FAHM cheat sheet

Board fiduciary duties: duty of care (informed, prudent decisions) and duty of loyalty (put the organization's interests first, avoid conflicts).

Governance vs. management: board sets mission, strategy, and policy; executives implement and manage daily operations.

Sarbanes-Oxley-like accountability: nonprofit boards should have audit, compensation, and governance committees; whistleblower protections are expected.

Common governance models: traditional (community board), corporate (smaller, business-focused), and hybrid (combines both).

CEO evaluation should be linked to strategic goals and quality outcomes, not just financial results.

Board development: orientation for new members, continuing education on healthcare trends, and periodic self-assessment.

Conflict-of-interest policy: require annual disclosure and recusal from votes where a conflict exists.

Leadership theories: transformational (inspire shared vision), transactional (rewards and penalties), and servant leadership (focus on follower needs).

Current ratio = current assets / current liabilities; measures short-term liquidity (target often 1.5–2.0).

Days cash on hand = (cash + marketable securities) / (total expenses − depreciation) / 365; measures liquidity in days.

Operating margin = (operating revenue − operating expenses) / operating revenue; indicates core operations profitability.

Debt service coverage ratio = (net income + depreciation + interest) / (principal + interest); measures ability to cover debt payments.

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

Capital budgeting: net present value (NPV) > 0 accept; internal rate of return (IRR) > cost of capital accept; payback period shows time to recover investment.

Cost behavior: fixed costs do not vary with volume; variable costs change with volume; semi-fixed (step) costs change at certain thresholds.

Revenue cycle: charge capture → coding → billing → claims submission → payment posting → denial management → collections.

Medicare inpatient uses MS-DRGs; outpatient uses APC groups; physician services use MPFS (RVUs × conversion factor).

Medicaid is federal-state partnership; reimbursement varies by state and eligibility category.

Commercial payers often use DRG-based or percent-of-charge contracts; value-based contracts tie payment to quality metrics.

Revenue cycle KPIs: days in accounts receivable (A/R), clean claim rate, denial rate, net collection rate, cost to collect.

Charge capture must be timely and accurate; charge master should be reviewed annually for compliance and pricing.

Denial management: categorize denials (clinical, technical, eligibility), appeal promptly, and track root causes.

Payer mix affects revenue: Medicare and Medicaid typically pay less than commercial payers.

Under the ACA, hospitals face readmission penalties and value-based purchasing adjustments based on quality and cost.

HIPAA Privacy Rule: protects PHI; requires minimum necessary use/disclosure; patient rights include access and amendment.

HIPAA Security Rule: requires administrative, physical, and technical safeguards for ePHI.

Anti-Kickback Statute: prohibits remuneration for referrals of federally reimbursed services; safe harbors protect certain arrangements.

Stark Law (Physician Self-Referral): prohibits physician referrals to entities with which they have a financial relationship for designated health services, unless an exception applies.

False Claims Act: prohibits knowingly submitting false claims; qui tam provisions allow whistleblowers to sue on behalf of government.

EMTALA: requires hospitals with emergency departments to provide medical screening exam and stabilizing treatment regardless of ability to pay.

Compliance program elements: written policies, compliance officer, training, monitoring, enforcement, and corrective action.

Fraud and abuse: fraud is intentional deception; abuse is improper practices that may not be intentional.

Donabedian model: structure (resources), process (activities), outcomes (results) for assessing quality.

PDSA cycle: Plan (identify and plan change), Do (implement on small scale), Study (analyze results), Act (adopt or adjust).

Six Sigma: DMAIC (Define, Measure, Analyze, Improve, Control) for process improvement.

Root cause analysis (RCA): structured method to identify underlying causes of adverse events; focuses on systems, not individuals.

Failure mode and effects analysis (FMEA): proactive risk assessment to identify potential failures and their effects.

Leapfrog Group: promotes hospital transparency and safety practices (e.g., computerized physician order entry, ICU staffing).

