HSCI 480 Healthcare Management Marina Mejia

Final Exam

March 19, 2013

1. What is the Health Insurance Portability and Accountability Act (1996) HIPAA? The HIPAA Privacy Rule provides federal protections for personal health information held by covered entities and gives patients an array of rights with respect to that information. At the same time, the Privacy Rule is balanced so that it permits the disclosure of personal health information needed for patient care and other important purposes.

2. What are the penalties/punishments for violating HIPAA? The table below provides a description of the penalties and punishments for violating HIPAA HIPAA Violation Individual did not know (and by exercising reasonable diligence would not have known) that he/she violated HIPAA Minimum Penalty $100 per violation, with an annual maximum of $25,000 for repeat violations (Note: maximum that can be imposed by State Attorneys General regardless of the type of violation) Maximum Penalty $50,000 per violation, with an annual maximum of $1.5 million

HIPAA violation due to reasonable cause and not due to willful neglect

$1,000 per violation, with an annual maximum of $100,000 for repeat violations

$50,000 per violation, with an annual maximum of $1.5 million

HIPAA violation due to

$10,000 per violation, with an annual

$50,000 per

willful neglect but violation is corrected within the required time period

maximum of $250,000 for repeat violations

violation, with an annual maximum of $1.5 million

HIPAA violation is due to willful neglect and is not corrected

$50,000 per violation, with an annual maximum of $1.5 million

$50,000 per violation, with an annual maximum of $1.5 million

Information retrieved from the American Medical Association http://www.ama-assn.org/ama/pub/physician-resources/solutions-managing-yourpractice/coding-billing-insurance/hipaahealth-insurance-portability-accountabilityact/hipaa-violations-enforcement.page

3. What is a SWOT Analysis? List and explain three components of the SWOT Analysis A SWOT analysis stands for Strengths, Weaknesses, Opportunities and Threats. Is a snapshot of how an organization is currently performing within the market in comparison to the internal capabilities, and intended strategic direction of the organization. It also serves to identify market opportunities and threats that the organization may want to address in the future. The 3 components of the SWOT analysis are o Market assessment This means examining all aspects of the market to determine whether it represent opportunities or threats for the organization and to determine their future implications for the organization o Mission & vision & value statement

This means identifying future of the organization and creating a statement of purpose

o Assessment of the organization This is an internal assessment that examines the quantitative and qualitative capabilities of the organization. It looks at volume forecast and an assessment of the final condition. It also focuses on past strategic performances and leaderships interpretation of the organizations core capabilities or lack thereof.

4. What is the Strategic Tactical Plan and what does it answers? Strategic Planning is the process of identifying a desired future state for an organization and a mean to achieve it. Its purpose is to identify market forces and how they may affect a specific organization, and to determine an appropriate strategic direction for the organization to take that will counteract those force and /or tap their potential It answers the Who, the What, the When and the Where.

5. Name and give an example of three challenges of teamwork in healthcare organizations. Clinicians reluctant to build teams o Clinicians believe that they have a unique work ethic, and when it comes to working in teams they refuse to take ideas from others. Higher level management uncertain that teamwork is worth the effort and short-term cost o For example, they may manager does not believe that it is worth to train others to build personal relationships and to work in teams. They believe that it is a waste of money and time and they should just focus on the tasks. Physicians and surgeons solo savior mentality

o Sometimes practitioners are used to doing things on their own and being their own boss that when it comes to working as a team, they resist to other ideas and they refuse to be led. For example, when working on a surgery, many surgeons may think they have the best methods, and refuse to cooperate

6. Explain and list the three elements of effective team members communication? Willingness to talk and share information o In order to effectively communicate team members must be willing to share their ideas and express their concerns. If all have the same concern but no one speaks up this will cause problems in the long run, and even team member conflict. Active Listening o Ask for others opinions, be prepared, and show an interest in the other persons views and feelings. This includes giving eye contact, repeating what others are saying, and summarizing what you took from the conversation in order to assure that the point got across. Understanding o Make sure information is properly received and that others understand the message as you intended it to be. In other words, this means that when you are talking, you need to make sure that others interpret the message the way you want them to and vice versa.

7. List the Five Force Model of a Market Assessment and Explain Each. Power of the Healthcare Workforce o composed of front line caregivers that provide service.

