CPHQ Exam
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60 questions
| 🇬🇧 | 🇬🇧 |
| Recommendations for improving transitions of care (7) | O IMPROVE COMMUNICATION during transitions between providers, patients, and caregivers o IMPLEMENT EMRs that include standardized medication reconciliation elements o ESTABLISH POINTS OF ACCOUNTABILITY for sending and receiving care, particularly for hospitals and nursing home providers o INCREASE USE OF CARE MANAGEMENT and professional care coordination o EXPAND ROLE OF PHARMACIST in transitions of care o IMPLEMENT PAYMENT SYSTEMS that align incentives and include performance measures to encourage better transitions o DEVELOP PERFORMANCE MEASURES to encourage better transitions of care |
| Recommendations for improving transitions of care (7) | O IMPROVE COMMUNICATION during transitions between providers, patients, and caregivers o IMPLEMENT EMRs that include standardized medication reconciliation elements o ESTABLISH POINTS OF ACCOUNTABILITY for sending and receiving care, particularly for hospitals and nursing home providers o INCREASE USE OF CARE MANAGEMENT and professional care coordination o EXPAND ROLE OF PHARMACIST in transitions of care o IMPLEMENT PAYMENT SYSTEMS that align incentives and include performance measures to encourage better transitions o DEVELOP PERFORMANCE MEASURES to encourage better transitions of care |
| Recommendations for improving transitions of care (7) | O IMPROVE COMMUNICATION during transitions between providers, patients, and caregivers o IMPLEMENT EMRs that include standardized medication reconciliation elements o ESTABLISH POINTS OF ACCOUNTABILITY for sending and receiving care, particularly for hospitals and nursing home providers o INCREASE USE OF CARE MANAGEMENT and professional care coordination o EXPAND ROLE OF PHARMACIST in transitions of care o IMPLEMENT PAYMENT SYSTEMS that align incentives and include performance measures to encourage better transitions o DEVELOP PERFORMANCE MEASURES to encourage better transitions of care |
| Recommendations for improving transitions of care (7) | O IMPROVE COMMUNICATION during transitions between providers, patients, and caregivers o IMPLEMENT EMRs that include standardized medication reconciliation elements o ESTABLISH POINTS OF ACCOUNTABILITY for sending and receiving care, particularly for hospitals and nursing home providers o INCREASE USE OF CARE MANAGEMENT and professional care coordination o EXPAND ROLE OF PHARMACIST in transitions of care o IMPLEMENT PAYMENT SYSTEMS that align incentives and include performance measures to encourage better transitions o DEVELOP PERFORMANCE MEASURES to encourage better transitions of care |
| Recommendations for improving transitions of care (7) | O IMPROVE COMMUNICATION during transitions between providers, patients, and caregivers o IMPLEMENT EMRs that include standardized medication reconciliation elements o ESTABLISH POINTS OF ACCOUNTABILITY for sending and receiving care, particularly for hospitals and nursing home providers o INCREASE USE OF CARE MANAGEMENT and professional care coordination o EXPAND ROLE OF PHARMACIST in transitions of care o IMPLEMENT PAYMENT SYSTEMS that align incentives and include performance measures to encourage better transitions o DEVELOP PERFORMANCE MEASURES to encourage better transitions of care |
| NA | NA |
| Recommendations for improving transitions of care (7) | O IMPROVE COMMUNICATION during transitions between providers, patients, and caregivers o IMPLEMENT EMRs that include standardized medication reconciliation elements o ESTABLISH POINTS OF ACCOUNTABILITY for sending and receiving care, particularly for hospitals and nursing home providers o INCREASE USE OF CARE MANAGEMENT and professional care coordination o EXPAND ROLE OF PHARMACIST in transitions of care o IMPLEMENT PAYMENT SYSTEMS that align incentives and include performance measures to encourage better transitions o DEVELOP PERFORMANCE MEASURES to encourage better transitions of care |
| What is the Board of Directors role in Quality? | 1. Set policy 2. Financial and strategic direction 3. Quality of Care 4. Goals and objectives (Should establish quality priorities ALONG with management and medical staff) |
| Which of these is the BOD's role in Quality? Set policy Financial and strategic direction Implementing Strategies Quality of Care Collecting quality measure indicators Goals and objectives | • Set policy • Financial and strategic direction • Quality of Care • Goals and objectives |
| What is the role of leadership? | Develop vision and align subsystems to cope with change |
| What is the role of management? | Plan and budget to cope with change |
| Mission | Organization’s purpose or reason for existence; why are we here? • Builds org direction Ex) ACS’s Mission is to save lives, celebrate lives, and lead the fight for a world without cancer. |
| Vision | Organization’s statement of its goals for the future (It LOOKS with VISION into the FUTURE) • Guides org direction • Core values help direct vision |
| Core values | Define organization’s attitudes and helps direct vision Ex) ACS’s core values are Integrity, Compassion, Courage, Determination, Diversity. |
| Goals | Board, general statements specifying a purpose or desired outcome • May be more abstract than objectives • One goal can have several objectives • SMART goals: Specific, Measurable, Actionable, Relevant, Timebound |
