CSBI – HFMA Exam 2023 Questions and Answers

What has changed for Healthcare Analytics? - Answer- 1 - Increased computing power and storage, decrease in cost; 2 - increased abundance of data in healthcare; 3 - increase in individuals having strong competencies Big Data - Answer- Refers to the Growth in available data, massive continually increasing volume of live and stored data for analysis; and the increase in tools available for highly sophisticated ways to combine and analyze data to yield new information and insights. (Size Scope Speed) Big Data View Points - Answer- Focused, Broad, Medium Focused Viewpoint - Answer- Enables one to know the work or business in detail Broad Viewpoint - Answer- Enables one to understand all the industry pieces and the background influencers Medium Viewpoint - Answer- Enables one to know how one's business or work fits with the other pieces and how the other industry components fit and work with each other NKBDSI - Answer- Nursing Knowledge Big Data Science Initiative NKBDSI Organization - Answer- National organization committed to developing, implementing, and guiding a dynamic plan of action that ensures nursing data are captured and available in sharing, comparable formats to help improve health outcomes. Small Data - Answer- A volume and format that makes it very readily accessible, informative and actionable. Triple Aim - Answer- A key support under healthcare reform and the drive for achieving value. What are the Viewpoints/Approach for Healthcare Delivery? - Answer- 1 - Provider-centric Approach 2- Patient-centric Approach Provider-centric - Answer- This approach is the traditional viewpoint for the healthcare delivery continuum. In this environment, the patient being cared for is guided along a care path that is largely predetermined and/or promoted by the provider. Includes the thought that patient being served do not have the necessary level of comprehension or understanding of their situation. Patient-centric - Answer- The healthcare industry is shifting towards this approach. Based on the patient's condition and prospects for improvement, services are rendered in relation to the situation, as opposed to only considering how an individual progress through a series of facilities. HIPAA Act - Answer- Health Insurance Portability and Accountability Act HITECH Act - Answer- Health Information Technology Economic and Clinical Health Act HIPAA - Answer- Covers how PHI is protected and handled. HITECH - Answer- To promote and expand adoption of HIT, spells meaningful use requirements. BI is a prime source of data information for MU rules. Now promoting interoperability. Professionalism - Answer- Basic values: Honesty and integrity, accountability, self regulation, specialized knowledge, building expertise, competency, image. The obligation to use one's specialized knowledge and expertise to add value What are the components of Healthcare delivery services? - Answer- 1-What is provided - the healthcare care services 2-What ways it is provided - types of services 3-Whom/Where? Providers and locations, payment providers 4-How - components of effective operations - providers, locations, supplier, payors, insurers 5-Influencers - education, government, research What are internal components of healthcare service delivery? - Answer- Medical care services, types of health services, providers and locations, ACA providers, Provider organization ownership status, supplier supply chain, payors, education/research, government. What are external components of healthcare service delivery? - Answer- Economic factors, social values, global influences, population characteristics, political climate, technology developments, physical environment SDoH - Answer- social determinants of health ( where people live, learn, work. and play) Their socioeconomic status, education, age, and access to health care. Healthcare Care Services - Answer- How the patient is served and is the mission of the healthcare industry. Examples are: preventive, treatment-curative, treatment-chronic, restorative Types of Health Services - Answer- Refer to locations, care settings or providers of care. Examples are: preventive, primary care, acute, specialty, subacute, chronic, long term, rehabilitative, end of life care Providers & Locations - Answer- Adds complexity to the healthcare delivery service that patients must navigate. Patients must have contacts with these touch points are required for care. CPP Constrained Payment Providers - Answer- Method in which payments for services paid are defined in advance of care. Examples are Accountable Care Organizations (ACO), Patient Centered Medical Homes (PCMHs), Medicare Advantage Plans, and service specific bundled payments Bundled Payments - Answer- service programs where payment is made on the basis of expected costs for clinically defined episodes of care. Also known as global payments, case rate, episodic payment. Provider Organization Ownership Status - Answer- Refers to Not For Profit or For Profit. Historically, physician entities were largely for profit, but now many are changing to not for profit status. Tax issues are affecting this area where efforts must be taken to ensure community service requirements are maintained for tax-exemptions. Supplier and supply chain - Answer- Comprised of all for-profit entities, manufacturers of all kind, distributions organizations, purchasing entities. Examples are - pharmaceuticals, biomedical, life sciences, comsumables Government - Answer- Key system component at the federal level. Has vast influence - Medicare, ACA implementation, FDA, Public health service, and general health regulations. examples are - public insurance financing, health regulations/policy, research funding, public health Economic Factors - Answer- general economy, consumer sentiments and demand elasticity, economic development, demand