 28. costs indirect expenses that cannot usually be controlled or varied. Examples might be rent, lighting, and depreciation of equipment.
  15. 30. incentive payments that are linked to both quality and efficiency improvements
  16. 32. source of income or the reward for providing a service to a patient
  17. 34. costs that do not vary according to volume. Examples of fixed costs are mortgage or loan payments.
  18. 36. a system of health-care financing in which providers deliver services to patients, and a third party, or intermediary, usually an insurance company or a government agency, pays the bill
  19. 37. ratio of registered nurses (RNs), licensed vocational nurses (LVNs)/licensed practical nurses (LPNs), and unlicensed workers (e.g., a shift on one unit might have 40% RNs, 40% LPNs/LVNs, and 20% others).
  20. 38. rate at which employees leave their jobs for reasons other than death or retirement. The rate is calculated by dividing the number of employees leaving by the number of workers employed in the unit during the year and then by multiplying by 100.
  21. 39. a prospective payment system (PPS) that pays health plans or providers a fixed amount per enrollee per month for a defined set of health services, regardless of how many (if any) services are used
  22. 40. smallest functional unit for which cost control and accountability can be assigned. A nursing unit is usually considered a cost center, but there may be other cost centers within a unit (orthopedics is a cost center, but often, the cast room is considered a separate cost center within orthopedics).
  23. 41. health-care financing and delivery program with a group of providers, such as physicians and hospitals, who contract to give services on an FFS basis.
  24. 42. coding used to report the severity and treatment of patient diseases, illnesses, and injuries to determine appropriate reimbursement; currently in its 10th revision (ICD-10)
  25. 43. total of all direct and indirect costs
Down
  1. 1. incentives are paid to providers to achieve a targeted threshold (typically a process or outcome measure) of clinical performance, typically a process or outcome measure associated with a specified patient population
  2. 2. officially known as the Patient Protection and Affordable Care Act, this act passed in March 2010 to provide more Americans access to affordable health insurance
  3. 7. point at which revenue covers costs. Most health-care facilities have high fixed costs. Because per-unit fixed costs in a noncapitated model decrease with volume, health-care facilities under this model need to maintain a high volume to decrease unit costs.
  4. 9. financial resources that a health-care organization receives, such as accounts receivable
  5. 10. costs that vary with the volume. Payroll costs are an example.
  6. 11. a reimbursement system whereby insurance companies reimburse health-care providers a billed amount for services after the services are delivered
  7. 12. weighted statistical measurement that refers to severity of illness of patients for a given time. Patients are classified according to acuity of illness, usually in one of four categories. The acuity index is determined by taking a total of acuities and then dividing by the number of patients.
  8. 15. costs that can be attributed to a specific source, such as medications and treatments; costs that are clearly identifiable with goods or service
  9. 16. historical information on dollars spent, acuity level, patient census, resources needed, hours of care, and so forth. This information is used as basis on which future needs can be projected.
  10. 17. historically, a prepaid organization that provided health care to voluntarily enrolled members in return for a preset amount of money on a per-person, per-month basis; often referred to as a managed care organization
  11. 18. organization in which the providers of funds have an ownership interest in the organization. These providers own stocks in the for-profit organization and earn dividends based on what is left when the cost of goods and of carrying on the business is subtracted from the amount of money taken in.
  12. 19. this type of organization is financed by funds that come from several sources, but the providers of these funds do not have an ownership interest. Profits generated in the not-for-profit organization are frequently funneled back into the organization for expansion or capital acquisition.
  13. 20. number of hours of work for which a full-time employee is scheduled for a weekly period.
  14. 24. numerical relationship between the value of an activity or procedure in terms of benefits and the value of the activity’s or procedure’s cost. The cost–benefit ratio is expressed as a fraction.
  15. 26. hours of nursing care provided per patient per day by various levels of nursing personnel. HPPD are determined by dividing total production hours by the number of patients.
  16. 29. daily costs required to maintain a hospital or health-care institution
  17. 31. type of patients served by an institution. A hospital’s case mix is usually defined in such patient-related variables as type of insurance, acuity levels, diagnosis, personal characteristics, and patterns of treatment.
  18. 33. federally assisted and state-administered program to pay for medical services on behalf of certain groups of low-income individuals.
  19. 35. style of budgeting that is based on a fixed, annual level of volume, such as number of patient-days or tests performed, to arrive at an annual budget total. These totals are then divided by 12 to arrive at the monthly average. The fixed budget does not make provisions for monthly or seasonal variations.