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Sarbanes Oxley ✔Correct Answer-US federal law that set new or expanded requirements for all US
public company boards, management and public accounting firms. Cover responsibilities of a public
corporation's board of directors, adds criminal penalties and required SEC to create regulations
FMLA ✔Correct Answer-1993: law requiring covered employers to provide employees with job-
protected and unpaid leave for qualified medical family reasons
Purpose of any HCO ✔Correct Answer-to provide care to individual patients and is usually stated in
organization's "mission"
Population Health ✔Correct Answer-defining the population (by geography, sociodemographic
factors, disease state, risk, insurance coverage or in some other way), measuring the current state of
health in the population, setting goals for improvement and directing resources to making
improvements. US HSS specifies national goals and objectives for population health in the Healthy
People 2020 program
Caregiving/Clinical/Logistic/Strategic Teams ✔Correct Answer-Caregiving Teams: Provide care to
patients with similar needs (PCP, ACUTE, rehab)
Clinical Support Teams: provide specific clinical services to Caregiving Teams (clinical laboratory,
pharmacy, imaging, cardiopulmonary)
Logistic Support Teams - provide trained personnel, information, facilities, accounting, cash,
management and supplies
Strategic Support Teams: provide marketing, governance, internal consulting, finance, stakeholder
relations management and strategic positioning
Service Lines ✔Correct Answer-Patient care teams coordinated around a set of similar diseases or
patient needs
Premise of a Healthy Community ✔Correct Answer-Costs tend to rise and benefits to decline as
care moves away from the healthy state. Therefore, optimum care maximizes use of prevention,
health maintenance, and health improvement
PCP, Acute inpatient or specialty outpatient care, rehab, continuing care in home or nursing home
setting, continuing care in home or nursing home setting, palliative care and death
Stakeholders ✔Correct Answer-Individuals or groups who have a direct interest in the
organization's success and shape its mission and strategies. Include buyers, workers, suppliers,
regulators and owners. Patients are the MOST important HCO stakeholders. They expect and deserve
care that meets the goals summarized in IOM's report: Crossing the Quality Chasm
Patient-centered care ✔Correct Answer-care that is respectful of and responsive to individual
patient preferences, needs and values and involving patients and families in care planning and
decision making
Fiscal intermediaries ✔Correct Answer-Outside contractor that processes claims for US
government programs such as medicare and medicaid and provide most of the revenue to HCOs,
making them essential stakeholders
, Patient Protection and Affordable Care Act (ACA) ✔Correct Answer-A federal law providing for a
fundamental reform of the US healthcare and health insurance system, signed by President Obama
in 2010. It includes: increase insurance coverage for many patients, new approaches to support
those with chronic disease, and a greater accountability for the cost and quality of care. Part of the
"Triple Aim" - improving the individual patient experience with healthcare, improving the health of
the population, and reducing per capita cost of care
Value-based purchasing ✔Correct Answer-Linking financial incentives to the quality of care
provided - reward HCOs for quality and sustained patient health
Certificate-of-need laws ✔Correct Answer-Certificate or approval of new services and construction
and renovation of hospitals or related facilities; issued in many states. Require that HCOs seek
permission for construction or expansion.
EMTALA - Emergency Medical Treatment and Active Labor Act ✔Correct Answer-Requires all HCOs
providing emergency care to accept all patients, regardless of ability to pay, until they are stabilized
and can be safely moved
The Joint Commission ✔Correct Answer-A voluntary consortium of professional provider
organizations that evaluates and accredits a wide range of different HCOs. HCOs MUST have an
accreditation by a CMS deemed-status organization in order to receive funds from Medicare. Some
insurance plans are accredited by the National Committee for Quality Assurance (NCQA)
Associates ✔Correct Answer-People who give their time and energy to the organization. They can
be employees, trustees and other volunteers and medical staff members.
Licensed Independent Practitioners (LIPs) ✔Correct Answer-Caregivers granted legal status to
provide specific kinds of healthcare, categorized as primary care or specialist providers who are
usually physicians or advanced practice nurses (NPs, nurse midwives)
Primary Care Practitioners (PCPs) ✔Correct Answer-physicians and advanced practice nurses
specializing in family medicine, general internal medicine, pediatrics, obstetrics, and psychiatry and
are the most common initial contacts for patients and specialize in family medicine, general internal
medicine, peds, OB/GYN, and psychiatry
Specialist Practitioners ✔Correct Answer-LIPs who care for patients referred by PCPs on a more
limited and transiet basis. More likely to manage episodes of inpatient care
Hospitalists ✔Correct Answer-Accept relatively broad categories of patients and manage inpatient
care only
Community Benefit ✔Correct Answer-Requires hospitals to satisfy the community benefit standard
in order to qualify as tax-exempt charities under 501c3 of the IRS code. The standard addresses
charitable care, educational services, and other benefits HCOs provide to their communities
Healthcare Systems ✔Correct Answer-A corporate or governmental structure including one or
more hospitals and often other HCO services
Privileges ✔Correct Answer-Define quality and service obligations but allow a wide variety of
financial agreements