IHOP Exam 2 UPDATED ACTUAL Questions and CORRECT Answers
provides services that allow for an overnight stay in a
Define inpatient care
hospital
At least 6 beds, deliver patient services, diagnostic and
therapeutic care
must be licensed, organized staff, continuous nursing ser-
vices (RN leadership)
What are the criteria of a hospital as defined by the AHA?
Identifiable governing body legally responsible for the
hospital
Governed by federal, state, local, and accreditation regu-
lations
1. Primitive institution of social welfare
2. Distinct institution of care for the sick
Describe the timeline of hospital transformation 3. Organized institution
4. Advanced institutions of medical training and research
5. Consolidation systems of healthcare delivery
Late 1800s-mid 1980s
Roemer's Law = "a built bed is a filled bed"
Describe hospital expansion Development of professional nursing
Growth of private health insurance
Role of government
What is the Hill Burton Act?
,AKA Hospital Survey and Construction Act of 1946
Authorized hundreds of millions for federal-state partner-
ships and grants to construct hospitals due to post WWII
shortages/maldistribution
3.2 beds per 1,000 --> 4.5 beds per 1,000
Describe how the Hill-Burton Act increased the number of 40% of beds in short-stay general hospitals during the
beds 50s-60s due to this act
main reason why most hospitals now are non-profit
Only "separate by equal" federal legislation in the 20th
century that permitted federal funds for racially exclusion-
ary practices
Simkins vs Moses vs Cone Memorial Hospital - found
Describe the negatives towards the Hill-Burton Act
segregation of through this act is unconstitutional (only
4th circuit)
Title VI of the Civil Right Act --> No federal funds for those
whose discriminate --> led to Medicare/Medicaid
Shift from inpatient to outpatient
Changes in reimbursement
Describe hospital downsizing Tax Equity and Fiscal Responsible Act (TEFRA)
Managed Care
Hospital closure
Cost plus payment for Medicare patients --> prospective
Explain TEFRA
payment system
Describe hospital closures
, 1990s = ~500 hospital closures; 8% of rural hospitals
2010s-now = 139+ rural hospital closures
number of patients discharged during a given period of
Define discharges
time, includes births and deaths
Define hospitalization rate discharges adjusted by population
Define days of care cumulative inpatient days, often adjusted by population
total days of care/discharges
Define average length of stay
varies by hospital type; has decreased over time
Define capacity number of beds AND staffed for inpatient use
Define average daily census average number of patient receiving care each day
Occupancy rates average daily census/average number of beds(capacity)
Demand driven by demographic trends, medical technol-
What influences hospital demand?
ogy advances, and increase in chronic disease
In-patient hospital service
What represents the highest % of health care expendi-
tures?
Medicare/Medicaid highest drivers
Profitability is decreasing while costs are increasing
Higher RN/bed ratio
Operating margin
Describe the trend of profitability for healthcare systems
Lower % of Medicare/Medicaid = better financial posi-
tion
Medicaid expansion protects against uncompensated
care
What are the 3 types of hospital ownership?
, Public
- publicly accessible = state, county, and local
- publicly inaccessible = VA, Indian Health Service
Private, Non-profit
- Owned operated by community orgs
- largest group (~58%)
Private, For Profit
- investor owned
Hill Burton Act - built hospitals with federal dollars so must
provide charity care
IRS tax exempt
Describe the expectations for non-profit hospitals
24 hr ER, must serve uninsured
Reasonable salaries for employees
- level of C-level salaries are contingent on org's effective-
ness & community health
Revenue and Costs
- Expenses grew 7.5% while revenue only grew 6.6%
- July 2022 margins worst of the pandemic
- Influx of federal pandemic $, public health emergency
regulations, future unknown
Do non-profit hospitals live up to their expectation?
