Free FACHE Exam Flashcards

HMOs require a primary care physician (PCP) gatekeeper and referrals to see specialists, using a narrow network to control costs. PPOs let members see specialists and out-of-network providers without a referral, trading lower cost-sharing for that flexibility.

A group of providers and hospitals that voluntarily coordinates care for a defined patient population and shares in the savings (and sometimes losses) generated by improving quality and lowering costs, as under the Medicare Shared Savings Program.

It uses a team-based model centered on the primary care physician to coordinate comprehensive, continuous care, emphasizing prevention and care coordination over episodic, one-off visits.

An IDN operates multiple care settings (hospitals, clinics, post-acute) under one common governance and ownership structure. A CIN links independently owned providers through shared clinical protocols and data without common ownership.

Primary (first contact, prevention) leads to Secondary (community hospital, specialist) leads to Tertiary (subspecialty care, e.g., transplant) leads to Quaternary (highly specialized, experimental care), with subacute care and hospice sitting along the post-acute and end-of-life continuum.

A periodic study, required by federal tax law for nonprofit hospitals, that identifies a community's priority health needs and produces an implementation strategy to address them, tied to maintaining tax-exempt status.

Non-clinical conditions - housing, food security, transportation, income, and education - that influence health outcomes as much as or more than clinical care; executives increasingly screen for and address them to cut readmissions and disparities.

Population health focuses on managing the outcomes and cost of a defined group over time using data analytics, risk stratification, and preventive outreach, rather than reacting only to individual episodes of illness.

A style that inspires followers around a shared vision and drives significant organizational change through motivation and role-modeling, rather than through the reward-and-punishment exchanges of transactional leadership.

Adapt your style - directing, coaching, supporting, or delegating - based on a specific follower's competence and commitment for the task at hand, rather than applying one fixed style to everyone.

Create urgency, build a guiding coalition, form a strategic vision, enlist broad support, remove barriers to action, generate short-term wins, sustain momentum, and institute the change into the culture.

Lewin's 3-stage model (unfreeze, change, refreeze) is a simple conceptual framework for making a change stick, while Kotter's 8-step model provides a more detailed, sequential action plan for large-scale organizational change.

Executives must identify and develop internal talent for key roles to protect institutional knowledge and ensure continuity during leadership transitions, reducing reliance on costly, slower external searches.

An all-hazards approach that also addresses infectious disease outbreaks, active shooter events, cyberattacks, and surge capacity, with defined incident command roles and regular drills.

It systematically evaluates internal Strengths and Weaknesses alongside external Opportunities and Threats to inform strategic decisions before an organization commits resources to a new initiative.

It measures how many days an organization could cover operating expenses using only its unrestricted cash and investments. A low figure signals liquidity risk that can affect bond ratings and vendor payment terms.

Operating Margin equals operating income divided by operating revenue. It shows how much profit an organization generates from core patient care operations, excluding non-operating gains like investment income.

It compares cash available for debt payments to the actual required principal and interest due, and lenders or bond covenants use it to judge whether an organization can meet its debt obligations.

Medicare pays a fixed, predetermined amount per inpatient stay based on the patient's diagnosis and severity, regardless of the actual costs incurred, creating an incentive to manage length of stay and resource use efficiently.

Capitation pays a fixed amount per patient per period regardless of services rendered, shifting utilization risk to the provider. Fee-for-service pays per unit of service, which rewards volume.

Patient registration and scheduling, insurance verification, charge capture, coding, claims submission, and payment posting and collections. A breakdown at any step delays or reduces cash flow.

Eligible employees at covered employers get up to 12 weeks of unpaid, job-protected leave per year for specified family and medical reasons, with continued group health coverage during the leave.

Provide reasonable accommodations to qualified employees with disabilities unless doing so would cause undue hardship to the organization, and avoid disability-based discrimination in employment decisions.

Minimum wage, overtime pay (time-and-a-half for non-exempt employees over 40 hours per week), recordkeeping, and child labor standards. Executives must classify staff correctly as exempt or non-exempt.

It protects most private-sector employees' rights to organize, join unions, and engage in collective bargaining or other concerted activity for mutual aid, and it restricts certain employer interference with those rights.

