Healthcare Payment Models and Employee Motivation

Payment Methodology

• Value-based purchasing (VBP) is a payment method that holds hospitals accountable for quality and cost of care.
• VBP uses performance measures and incentives to encourage quality care.

Propensity of Insured Patients

• Moral hazard is the tendency of insured patients to utilize more medical services than necessary because insurance covers most of the cost.

Nursing Care Hours/Patient Census (NCH/PPD)

• NCH/PPD is calculated by dividing the total nursing hours worked in 24 hours by the patient census.
• Example: 160 RN hours + 80 CNA hours = 240 total hours; 240 hours / 28 patients = 8.57 NCH/PPD.

Largest Budget Expenditure

• Healthcare has a labor-intensive workforce, and the personnel budget is the largest expenditure.

Capitation

• Capitation is a fixed monthly payment to providers regardless of the services utilized by the patient.

Standard of Excellence

• A standard is a predetermined level of excellence a guide for practice.

McGregor's Theory X

• Theory X managers believe employees avoid work, dislike work, need direction, and are indifferent to organizational needs.
• They require constant direction, supervision, and threats to be motivated.

McGregor's Theory Y

• Theory Y managers believe employees enjoy work, are self-motivated, and willing to work hard to meet personal and organizational goals.

Motivating Staff

• Immediate praise is the best way to motivate staff.

Stretching

• Stretching is energizing people to do things beyond their perceived capability.

Gellerman's Theory Of Stretching

• People should be periodically "stretched" to do tasks more complex than their usual work.

Intrinsic Motivation

• Intrinsic motivation is an internal drive that motivates individuals without external influence.

Performance Appraisal

• Performance appraisals evaluate actual employee performance.
• Appraisals measure an employee's behavior and assess the relevance of the description of the job.

Anecdotal Notes

• Managers should keep ongoing anecdotal notes during the evaluation period.

Halo Effect

• The appraiser may let 1 or 2 positives influence the entire evaluation of an employee's performance.

Horn Effect

• The appraiser may allow some negative aspects of an employee's performance to influence the entire evaluation, affecting the final assessment.

360-Degree Evaluation

• A 360-degree evaluation includes an assessment by all individuals within the employee's sphere of influence.

Chemical Influence of Employee

• If a manager suspects an employee is chemically influenced and poses a patient safety hazard, the first action should be to immediately remove the employee from patient care.

Progressive Discipline

• The second step of progressive discipline involves an informal reprimand.

Enforcing Rules

• Failure to discipline employees who should be disciplined can tarnish the organization's morale.

Delegation Rights

• Five rights of delegation include the right circumstance, right task, right direction, right supervision, and right person.

Decision Making

• Decision making is a cognitive process that involves selecting a specific course of action.

Hawthorne Effect

• People behave differently when they know they are being observed. Behaviors usually improve during observation.

Authoritarian Leadership

• Authoritarian leaders control decisions and don't involve others, and communication flows downward.

Multiple Communication Modes

• Managers should use several methods for important messages to ensure they are understood.

Nurse Advocates

• Nurses act as advocates for their patients.

Nursing Care Hours per Patient per Day

• Decreasing nursing care hours per patient per day may increase patient injuries or errors.

Delegation

• Delegation of a tube feeding to a NAP for a comatose patient is, generally, incorrect.

Moral hazard

• If a patient wants a PET scan because their insurance covers it, this is an example of moral hazard.

Wrong Person Delegation

• Giving a new graduate the responsibilities for tasks that are beyond their skill levels for a specific patient is not appropriate.

Self-care

• A new graduate should practice self-care to avoid burnout.

Management Styles

• Theory Y managers believe employees are self-motivated and creative. This approach is different to Theory X.

Time Management

• Time management courses can help maintain unit productivity standards.

Ethical Dilemmas

• A nurse being forced to provide care that conflicts with their religious beliefs is an example of an ethical dilemma.

Human Capital

• Human capital consists of the individual’s skills and capabilities.

Professional Negligence

• Professional Negligence is the failure of a trained professional to meet expected standards of care.

HIPAA

• Violating HIPAA happens when a nurse shares patient information with a family before discussing it with the patient.

Patient Satisfaction

• Patients are more satisfied when nurses manage their time effectively.

Prioritize Tasks

• Planning priorities for the day can increase productivity.

Communication Methods

• Multiple communication methods are required to assure messages are received.

Critical Pathways

• Critical pathways are evidence-based interventions that help shorten hospital stays.

Financial Management - Budgeting

• Operating budget expenses include salaries, supplies, and other daily expenses.
• The Capital budget is used for purchasing large equipment like renovating facilities, and other investments.
• The personnel budget covers employee salaries and benefits.

Fixed and Variable Expenses

• Fixed expenses, like salaries, do not change with volume. Variable expenses (supplies) may vary.

Cost-Effectiveness

• Cost-effectiveness means ensuring good results for an amount of money spent. This analysis takes factors like duration, need, and availability of other options into account.

Managed Care Pros and Cons

• Managed care is a system integrating care, access, and cost. It utilizes utilization review processes. This will assure payment.
• Capitation is a fixed payment to providers regardless of the services utilized by the patient.
• Disadvantages include loss of physician-patient relationships, limited choice of physicians, and consumer confusion. Lower level continuity of care and reduced physician autonomy are noted in cons.

Prospective Payment System

• Healthcare costs increased leading to a prospective payment system.

McGregor's Theory X & Y

• The attitudes and energy of managers have a direct effect on staff attitudes and productivity.

Employee Motivation

• Motivation is increased when employees trust and respect their managers.
• Clear expectations, fairness, and consistent treatment are essential.
• Encouraging teamwork, recognizing individual employee strengths, and rewarding appropriate behaviors, are ways to motivate employees.

Types of Motivation

• Intrinsic motivation is an internal drive.
• Extrinsic motivation comes from sources outside the individual.

Preventing Burnout

• Organizational climates and staff motivation are important factors.

This quiz covers various aspects of healthcare payment methodologies, including quality of care incentives and service utilization. It also explores employee motivation theories and performance appraisal concepts, providing a comprehensive understanding of both topics.