| Objectives | Specific statements that detail how goal(s) will be achieved through specific and measurable actions; Relatively narrow and concrete |
| Voice of the Customer (VOC) | A process conducted at the start of any new product, process or service design initiative to understand better the customer’s wants and needs |
| 4 aspects of VOC | O Customer needs o Hierarchical structure o Priorities o Customer perceptions and performance |
| How do you construct VOC research? | 1. Identify customers of a process output 2. Develop a list of questions to ask customers about the process and their needs 3. Refine the list to use with the process review and improvement |
| Goals of strategic planning (6) | • Create a framework for operations • Create a fit with external environment • Establish process for coping with change and renewal • Foster anticipation, innovation, and excellence • Facilitate consistent decision making • Create an organizational focus |
| Hoshin Planning | A Japanese term that means policy deployment • One approach for integration in a quality, safety, and performance improvement system • Used to ensure that the vision set forth by top management is being translated into planning objectives and actions that both management and employees will take to accomplish long-term organizational strategic goals |
| Balanced Scorecard | Views organization from multiple perspectives• 4 perspectives of measurement |
| Population Health | Outcomes for a group of individuals |
| Population Health Management (PHM) | Improving health within and across populations of patients who have/are at risk for chronic disease • Cornerstone of value-driven healthcare • Value defined as outcomes achieved for cost expended • Involves gaining understanding of clinical and social determinants of health of population/subpopulation and associated risks • Enables appropriate allocation of resources for greatest benefit to entire population |
| Transitions of Care | Occurs when a patient moves from one healthcare provider or setting to another EXAMPLES: - Sharing patient hx and vitals during transfer from nursing home to hospital - Hospital sharing pt. information on hospital stay with home health service |
| Recommendations for improving transitions of care (7) | O IMPROVE COMMUNICATION during transitions between providers, patients, and caregivers o IMPLEMENT EMRs that include standardized medication reconciliation elements o ESTABLISH POINTS OF ACCOUNTABILITY for sending and receiving care, particularly for hospitals and nursing home providers o INCREASE USE OF CARE MANAGEMENT and professional care coordination o EXPAND ROLE OF PHARMACIST in transitions of care o IMPLEMENT PAYMENT SYSTEMS that align incentives and include performance measures to encourage better transitions o DEVELOP PERFORMANCE MEASURES to encourage better transitions of care |
| Handoffs | Real-time process of passing patient-specific information from one caregiver to another or from one team of caregivers to another for the purpose of ensuring the continuity and safety of the patient’s care EXAMPLES: - Sharing vital signs and care with the care providers on the next shift - Sharing patient hx when transferring to a new unit |
| What information should handoffs include? | O Patient history o Health rhythm o Infections o Complications o Need for restraints |
| Name 5 people frequently involved in care transitions | Patient Family/caregiver Nurses Social workers Case managers Pharmacists Physicians Other providers |
| Episode of care | All the care a patient receives during treatment for a specific illness, condition, or medical event EXAMPLES: - Cardiac specialist called in to provide consultation on cardiac issues with a surgical patient - Provide patient information to a dietician consulted about patient who is losing weight after a procedure |
| Managed healthcare | System of healthcare delivery to manage cost, quality, and access to healthcare |
| Name the 7 types of reimbursement | Fee-for-service: Providers receive payment for each service provided Traditional Retrospective Payment: Pays providers after services have been provided Managed Care Reimbursement: Third Party payers manage cost of healthcare and episodes of care Episode of Care Reimbursement: Providers receive one lump sum for all services related to a condition/disease Capitation: Third party payer reimburses providers a fixed per capita amount for a period (PMPM or Per Member Per Month) Prospective Payment: Payment rates established in advance for a specified time period; pre-determined rates based on average levels of resource use (DRGs) Pay for Performance: Provides bonus to health care providers if they meet or exceed agreed upon quality or performance measures |
| Fee-for-Service | Providers receive payment for each service provided |
| Traditional Retrospective Payment | Pays providers after services have been provided |
| Managed Care Reimbursement | Third Party payers manage cost of healthcare and episodes of care |
| Episode of Care Reimbursement | Providers receive one lump sum for all services related to a condition/disease |
| Capitation | Third party payer reimburses providers a fixed per capita amount for a period (PMPM or Per Member Per Month) |
| Prospective Payment | Payment rates established in advance for a specified time period; pre-determined rates based on average levels of resource use (DRGs) |