For example: few years ago there was an issue of having a shortage of nursing and radiology personnel. With the shortage, wages and hiring expenses increased, jeopardizing the ability to offer these specific services.

Power of Consumers and Payers o Consumers are demanding more from their healthcare providers (doctors, hospitals, insurance companies) both in term of availability of specific services offered and in the delivery of these services.

Innovations in Technology o With the advancement in technologies it is important to know how an organization stands in terms of technology, and weather it is going to be able to compete with other providers.

The Regulatory Environment o There are more and more regulations to protect patient information and to assure quality of care. In order to be successful, organization must maintain up to date with these laws.

Competitive Rivalry o More and more diverse services are being provided, and it is important to be innovative in order to keep up with market needs and demands, as well as to stand out from other competitors.

8. _______________ is the difference between the benefit a customer perceive from a purchase of a product, service, or idea and the cost to acquire those benefits. Customer Value

9. How are Market Segments Selected? By examining the targeted markets needs The characteristics of the organization The organizations products and services, objectives and resources o In order to do this, the market needs need to be researched. The provider needs to know that type of people it is serving (for example a socioeconomically challenged community), and assessing the characteristics of the organization and comparing them with those of the market

10. Explain the Concentration Strategy in Healthcare marketing. Give an example and list the advantages. Concentration Strategy targets a single market in order to specialize with the objective of gaining a large share of the market. In other words, in concentration strategy one chooses a specialization per say, and it focuses on serving that specific community in order to receive the greatest benefit from them. For example, when an Orthodontic choosing to only serve children, he or she will focus on obtaining all the resources to better serve this part of the population, that way more people are willing to go with him as opposed to going with a general practitioner. The advantage of Specialization is that it enables the healthcare provider to focus all marketing activities on creating, delivering and sustaining long-term value to a distinct set of customers. Also, it allows to provide better care.

11. In the Marketing Mix there are Four Controllable Ps. List and explain them. The 4 Ps of Marketing Mix are:

o Product which include all the goods, services, ideas (for example the product of a fitness center are group exercise, facilities, and personal training) o Price value placed upon product (in the example above, price could include the membership, but it can also mean the value the costumer puts on the services, and how much he/she is willing to pay) o Promotion marketing activities used to communicate to the target market (advert. Selling)(for example, creating a facebook page or providing discounts or having a loyalty program). o Place the offering delivery route (drug store, doctors office, hospital) (in the example of the fitness center, it means where it is located and how people will access it).

12. What is an EMR? An Electronic Medical Record (EMR) is a record created in an organization that delivers care, such as a hospital or physician's office An EMR is an application environment composed of the clinical data repository, clinical decision support, controlled medical vocabulary, order entry, computerized provider order entry, pharmacy, and clinical documentation application. EMR are used to document, monitor, and manage healthcare delivery within a care delivery organization. The data in the EMR is the legal record of what happened to the patient during their stay at the healthcare provider and is owned by the provider. If the patient desires a copy of these record for personal purposes it must request this information following specific procedures. EMR are constantly being improved to assure that the privacy of the patient is protected, and to improve the method of health care delivery (example- accessing information faster and archiving data in a way that is easy to understand).

13. List the Most Common Forms of Fraud and Abuse In Healthcare: Providers billing for services that were not provided o For example, when someone receives a bill in the mail for a mammogram that they never had. Filing of false claims o For example, when an entity claims a patient stayed overnight and requested specific services, when they never were inpatients. Submitting duplicate bills o Purposely sending the same bill twice to see if they receive the money twice. Up coding services to receive higher reimbursements o Using services that have a higher cost and require more specialization, in order to be able to claim a higher reimbursement. Receiving kick-backs for referrals o This would imply a physician referring a patient to a specific clinic, in which he receives part of the profit for having patients go there.

