Healthcare Administration 2 Assignment 1

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THE DYNAMIC ENVIRONMENT OF HEALTH CARE

Chapter 1

Objectives

Describe the present healthcare environment.

Examine megatrends in the environment. 

Address organizational survival.

Identify the role of the healthcare practitioner as manager.

Review the classic functions of the manager.

Define and differentiate between management as an art and a science.

Conceptualize the characteristics of an effective manager.

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Megatrends

Client characteristics

Professional practitioners and caregivers

The healthcare marketplace and settings

Applicable laws, regulations, and standards

The impact of technology

Privacy and security considerations

Financing of health care

Social and cultural factors

Healthcare Regulation

State licensure laws for facilities

State licensure laws for professions

State-mandated healthcare planning

State laws governing reimbursement and insurance

 

Healthcare Regulation

Federal laws governing reimbursement

Federal laws regarding privacy and security of information

Patient Protection and Affordable Care Act

American Recovery and Reinvestment Act

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Reimbursement and Payment

Charitable roots and the not-for-profit model

Fee-for-service

Health insurance: Non-profit and commercial

Managed care

Current legislation: Healthcare reform

The Managed Care Era

Providing access to quality care at affordable cost

Primary care physician as “gatekeeper”

Premium costs by limits on services

Arrangements between managed care groups and hospitals

Issues about denial of service or payment

 

Capitation

Reimbursement system under which provider is paid specific amount of money to look after all the healthcare needs of a given population  

Literally, reimbursement based on so much “per head”

Reasons for Restructuring 

Desire to achieve greater negotiating clout

Desire to penetrate new markets

Need for improved efficiencies

Desire to express an overall value of promoting comprehensive, readily accessible care

Mergers and Affiliations

MERGER: Two or more corporate entities blend to create one new organization

AFFILIATION: Formal agreement between facilities to coordinate and share activities while remaining separate corporate entities

Range of Service

Note the variety of services and levels of care

Examples:

Adult day care center

Hospice

Urgent care clinic

Impact of Technology

“eVisits” and “digital doctors”

Translational medicine

Data warehousing

Data mining

“Real-time” interventions 

Common language and standards: Standard vocabulary and classification systems

National information infrastructure: To capture, access, use, exchange, and store data

Increased use by patients of alternative therapies and interventions

The embedded nurse representative on patient care teams

Rationing; quality-adjusted remaining years

Social and Ethical Factors

Unit supervisor; project manager; department head

Specialized division head

Manager of independent practice

Role of Healthcare Practitioner as Manager

Management Functions

 

 Typical management functions include:

Planning

Decision making

Organizing

Staffing

Directing or actuating (motivating)

Controlling

 

Effective Managers

 Characteristics of effective managers include:

Knowledge of the internal structure and characteristics of their organization

Knowledge of the internal and external dynamics of their organization

Leading and motivating the workforce

Engaged in continuous search for excellence

Aware of and responsive to trends and challenges

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