| Pay for Performance | Payment rates established in advance for a specified time period; pre-determined rates based on average levels of resource use (DRGs) |
| Patient Protection and Affordable Care Act (PPACA) Goals (3) | O Give more individuals access to affordable, quality health insurance o Reduce the growth in health care spending in the country o Expand affordability, quality, and availability of private and public health insurance though consumer protections, regulations, subsidies, taxes, insurance exchanges, and other reforms |
| Types of Provider Networks (3) | Health Maintenance Organization (HMO) Preferred Provider Organization (PPO) Exclusive Provider Organization (EPO) |
| Health Maintenance Organization (HMO) | O Members need to receive most or all care from network provider o Select PCP responsible for managing and coordinating all healthcare o PCP provides referrals to network specialists or laboratory or radiology test o Members pay for using providers outside the network |
| Preferred Provider Organization | O Health plan contracts with a network of preferred providers from which to choose o Do not need to select PCP o Do not need referrals to see other network providers o Only responsible for annual deductible and copay for visit o Pay higher amount if using providers out of network |
| Exclusive Provider Organization | O Network of individual medical care providers or groups of medical care providers who have entered into a written agreement with an insurer to provide health insurance to subscribers o Must receive care exclusively from healthcare providers with EPO contracts of EPO won’t pay o Services limited to medically necessary or preventive care |
| Purpose of Credentialing physicians | • Encompasses practitioners, privileges, place • Provides protection from - Incompetent or unlicensed professionals or orgs - Liability claims |
| Required credentialing elements | 1. Current licensure or certification 2. Specific relevant training 3. Peer or faculty recommendation - Medical/clinical knowledge - Technical/clinical skills - Clinical judgement - Interpersonal and communication skills - Professionalism 4. Evidence of physical ability to perform requested privilege |
| Privileges and types of privileges (5) | Defines what a practitioner can do in a specific healthcare org and reflect their training, experience, and qualifications 1. Provisional 2. Active 3. Consulting 4. Temporary 5. Emergency |
| Provisional privileges | Enables someone to practice as a health care provider, with certain restrictions imposed. - Applies to individuals who do not meet the requirements for full credentialing. |
| Active privileges | Granted based on education, training, experience, and recommendation of the Credentialing Committee/Medical Staff to the governing body. - Privileges periodically reviewed - Have to work within the scope of their privilege criteria |
| Consulting privileges | Privileges may be granted to medical staff members who may respond to requests from attending physicians or department chairs for consultations in their area of specific clinical expertise. |
| Temporary privileges | May be granted when an applicant is awaiting review and approval by the medical executive committee (MEC) and the governing body to fulfill important patient care, treatment, or service needs. o Last no longer than 120 days o Must be granted by the hospital CEO |
| Emergency privileges | Granted during disasters to volunteer Licensed Independent Practitioners (LIPs) when the Emergency Operations Plan has been activated in response to a disaster and the hospital is unable to meet immediate patient needs. |
| Credentialing Process | 1. Application 2. Primary Source Verification 3. Privileges Selected 4. Department Head Review 5. Credentialing Committee Review 6. Medical Executive Committee Review 7. Governing Board Review and Approval |
| Focused Professional Practice Evaluation (FPPE) | Time-limited process for organization to evaluate and confirm current competence for initially requested privileges. Purpose: demonstrate competency in delivering safe, effective care - Provides a method for establishing a monitoring plan specific to a requested privilege and determining the duration of performance monitoring Occur at 3 times: - At time of initial appointment to medical staff - At time of new privileges - Provider-specific issues affecting provision of safe, effective patient care |
| Ongoing Professional Practice Evaluation (OPPE) | Purpose: To demonstrate ongoing competency in delivering safe, effective care - Used to determine whether to continue, limit, or revoke existing privileges Like a report card to help practitioner improve patient care Compares performance to criteria to identify opportunities for improvement |
| The Joint Commission | Improves safety of care using accreditation and certification as risk reduction activities |
| National Committee for Quality Assurance (NCQOA) | Dedicated to improving healthcare quality and driving improvement through the healthcare system |
| Det Norske Veritas (DNV) GL - Healthcare | Accreditation program CMS-approved to accredit hospitals and critical access hospitals and acquire ISO 9001 certification by 4th year; risk management and TA |
| International Organization for Standardization (ISO) | Developer of voluntary international standards for products, services, and good practice |
| Accredidation Association of Ambulatory Health Care (AAAHC) | Exclusive focus on ambulatory healthcare |