Never events: serious reportable adverse events (e.g., wrong-site surgery, retained foreign object) that should never occur.

Quality measures: process (e.g., hand hygiene compliance), outcome (e.g., infection rate), and patient experience (e.g., HCAHPS).

EHR vs. EMR: EHR is longitudinal, interoperable, and shared across providers; EMR is a single-provider record.

Data quality dimensions: accuracy, completeness, timeliness, consistency, validity, and granularity.

Health information exchange (HIE): electronic movement of health information among organizations according to national standards.

ICD-10-CM for diagnoses; ICD-10-PCS for inpatient procedures; CPT for outpatient procedures and physician services.

Meaningful Use (now Promoting Interoperability): incented EHR use to improve quality, safety, and efficiency.

Data governance: policies and procedures to ensure data integrity, security, and appropriate use.

Clinical decision support (CDS): provides knowledge and person-specific information to enhance health decisions.

Telehealth modalities: synchronous (real-time), asynchronous (store-and-forward), and remote patient monitoring.

Population health: health outcomes of a group, including distribution of outcomes within the group.

Care management: coordination of services to improve outcomes for high-risk populations; often uses risk stratification.

Social determinants of health (SDOH): conditions where people live, work, and play that affect health (e.g., income, education, housing).

Preventive care: primary (prevent disease), secondary (early detection), tertiary (reduce complications).

Accountable Care Organizations (ACOs): groups of providers accountable for quality and cost of care for a defined population.

Patient-centered medical home (PCMH): team-based primary care model with enhanced access, coordination, and quality.

Risk stratification tools: use data (claims, clinical) to identify patients needing intensive management.

Health promotion: enable people to increase control over and improve their health (Ottawa Charter).

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

SMART goals: specific, measurable, achievable, relevant, time-bound.

Porter's Five Forces: rivalry, threat of new entrants, threat of substitutes, bargaining power of buyers, bargaining power of suppliers.

Balanced Scorecard: four perspectives-financial, customer, internal processes, learning and growth.

Capacity planning: match resources (staff, beds, equipment) to demand; use forecasting and queuing theory.

Lean methodology: eliminate waste (overproduction, waiting, transport, overprocessing, inventory, motion, defects).

Supply chain management: sourcing, procurement, logistics, and inventory control to ensure timely availability at optimal cost.

Project management: define scope, schedule, budget; use Gantt charts and critical path method.

Job analysis: systematic process of gathering information about a job (tasks, duties, responsibilities) to create job descriptions.

FTE (full-time equivalent): 1.0 FTE = 40 hours per week; used for staffing and budgeting.

Recruitment and selection: job posting, screening, interviewing, background checks, and onboarding.

Performance appraisal methods: graphic rating scales, behaviorally anchored rating scales (BARS), 360-degree feedback.

Employee engagement: emotional commitment to the organization; linked to retention and productivity.

Labor relations: collective bargaining, grievance procedures, and adherence to labor laws (e.g., NLRA).

Training and development: needs assessment, program design, implementation, and evaluation (Kirkpatrick model: reaction, learning, behavior, results).

Compensation: base pay, incentives, benefits; must comply with Fair Labor Standards Act (FLSA) for overtime and minimum wage.

Four principles of biomedical ethics: autonomy (respect patient choices), beneficence (do good), nonmaleficence (avoid harm), justice (fairness).

Informed consent: patient must be competent, receive adequate information, understand, and voluntarily consent.

Health equity: attainment of highest level of health for all people; requires addressing avoidable inequalities.

Cultural competence: ability to understand and interact effectively with people from different cultures.

Patient engagement: patients involved in decision-making and care design; improves outcomes and satisfaction.

Shared decision-making: clinician and patient collaborate to make healthcare decisions using evidence and patient preferences.

Advance directives: living will, durable power of attorney for healthcare; guide care when patient lacks capacity.

Health literacy: degree to which individuals can obtain, process, and understand health information to make decisions.