Turnover rate equals separations divided by average headcount over a period. High clinical turnover drives up recruiting and orientation costs and can directly harm quality and patient safety metrics.

It gathers feedback on an employee, often a manager, from multiple perspectives - supervisors, peers, direct reports, and sometimes patients - producing a more complete picture than a single-rater review.

EMTALA requires any Medicare-participating hospital with an ED to provide a medical screening exam to anyone who arrives and to stabilize any emergency condition found, regardless of the patient's ability to pay or insurance status.

Stark Law prohibits physician self-referral for certain designated health services to entities in which the physician has a financial relationship, and a violation occurs regardless of intent. The Anti-Kickback Statute, by contrast, requires proof of intent to induce referrals.

It imposes civil liability for knowingly submitting false or fraudulent claims for payment to federal programs like Medicare. Violations are frequently reported by whistleblowers under qui tam provisions, which can earn them a share of recovered funds.

Deemed status means a hospital accredited by a CMS-approved body - most often The Joint Commission - is presumed to meet Medicare Conditions of Participation, avoiding a separate state certification survey.

Structure (resources, staffing, facilities), Process (how care is actually delivered), and Outcome (the resulting patient result). Quality problems can originate at any of these three levels.

Improve population health, improve the patient experience of care, and reduce the per capita cost of care. Later frameworks add clinician well-being as a 'Quadruple Aim.'

A never event is a specific, serious, largely preventable error from a standardized list, such as wrong-site surgery. A sentinel event is any unexpected occurrence involving death or serious harm, whether or not it appears on the never-event list.

An RCA works backward from an adverse event to identify the underlying system and process failures that allowed it to occur, so corrective action addresses root causes rather than just the immediate incident.

Product, Price, Place, and Promotion. Healthcare strategic marketing plans define each element to position a service line or facility against competitors.

It systematically reviews external market conditions - competitor activity, demographic shifts, regulatory changes, and payer trends - to inform an organization's strategic direction before finalizing a business plan.

Market demand and feasibility, competitive analysis, an operational plan, and financial projections covering revenue, expenses, and capital needs, used to justify a new service line or capital investment to the board.

Aligning contract terms with organizational strategy and risk tolerance, covering compensation or pricing, term length, and termination and renewal clauses, and, where physicians are involved, compliance with Stark Law and Anti-Kickback Statute safe harbors.

The ability of different EHR and health IT systems to exchange, interpret, and use patient data across care settings and organizations, enabling coordinated care rather than isolated data silos.

The Security Rule applies only to electronic protected health information (ePHI) and requires administrative, physical, and technical safeguards. The Privacy Rule applies to PHI in any form and governs permitted uses and disclosures.

To restore critical clinical and administrative systems, such as the EHR, order entry, and billing, after an outage or cyberattack within a defined recovery time objective, minimizing disruption to patient care.

It lets patients receive consultations, monitoring, and some treatment remotely via video or digital platforms, expanding access, especially in rural areas, while raising new questions about licensure, reimbursement, and data security.

Autonomy (patient self-determination), Beneficence (acting for the patient's benefit), Nonmaleficence (avoiding harm), and Justice (fair distribution of resources and treatment).

It sets the professional standard of conduct for ACHE members, covering responsibilities to patients, the organization, employees, and the community, and it underpins disciplinary action against members who violate it.

Disclose the conflict of interest to the appropriate governance body, such as the board or compliance officer, and recuse themselves from the decision, rather than relying on their own judgment about whether it is material.

Patient populations are increasingly diverse, and failing to account for cultural and linguistic differences in care decisions and communication can create both ethical breaches and quality or disparity problems.

The board holds ultimate legal responsibility for the organization's mission, quality of care, and financial health, and must act in the organization's best interest above personal or competing interests - distinct from management's operational execution role.

Medical staff bylaws set the rules for physician credentialing, privileging, peer review, and medical staff self-governance within a hospital, while corporate bylaws govern the organization's overall governance structure and procedures.

They let the full board delegate focused oversight of a specific domain to a smaller group with relevant expertise, which then reports recommendations back to the full board for final decisions.