ABPS Administrative Medicine flashcards
ABPS Administrative Medicine · Build recall with a focused review session.
32 cards. Read the term and the definition here. The deck at the top of this page is optional.
- EMTALA
- Federal law requiring Medicare-participating hospitals with emergency departments to provide a medical screening exam and stabilizing treatment regardless of insurance or ability to pay.
- Accountable Care Organization
- A group of providers jointly accountable for quality and total cost of care for a defined population, eligible for shared savings when benchmarks are met.
- MS-DRG payment
- Prospective inpatient payment that bundles a fixed case rate by diagnosis-related group, with outlier payments for unusually costly cases.
- Donabedian model
- Quality framework evaluating structure (resources), process (care delivery), and outcomes (results); structure and process are proxies for outcomes.
- PDSA cycle
- Rapid-cycle improvement method: Plan a change, Do it on a small scale, Study the results, Act to adopt, adapt, or abandon.
- Just culture
- Safety framework that consoles human error, coaches at-risk behavior, and sanctions reckless behavior, distinguishing system from individual accountability.
- Stark Law
- Strict-liability civil statute prohibiting physician self-referral for designated health services payable by Medicare or Medicaid unless an exception applies.
- Anti-Kickback Statute
- Federal criminal law prohibiting remuneration intended to induce referrals for items or services payable by federal health care programs.
- HIPAA minimum necessary
- Privacy Rule standard requiring that uses and disclosures of protected health information be limited to the minimum needed for the purpose, excluding treatment.
- Break-even volume
- The number of units at which total revenue equals total cost, calculated as fixed costs divided by price minus variable cost per unit.
- Contribution margin
- Revenue minus variable costs; it measures how much each unit contributes to covering fixed costs and generating profit.
- Adverse selection
- A market phenomenon in which sicker individuals disproportionately purchase generous insurance, raising average costs and premiums.
- RVU conversion factor
- A dollar multiplier applied to relative value units (work, practice expense, malpractice) adjusted by geographic indices to set physician payment.
- Situational leadership
- Model matching leader style (directing, coaching, supporting, delegating) to follower readiness and competence for the task.
- Tuckman stages
- Group development sequence: forming, storming, norming, performing, and adjourning, describing how teams mature over time.
- Thomas-Kilmann conflict modes
- Five conflict-handling styles: competing, collaborating, compromising, avoiding, and accommodating; collaborating suits important complex issues.
- Kotter change model
- Eight-step change framework beginning with creating urgency and ending with anchoring new approaches in organizational culture.
- SWOT analysis
- Strategic tool pairing internal strengths and weaknesses with external opportunities and threats to inform strategy formulation.
- Porter five forces
- Framework assessing industry attractiveness via rivalry, new entrants, substitutes, buyer power, and supplier power.
- Balanced Scorecard
- Performance framework with four perspectives: financial, customer, internal process, and learning and growth.
- Little's Law
- Queueing relationship stating average number in a system equals arrival rate multiplied by average time spent in the system.
- FHIR standard
- Modern interoperability standard using RESTful APIs and modular resources to exchange health data across systems.
- Clinical decision support
- EHR tools delivering evidence-based prompts, alerts, or order sets at the point of care to improve decisions and safety.
- CPOE
- Computerized provider order entry allowing clinicians to enter orders electronically, reducing transcription errors and improving medication safety.
- Master patient index
- A database that links patient identities across systems to prevent duplicate records and support data exchange.
- wRVU
- Work relative value unit quantifying physician effort and time for a service, commonly used in productivity-based compensation models.
- Credentialing vs. privileging
- Credentialing verifies training, licensure, and experience; privileging grants permission to perform specific clinical procedures within an organization.
- OPPE
- Ongoing professional practice evaluation: periodic review of a provider's competence and performance using data such as outcomes and complaints.
- Maslach burnout dimensions
- Burnout comprises emotional exhaustion, depersonalization, and reduced personal accomplishment, driven largely by system and workload factors.
- Four ethical principles
- Beauchamp and Childress framework: autonomy, beneficence, nonmaleficence, and justice guide clinical and organizational ethical decisions.
- Substituted judgment
- Surrogate decision standard that asks what the patient would have chosen, based on known values and prior statements.
- Fiduciary duty
- Board and officer obligation to act in the organization's best interest with care and loyalty, avoiding self-dealing and conflicts.