elasticity by service, labor market/union strength, employer strength, demand elasticity, market liquidity Social Values - Answer- Diversity, social cohesion, established precedents, religious preferences Global Influences - Answer- Immigration, vacation travel, tourism, epidemics, terrorism, demands for equity in medication distribution Population Characteristics - Answer- demographics - education level, age; socio-economics morbidity related to ethnic and gender gaps, social morbidity, social determinants of health Political Climate - Answer- elected officials, current party dominance, social healthcare policy, interest groups Technology development - Answer- engineering science, information science, applied mathematics, IoT coverage and access Physical Environment - Answer- Pollution, sanitation, workplaces, neighborhoods What are the challenging areas of healthcare continuum of care? - Answer- 1-Lack of Coordination 2-Healthcare Users on their own 3-Service Coordination What are the types of service on health continuum? - Answer- 1-Well - preventative care, primary care 2-At Risk - acute care 3-At risk mild - specialty care 4-Early Chronic - chronic care 5-Late Chronic - long-term care 6-Terminal - end of life care Supply Sensitive Care - a driver of utilization - Answer- Care decisions are strongly influenced by capacity, rather than medical evidence or severity of illness. Decisions depend on the number of available hospital beds, clinics, CT scanners, doctors.. Also based on competition, supplier promotional efforts and influences in supply variations impacting cost of care delivered. Preference Sensitive Care - a driver of utilization - Answer- Care selection and selection frequency driven in large measure by the physician opinion. What are misalignment with healthcare user and hospitals? - Answer- 1-focus on cost 2-drivers of service utilization 3-financing mechanism What are the Foundational Ideas for Change? - Answer- 1 - Triple Aim 2 - Transparency in cost - gave way to Meaningful Use and now Promoting Interoperability 3 - Understand Production Cost - gave way to Activity Based Costing (ABC type analysis) 4- Community Based Services Disruptive Innovation - Answer- disrupts and replaces existing markets with ways of working or products previously not thought of as possible, now are possible due to new technology or other catalysts. Disruptive Innovation - Answer- Examples are- telehealth, retail health, pharma firms exploring more direct connections with healthcare users, PHI - Answer- Protected Health Information PHI - Answer- a subset of patient level data, composed of 18 unique identifiers - any of the 18 identifiers by themselves or in combination must be removed to de-identify the individual/patient. HIPAA - Answer- Sections include privacy rule and security HIPAA - Answer- Applies to organizations that are defined as a covered entity and directly to business associates as well HIPAA - Answer- Signed into law in 1996, and revised by 2013 Omnibus Rule HITECH - Answer- Allows for sanctions for non-compliance, including fines of up to $1.75 million and 10 years prison HITECH - Answer- Covers application to both CE and individuals HITECH - Answer- Covers application of the rule to business associate contractors HIPAA & HITECH - Answer- Covers how PHI is handed and protected. Top Challenges confronting Hospital - Answer- 1 - Financial challenges 2- Governmental Mandates & Patient safety and quality 3- Personnel shortage What are the main functions for organization? - Answer- operations, finance, and marketing Operation - Answer- function that meets the demand for product or service by the market. In healthcare, this includes all production services Finance - Answer- Must have this function to ensure monetary resources are available to conduct operation. Accounting is only one component. Marketing - Answer- function that is focused on understanding what the marketplace seeks, anticipate shifts, and ensure a strong presence. Role of Case/Care Managers - Answer- These workers in combination with nurse educators will play an important role in ensuring expeditious and efficacious movement of healthcare users in the care system. Will be driven to focus on 30-day readmissions. Role of Case/Care Managers - Answer- These professionals are at the front lines in providing situational evaluation and action activities related to potential clinical issues and social determinants of health likely to affect readmission. Proactive in healthcare user education and providing guidance on follow-up and continuing care. Role of Nurse - Answer- Non-physicians performing some management of health conditions a step further. Moving beyond the traditional role of supportive bedside care and following physician orders. Role of Internal Financial Payor Experts - Answer- Will work closely with external counterparts. Have transparency through the collaborative discovery and sharing of information. These professionals must increase understanding of and capabilities at pricing contract risk. Role of Supply Support Decisions - Answer- Related to operational management decisions of supply chain. Increased focus on procurement sourcing and management of suppliers and supply lines rather than on inventory and processing orders. Supply acquisition and equipment decisions friction contribute to inefficiency and cost. Role of Quality Performance Improvement Specialists - Answer- work will be performed in direct collaboration with clinicians, decision support professionals and patient access team members. Role of Providers, Suppliers, and Payers - Answer- Linked together in service of the healthcare user. Transparency by all parties is vital to provide high value and meet need for related costs. Role of BI Analytics Consultants - Answer- work in concert with nurse and physician informaticists to unlock the big data an