Master 5306 Set
Defining QUALITY
"The degree to which health services for individuals and populations increase the likelihood of desired health outcomes and are consistent with current professional knowledge." -Institute of Medicine (IOM)
EVIDENCE-BASED MANAGEMENT
"The systematic application of the best available evidence to the evaluation of management strategies for improving organizational performance" - Hsu et al., 2006
public health
"What society does collectively to assure the conditions for people to be healthy" (IOM) The science, practice, and art of protecting & improving the health of populations Historically focused on sanitation & environment Later on communicable diseases, health behavior Late 20th century, last-resort provider of indigent care With the ACA, new focus on prevention
The roles and responsibilities of health services administrators include:
- leadership and strategic direction - Departmental management - program oversight
Part C of medicare specifially covers
--> NONE OF THE FOLLOWING rehab services; preventative care; prescription drugs
Which of the following can be considered an environmental factor contributing to health status?
-Access to health care -Air quality -Safety of neighborhoods
CHARACTERISTICS OF THE US HEALTH SYSTEM
-Based on actuarial principles -Not an NHS or NHI system -Patchwork of public & private insurance -Systems Framework: Inputs Outputs
Providers and health care professionals face pressures to
-Contain costs -Accept lower fees -Provide higher quality at a greater value -Provide better patient experiences
ROLE OF THE US FEDERAL GOVERNMENT IN HEALTH CARE:
-Develop national health policies -Provide health insurance for poor, disabled, & elderly -Provide care for certain groups (e.g., veterans) -Formulate tax policies favorable to employer health insurance -Fund physician training -Fund Medicaid programs -Administer Medicaid programs -License health care providers -Provide care (operate facilities for mentally ill) -Own, manage & operate public hospitals -Develop & enforce public health codes
The elements of the Epidemiology Triangle of disease occurrence
-Environment -Agent -Host
ACA goals
-Establish consumer rights & protections -Provider more affordable coverage -Improve access to care -Strengthen Medicare
A multiple payer system is more cumbersome than a single payer system:
-Government programs require extensive documentation proving services were provided before paying providers -There are numerous health plans, which is difficult for providers to handle -Payments are not standardized across health plans
Primary care is:
-Holistic -The portal to the healthcare system -Longitudinal
A free market in healthcare requires:
-Independent actions between buyers (patients) and sellers (providers) -Adequate information for patients -Unencumbered interaction of the forces of supply and demand
The roles and responsibilities of health services administrators include:
-Leadership and strategic direction -Program oversight -Departmental management
Essential Health Benefits
-Outpatient care (ambulatory patient services) - emergency services -hospitalizations -maternity and newborn care -mental health services and addiction treatment -prescription drugs -Rehabilitative services and devices -lab services -Preventive and wellness services, and chronic disease treatment -pediatric services
The primary functions of managed care.
-Setting prices at which providers are paid -Achieving efficiencies -Controlling patients' utilization of services
The limitations of market justice
-Society is not always protects from the consequences of ill health -Social problems are not adequately addressed -It leads to inequitable access to health care
Medicare
-covers all elderly, nonelderly disabled on social security, and nonelderly with end stage renal disease -no income/means test -no class distinction -Part A for hospitalization and short-term nursing home stay -Part B for physician and other outpatient services -nationally uniform federal program -title 18 of social security act -part a financed through payroll tax paid by employees, employers, and self-employed -part b paid by general taxes and participants pay part of premium
Medicaid
-covers only the very poor -income test -public welfare -all services covered under one program -varies state to state -title 19 of social security act -financed by states with matched federal funds according to state's per capita income
CHALLENGES IN SERVICE DELIVERY AND PAYMENT:
-fragmented delivery system -silo structures -volume vs. value -reactive vs. preventative care
The wellness model is built on:
-intervention -adequate public health and social services -understanding risk factors
The number of specialists is increasing because
-specialists earn more than primary care physicians -The development of medical technology -Demand for specialists' services in high
Managed Care
-specialized payment approach Prepaid health plans Preferred Provider Organizations (PPOs) Accountable Care Organizations (ACOs) Consumer-driven health care & high deductibles
Diagnosis-related groups (DRG)
-specialized payment approach Prospective payment for hospital care Prospective rates for physician payments
Main reasons for the high cost of health care:
-third party payment -growth of technology -increase in elderly population -medical model of healthcare delivery -multipayer system and admin costs -defensive medicine -waste and abuse -practice variations
Defining Characteristics of the U.S. Health Care System
1. Disorganization & lack of coordination 2. Tension between "the free market" and "government control" 3. Public Health vs. Medical Care System 4. Economic & social determinants of health 5. Emergence of new technology & drugs 6. Dysfunctional payment system
According to the CDC, approximately what percentage of premature deaths in the U.S. population can be attributed to inadequate access to medical care?
10%
for medicare beneficiaries the max stay in an SNF during a benefit period cannot exceed
100 days
Healthcare accounts for ____% of jobs
13%
5. __% of GDP is spent on health care.
17%
Approximately what percentage of GDP is spent on health care?
17%
The health care sector constituted what percentage of the U.S. gross domestic product in 2005?
17%
1940s and 50s
1940s & 1950s The rise of employer-sponsored health insurance Major federal investment in research & hospitals President Truman called for universal coverage "Welfare medicine" bill passed
Per capita health care spending, 1963 vs. 2012
1963: $1440 (adjusted for inflation) 2012: $9,000 A 550% increase
Healthcare accounts for _____% of GDP.
