LTC exam 2 terms and questions
1. competition: rivalry between two or more businesses striving for the same cus- tomer or market
2. background LTC: environment: -increased demand
- availability of services
- consumer expectations
3. background: financing: - pressures to reduce costs
- introduction and growth of managed care
4. sources of competition: - other providers of the same type
- other types of LTC providers
- other health care providers
5. why is LTC more competition-driven?: increased managed care and private LTC insurance
6. what are the effects of competition?: - new opportunities for some providers, threats to others
who do not compete
- more large, multi-unit chains and fewer stand alone providers
- more cooperation and integration
7. cooperation: an agreement that provides benefits for all involved (transfer/refer- ral agreements,
shared purchasing)
- not highly formalized
8. integration: more formal than cooperation (mergers, contracts, alliances)
- seeks organizational efficiency
- terminology is inconsistent
9. horizontal integration: multiple providers of the same level of care
10. vertical integration: multiple providers, different levels of care
11. what are the reasons for integrating: - economies of scale
- gaining market share
- increased bargaining power with payers
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,- protection from competitors
12. what are the benefits of integrating for consumers?: - larger range of ser- vices
- better access to and availability of services
- coordinated referrals and information
- a true continuum
13. what are the external controls of LTC: public
- results from passages of laws
- non voluntary and imposed by government agencies private
- provided by nongovernment agencies or organizations
- compliance is voluntary
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, 14. public control mechanisms: a legislative body enacts a law (vague) and a government agency
enacts regulations (specific) to implement the law
- regulations cover organizations providers and individual employees
- LTC is highly regulated
15. why is LTC highly regulated? and by whom?: Health and Human Services, CMS
- dealing with a vulnerable population
- involves government financing
- poor past performance
16. what are the two main areas of regulatory focus?: -quality via the survey process
- payment via eligibility criteria and reimbursement rates
17. who are the main sources of regulation at the federal level?: - Medicare, Medicaid, and
OBRA
18. Omnibus Budget Reconciliation Act (1987): - discouraged use of restraints
- increased minimum staffing levels
- improved training requirements for CNAs
- required a resident assessment process
- implemented resident rights
19. what are nursing regulations in compliance with?: "requirements of partici- pation" for federal
certification for Medicare and Medicaid
- state licensing regulations
- staffing requirements
20. "substantial compliance": violation of a standard should not endanger the health and safety of
a resident
21. Other regulations not specific to LTC: HIPAA, EEOC, FLSA, FMLA
- life safety code
-ADA
-OSHA
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1. competition: rivalry between two or more businesses striving for the same cus- tomer or market
2. background LTC: environment: -increased demand
- availability of services
- consumer expectations
3. background: financing: - pressures to reduce costs
- introduction and growth of managed care
4. sources of competition: - other providers of the same type
- other types of LTC providers
- other health care providers
5. why is LTC more competition-driven?: increased managed care and private LTC insurance
6. what are the effects of competition?: - new opportunities for some providers, threats to others
who do not compete
- more large, multi-unit chains and fewer stand alone providers
- more cooperation and integration
7. cooperation: an agreement that provides benefits for all involved (transfer/refer- ral agreements,
shared purchasing)
- not highly formalized
8. integration: more formal than cooperation (mergers, contracts, alliances)
- seeks organizational efficiency
- terminology is inconsistent
9. horizontal integration: multiple providers of the same level of care
10. vertical integration: multiple providers, different levels of care
11. what are the reasons for integrating: - economies of scale
- gaining market share
- increased bargaining power with payers
1/
18
,- protection from competitors
12. what are the benefits of integrating for consumers?: - larger range of ser- vices
- better access to and availability of services
- coordinated referrals and information
- a true continuum
13. what are the external controls of LTC: public
- results from passages of laws
- non voluntary and imposed by government agencies private
- provided by nongovernment agencies or organizations
- compliance is voluntary
2/
18
, 14. public control mechanisms: a legislative body enacts a law (vague) and a government agency
enacts regulations (specific) to implement the law
- regulations cover organizations providers and individual employees
- LTC is highly regulated
15. why is LTC highly regulated? and by whom?: Health and Human Services, CMS
- dealing with a vulnerable population
- involves government financing
- poor past performance
16. what are the two main areas of regulatory focus?: -quality via the survey process
- payment via eligibility criteria and reimbursement rates
17. who are the main sources of regulation at the federal level?: - Medicare, Medicaid, and
OBRA
18. Omnibus Budget Reconciliation Act (1987): - discouraged use of restraints
- increased minimum staffing levels
- improved training requirements for CNAs
- required a resident assessment process
- implemented resident rights
19. what are nursing regulations in compliance with?: "requirements of partici- pation" for federal
certification for Medicare and Medicaid
- state licensing regulations
- staffing requirements
20. "substantial compliance": violation of a standard should not endanger the health and safety of
a resident
21. Other regulations not specific to LTC: HIPAA, EEOC, FLSA, FMLA
- life safety code
-ADA
-OSHA
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