Healthcare Systems and Operations Flashcards

Which payment model groups hospital inpatient reimbursement for Medicare patients by diagnosis category?

Answer: Diagnosis-Related Groups (DRGs)

Medicare pays hospitals for inpatient care using Diagnosis-Related Groups (DRGs), which bundle payment based on the patient's principal diagnosis and procedures.

What is a 'never event' in patient safety terminology?

Answer: A serious, largely preventable adverse event that should never occur in healthcare

Never events are serious, largely preventable patient safety incidents—such as wrong-site surgery—that should not occur if proper protocols are followed.

In managed care, what distinguishes a Health Maintenance Organization (HMO) from a Preferred Provider Organization (PPO)?

Answer: HMOs typically require a primary care physician referral; PPOs generally do not

HMOs require members to select a primary care physician who coordinates care and provides referrals, while PPOs allow members to see specialists without referrals.

What is the purpose of root cause analysis (RCA) after a sentinel event in a healthcare facility?

Answer: To identify underlying system failures that contributed to the event

Root cause analysis examines the processes and systems that led to a sentinel event to identify and correct systemic vulnerabilities rather than focusing on individual blame.

Which government program provides health insurance to low-income individuals and families and is jointly funded by federal and state governments?

Answer: Medicaid

Medicaid is a joint federal-state program that provides health coverage to eligible low-income adults, children, pregnant women, elderly adults, and people with disabilities.

What does 'interoperability' mean in the context of health information technology?

Answer: The ability of different EHR systems to exchange and use health data seamlessly

Interoperability refers to the capacity of different health IT systems and software to communicate, exchange, and use shared data effectively.

In healthcare supply chain management, what is the 'par level'?

Answer: The minimum stock quantity that triggers a reorder to maintain adequate supply

Par level is the minimum quantity of a supply item that must be on hand; when stock falls to this level, a reorder is triggered to prevent shortages.