Community Benefit
- measurement and reporting of charity care is inconsis-
tent and distorted
- discrepancies in reporting to CMS and the IRS
- hiring firms to collect payment from patients who may
have been eligible for charity care
Hospitals by types of service
provides services that allow for an overnight stay in a
Define inpatient care
hospital
At least 6 beds, deliver patient services, diagnostic and
therapeutic care
must be licensed, organized staff, continuous nursing ser-
vices (RN leadership)
What are the criteria of a hospital as defined by the AHA?
Identifiable governing body legally responsible for the
hospital
Governed by federal, state, local, and accreditation regu-
lations
1. Primitive institution of social welfare
2. Distinct institution of care for the sick
Describe the timeline of hospital transformation 3. Organized institution
4. Advanced institutions of medical training and research
5. Consolidation systems of healthcare delivery
Late 1800s-mid 1980s
Roemer's Law = "a built bed is a filled bed"
Describe hospital expansion Development of professional nursing
Growth of private health insurance
Role of government
What is the Hill Burton Act?
,AKA Hospital Survey and Construction Act of 1946
Authorized hundreds of millions for federal-state partner-
ships and grants to construct hospitals due to post WWII
shortages/maldistribution
3.2 beds per 1,000 --> 4.5 beds per 1,000
Describe how the Hill-Burton Act increased the number of 40% of beds in short-stay general hospitals during the
beds 50s-60s due to this act
main reason why most hospitals now are non-profit
Only "separate by equal" federal legislation in the 20th
century that permitted federal funds for racially exclusion-
ary practices
Simkins vs Moses vs Cone Memorial Hospital - found
Describe the negatives towards the Hill-Burton Act
segregation of through this act is unconstitutional (only
4th circuit)
Title VI of the Civil Right Act --> No federal funds for those
whose discriminate --> led to Medicare/Medicaid
Shift from inpatient to outpatient
Changes in reimbursement
Describe hospital downsizing Tax Equity and Fiscal Responsible Act (TEFRA)
Managed Care
Hospital closure
Cost plus payment for Medicare patients --> prospective
Explain TEFRA
payment system
Describe hospital closures
, 1990s = ~500 hospital closures; 8% of rural hospitals
2010s-now = 139+ rural hospital closures
number of patients discharged during a given period of
Define discharges
time, includes births and deaths
Define hospitalization rate discharges adjusted by population
Define days of care cumulative inpatient days, often adjusted by population
total days of care/discharges
Define average length of stay
varies by hospital type; has decreased over time
Define capacity number of beds AND staffed for inpatient use
Define average daily census average number of patient receiving care each day
Occupancy rates average daily census/average number of beds(capacity)
Demand driven by demographic trends, medical technol-
What influences hospital demand?
ogy advances, and increase in chronic disease
In-patient hospital service
What represents the highest % of health care expendi-
tures?
Medicare/Medicaid highest drivers
Profitability is decreasing while costs are increasing
Higher RN/bed ratio
Operating margin
Describe the trend of profitability for healthcare systems
Lower % of Medicare/Medicaid = better financial posi-
tion
Medicaid expansion protects against uncompensated
care
What are the 3 types of hospital ownership?
, Public
- publicly accessible = state, county, and local
- publicly inaccessible = VA, Indian Health Service
Private, Non-profit
- Owned operated by community orgs
- largest group (~58%)
Private, For Profit
- investor owned
Hill Burton Act - built hospitals with federal dollars so must
provide charity care
IRS tax exempt
Describe the expectations for non-profit hospitals
24 hr ER, must serve uninsured
Reasonable salaries for employees
- level of C-level salaries are contingent on org's effective-
ness & community health
Revenue and Costs
- Expenses grew 7.5% while revenue only grew 6.6%
- July 2022 margins worst of the pandemic
- Influx of federal pandemic $, public health emergency
regulations, future unknown
Do non-profit hospitals live up to their expectation?
Community Benefit
- measurement and reporting of charity care is inconsis-
tent and distorted
- discrepancies in reporting to CMS and the IRS
- hiring firms to collect payment from patients who may
have been eligible for charity care
Hospitals by types of service
