Health Care Delivery Systems and Operations
Core content
Know the structural landscape: payers (Medicare, Medicaid, commercial, self-insured employers), delivery models (fee-for-service, capitation, bundled payments, accountable care organizations), and the shift from volume to value-based purchasing. Understand EMTALA as an unfunded federal mandate governing medical screening examination and stabilization/transfer, and its interaction with COBRA/EMTALA-type transfer rules and on-call obligations. Know HIPAA privacy/security basics, meaningful use/interoperability, and the HITECH breach-notification framework.
Operations content centers on flow: input–throughput–output, Little's Law (L = λW), queueing theory (arrival variability, utilization, and wait times), boarding and crowding metrics (e.g., ED occupancy, LOS, LWBS), and front-end design (triage models, provider-in-triage, split-flow). Understand lean concepts (value, waste, standard work, PDSA), six sigma (DMAIC), and constraint theory (identify and exploit the bottleneck). Know surge capacity tiers, disaster triage (START), and hospital incident command structures.
Traps
Questions conflate crowding (a system state) with boarding (a specific output-blocking phenomenon), or misapply Little's Law by mixing units. EMTALA stems often hinge on whether a medical screening examination occurred and whether transfer was appropriate (stabilized or benefit outweighs risk, with qualified receiving facility and acceptance).
Worked example / rule of thumb
If 60 patients are in the ED and average length of stay is 3 hours, Little's Law gives arrival rate λ = L/W = 60/3 = 20 patients/hour. Rule of thumb: when utilization exceeds ~85%, waits rise nonlinearly - protect the bottleneck (inpatient beds, imaging, or provider throughput) rather than adding upstream capacity.