DHCA Doctor Exam cheat sheet

Governing board fiduciary duties: duty of care, duty of loyalty, and duty of obedience to the organizational mission.

Board retains authority over mission, CEO selection, budget approval, and quality oversight; management handles day-to-day operations.

Conflict-of-interest policy requires disclosure, recusal from deliberation and vote, and documentation in board minutes.

Sarbanes-Oxley-style governance norms for nonprofits: independent audit committee, whistleblower channel, document retention policy.

Span of control: number of direct reports per manager; wider spans suit routine standardized work, narrower spans suit complex clinical work.

Leadership contingency theory (Fiedler): effectiveness depends on match between leader style and situational favorability, not a single best style.

Transformational leadership components: idealized influence, inspirational motivation, intellectual stimulation, individualized consideration.

Quorum is the minimum number of members who must be present to transact official business; defined in bylaws, not by majority of attendees.

EMTALA requires a medical screening exam and stabilizing treatment for anyone presenting to a Medicare-participating ED, regardless of insurance or ability to pay.

HIPAA Privacy Rule permits disclosure for treatment, payment, and operations without authorization; other uses need authorization or a legal exception.

HIPAA Security Rule covers electronic PHI only; requires administrative, physical, and technical safeguards.

Informed consent elements: capacity, disclosure of material risks and alternatives, voluntariness, and documentation.

Four principles of biomedical ethics: autonomy, beneficence, nonmaleficence, and justice.

Anti-kickback Statute prohibits remuneration to induce referrals of federally reimbursed items; Stark Law separately bans physician self-referral for designated health services.

False Claims Act liability attaches to knowingly false claims; qui tam relators may receive a statutory share of recovery.

Medicare Conditions of Participation set minimum health and safety standards that providers must meet to receive payment.

Contribution margin = revenue per unit minus variable cost per unit; used to evaluate service line profitability.

Break-even volume = fixed costs / (price per unit - variable cost per unit).

Days in accounts receivable = (accounts receivable / total charges) x days in period; a core revenue cycle metric.

DRG-based inpatient payment bundles costs by diagnosis-related group; outlier payments adjust for unusually costly cases.

Medicare physician payment uses the Resource-Based Relative Value Scale: payment = (work + practice expense + malpractice RVUs) x GPCI x conversion factor.

Capitation pays a fixed per-member-per-month amount regardless of services used, shifting utilization risk to the provider.

Payer mix is the proportion of revenue from Medicare, Medicaid, commercial, and self-pay sources; it drives margin variability.

Charity care and bad debt are distinct: charity care is provided free to qualifying patients; bad debt is uncollected amounts from patients expected to pay.

Donabedian model: structure (resources), process (what is done), and outcome (results) as the three quality domains.

IHI Model for Improvement: three questions (aim, measures, changes) plus Plan-Do-Study-Act cycles for testing changes.

Six aims of the STEEEP framework: safe, timely, effective, efficient, equitable, and patient-centered care.

Never events are serious reportable events (e.g., wrong-site surgery) that are largely preventable and non-reimbursable.

Root cause analysis is a retrospective, systems-focused method for sentinel events; failure mode and effects analysis is prospective.

Statistical process control distinguishes common-cause variation (inherent to the process) from special-cause variation (assignable, signaled by control-chart rules).

Hand hygiene compliance is a leading process measure for health care-associated infection prevention.

Leapfrog and CMS quality reporting use standardized measures (e.g., HCAHPS, readmission rates) for public transparency.

EHR meaningful use criteria emphasize electronic capture of data, care coordination, and reporting of clinical quality measures.

Interoperability standards: HL7 for messaging, FHIR for modern API-based exchange, DICOM for imaging.

Data governance defines ownership, stewardship, access controls, and quality standards for organizational data assets.

Sensitivity and specificity: sensitivity = true positives / (true positives + false negatives); specificity = true negatives / (true negatives + false positives).

Positive predictive value depends on prevalence; a test with high sensitivity can have low PPV in a low-prevalence population.

Dashboards should align with strategic goals and use consistent definitions for measures to avoid misleading comparisons.

Business intelligence layers: data sources, ETL (extract-transform-load), data warehouse, and visualization/reporting.

Predictive analytics models require validation on separate data to assess generalizability and avoid overfitting.

SWOT analysis: internal strengths and weaknesses; external opportunities and threats.

Porter's five forces for health care: rivalry, new entrants, substitutes, supplier power, and buyer power.

Service line strategy evaluates profitability, growth potential, and mission alignment before investment.

Capacity planning uses demand forecasts and throughput (units per time) to size staffing and beds.

Little's Law: average work-in-process = arrival rate x average time in system; useful for patient flow analysis.

Bottleneck is the constraint with the lowest capacity in a process; throughput is limited by it.

Lean targets waste (waiting, overproduction, defects, transport, inventory, motion, overprocessing); Six Sigma targets variation reduction.

Balanced Scorecard perspectives: financial, customer, internal process, and learning and growth.

Maslow's hierarchy: physiological, safety, belonging, esteem, and self-actualization needs motivate behavior in order.

Herzberg's two-factor theory: hygiene factors prevent dissatisfaction; motivators drive satisfaction.

Expectancy theory: motivation = expectancy x instrumentality x valence; a zero in any term yields zero motivation.

Equity theory: employees compare input/output ratios to referents; perceived inequity motivates corrective behavior.

Job redesign principles (Hackman and Oldham): skill variety, task identity, task significance, autonomy, and feedback drive engagement.

Turnover cost includes recruiting, onboarding, lost productivity, and vacancy coverage; often estimated as a multiple of annual salary.

Structured behavioral interviews improve predictive validity and reduce adverse impact compared with unstructured interviews.

Just culture distinguishes human error (console), at-risk behavior (coach), and reckless behavior (sanction).

Population health management stratifies a population by risk to target interventions to high-need segments.

Social determinants of health include income, education, housing, food security, and neighborhood environment.

Community health needs assessment is required of nonprofit hospitals every three years under the ACA, with an implementation strategy.

Prevalence is the proportion of a population with a condition at a point in time; incidence is new cases over a period.

Attributable risk = incidence in exposed minus incidence in unexposed; population attributable risk accounts for exposure prevalence.

Herd immunity threshold depends on basic reproduction number: threshold = 1 - 1/R0 for a perfectly immunizing infection.

Accountable care organizations share savings when spending and quality targets are met, aligning population health with financial incentives.

Screening programs should target conditions that are common, treatable, and detectable early with acceptable test characteristics.