14. The Emergency Medical Treatment and Active Labor Act: (EMTALA) was enacted in 1986 to prevent patient dumping. True True or False

15. Operation Restore Trust was enacted to prevent Emergency Departments from refusing treatment or transferring a patient to another facility because of the patients inability to pay for treatment. False True or False

16. In order for a contract to exist, there must be four key elements: Name these elements. 1. The agreement must be between two or more parties 2. The parties must both be competent to consent to such an agreement 3. The agreement must be for something of value 4. The agreement must be lawful

17. In what instances are legal behavior and ethical behavior similar, and in what instances are they different? Legal and Ethical behavior are similar in many aspects. Both of these have consequences and action may be taken, although these vary for ethical behavior. Also, both may result in a form of sanction, depending on the governing body. In legal behavior, some type of action is required by law, and legal consequences may occur if no action is taken. Under the law, professionals have a duty to report any behavior. In these circumstances individuals may face criminal sanction if they deviate from the law. In ethical behavior there are no legal requirements but professional organization may require it. Censuring by the governing body may occur if unethical behavior occurs. Also, ethics help to define the dues of care. However, as opposed to legal, ethical standards are defined by governing bodies that license professionals. Violators may lose their license or professional privileges.

18. What is the role of healthcare managers in strategic planning? Be able to monitor your environment, look at current trends (ex) technology), understand the local market around you (are customers moving out?), know how youre going to support your organization, make sure the people you have hired are knowledgeable.

Bring a background that enables to enhance the environment in which highly specialized personnel delivers healthcare services. Also, health care managers are responsible for making sure doctors, nurses and other HC professionals have the resources to provide safe and effective patient care. Moreover, they are to provide and monitor the infrastructures and processes to make the HC org. responsive to the needs of patients and the employees.

In summary, health care managers: 1) 2) 3) 4) 5) 6) Monitor environment Access and look at current trends Find out what is going on in local market Know the intent of your organization Identify ways to support your organization Look at your staff, make sure it is knowledgeable

19. The supply and demand for healthcare professionals are primarily caused by what factors? Growth in the Insured Population as a result of Health Reform Laws o With the new changes coming with the implementation of ACA many more individuals will be forced to participate in the program and have insurance. This means that the need for health care professionals will increase. An Aging Population o The baby boomers are retiring, and this will cause and increase in health services, including home health and skilled nursing facilities. An Aging Health Care Work Force o Many professionals have been in the field for a long time and are getting closer to retirement. The Diversity of the Workforce

o A diverse community requires certain specific services. In the workforce, this diversity implies not only that of the consumer, but also the practitioners, who may have different and innovative ideas. The State of the Economy o With improvements in the economy, more individual and businesses are able to afford health insurance. The same way, during rough times the demand may decrease.

20. List and explain one of the Quantum Leadership Principles. I chose the last of the principles of Quantum Leadership: Revolution Results from the Aggregation of Local Change. This means that the changes we see today at a greater scale were started at a very small dimension, and with time it grew into what it is today. In terms of healthcare, organizations are transformed by new leaders, and new technologies. Revolution usually occurs in a system when the components jointly make enough of a demand for significant change The foundation of health care are being transformed by impact of new technologies. Health services are less bed based. Healthcare organizations are being radically transformed and providers must seek new ways of offering services (EMR, Internet). The role of Healthcare leaders is to help other healthcare professionals adapt to the change and position Healthcare Organizations to continue to thrive. Leaders must discern the new roles, processes and behaviors that will be necessary for future success. If healthcare was to stay unchanged, the system would eventually break, and many individuals would be have incompetent services that wouldnt meet their needs.

21. Douglas McGregor developed a philosophical view of humankind with his Theory X and Theory Y. These are two opposing perceptions about how people view human behavior at work and organizational life. Explain Theory X and Theory Y ( 10 pts.) Theory x ('authoritarian management' style) o In this theory the average person dislikes work and will avoid it he/she can. Therefore most people must be forced with the threat of punishment to work towards organizational objectives. The average person prefers to be directed; to avoid responsibility; is relatively unambitious, and wants security above all else. In this theory there is a lack of drive, and managers struggle to keep them motivated. theory y ('participative management' style) o Effort in work is as natural as work and play. People will apply self-control and self-direction in the pursuit of organizational objectives, without external control or the threat of punishment. Commitment to objectives is a function of rewards associated with their achievement. People usually accept and often seek responsibility. The capacity to use a high degree of imagination, ingenuity and creativity in solving organizational problems is widely, not narrowly, distributed in the population. In industry the intellectual potential of the average person is only partly utilized.