20%
____% of Americans use 80% of all health care expenditures in a given year
20%
CHIP is available to children without any health insurance in families whose incomes are at or below ____ of the federal poverty level.
200%
ACA Limitations:
24 million people remained uninsured Many states opted out of Medicaid expansion Does not cover undocumented immigrants Burden placed on safety-net hospitals Neglect of social services
After posting your initial introduction, how many responses must be submitted to other students' responses to receive full credit for the assignment
3
Medicare Part A coverage is limited in that a long-term care resident must first qualify with a minimum of a _____ hospital stay.
3-day
Families with incomes ___% of FPL eligible for subsidies.
400%
to purchase private insurance through an exchange premium subsidies are made available to people with incomes up to
400% federal poverty line
Approximately how many emergency departments exist in the US?
4000
Public (government) share of the total health care spending in the United States is approximately
45%
public/government share of the total health care spending in the US is approximately
45%
_____ million uninsured prior to ACA.
46 million
what criterion does ACA use to classify an employer as a large employer
50 or more full time employees
a. 2. ___% of Americans are living with chronic disease
50%
by law federal matching funds to the states for medicaid cannot be less than
50%
To be called a hospital, a facility must have at least ____ beds.
6
According to federal regulations, the care plan should be completed within _______ of the comprehensive assessment.
7 days
POSITIVE RESULTS OF THE ACA
8 to 11 million formerly uninsured gained coverage in 2014 ½ in Medicaid Modest contribution to slowing of growth of health care costs Expansion of Accountable Care Organizations
Optimum health exists when:
A person is free of symptoms A person does not require medical treatment
What is meant by the term"continuum of health care services"?
A range of health care services that go beyond what hospitals and physicians provide
Which health care system model is funded by progressive tax-financing, with the government acting as the single insurer and payer? • A. Beveridge model • B. Bismarck model • C. National health insurance • D. Private health insurance
A. Beveridge model
Which of the following terms describes a network of health care providers and organizations that provides and facilitates coordinated, ongoing health care services? A. Integrated delivery system (IDS) B. Health maintenance organization (HMO) C. Preferred provider organization (PPO) D. Department of Health and Human Services (DHHS)
A. Integrated delivery system (IDS)
Which federal program is a collection of 50 state-administered programs, each providing health insurance to low-income state residents, but with differing eligibility rules, benefits, and payment schedules? • A. Medicaid • B. Medicare • C. CHIP • D. Affordable Care Act
A. Medicaid
What was the main consequence of early proprietary medical schools, as opposed to state-sponsored schools, in the preindustrial era? • A. Standards were low. • B. The cost of medical education became too high. • C. Medical education became regulated. • D. Science and research became part of medical education
A. Standards were low.
The majority of beneficiaries receiving health care through Medicare are • A. elderly • B. disabled • C. financially poor • D. those suffering from end-stage renal disease
A. elderly
What makes up the "Iron Triad" of healthcare?
Access Cost Quality
STATE GOVERNMENT'S ROLE IN THE HEALTHCARE SYSTEM
Administers and funds the Medicaid program License health care providers Regulate private health insurers Operate facilities for the mentally ill and developmentally disabled
5 A's
Ask Advise Agree Assist Arrange follow-up
Title VII- Improving Access to Innovative Medical Therapies
Attempt to end anti-competitive behavior by pharmaceutical companies (such as keeping generic drugs off the market)
HEALTH CARE SPENDING GROWTH
Average annual growth of health care spending: 9.5% National health expenditures are evaluated by annual changes in the consumer price index (CPI) Nominal GDP growth: 6.8%
Life expectancy and infant mortality are effective measures of comparative healthcare systems. A. True B. False
B. False
The Patient Protection and Affordable Care Act will achieve universal coverage in the United States. A. True B. False
B. False
Which of the following is a characteristic of the U.S. health care system? A. It has a strong central governing agency. B. It is technology-oriented and emphasizes acute care. C. It operates under a pure market justice system. D. Access to health care is equitable and universal.
B. It is technology-oriented and emphasizes acute care.
Supplier-induced demand is created by: • A. Patients • B. Providers • C. Health insurance companies • D. The government
B. Providers
Among OECD nations, which country had the highest per capita health care spending when adjusted for purchasing power parity? • A. United Kingdom • B. United States • C. Germany • D. France
B. United States
NHI Systems
Based on model devised by Bismarck Most financing from payroll taxes Significant variations in financing & organization Core of care is delivered by private providers Found in Germany, Canada & France
THREE DIMENSIONS OF QUALITY:
Based on the Donabedian Quality of Care Framework: 1.Structure Facilities & health care professionals Measure: presence of equipment, credentials 2. Process Set of services provided Measure: % of patients who receive a service 3. Outcomes End results experience by people Measure: results of service
NHS Systems
Based on the UK model devised by Lord Beveridge Public & government managed Most providers are government employees Most medical institutions are operated by the government Most financing from general revenue taxes Some private funding (particularly in Italy & Spain) Found in the UK, Sweden, Norway, Finland, Denmark, Portugal, Spain, Italy, & Greece
What is the main force that prevented a govt-run national health care program from becoming a reality in the US?
Beliefs and values
1920s
Blue Cross created to fund care for the middle class Private insurance industry emerged
Emergency departments, in most cases, are equipped to provide:
Both secondary and tertiary care services
Emergency departments, in most cases, are equipped to provide:
Bothe secondary and tertiary care services
What percentage of gross domestic product were U.S. national health expenditures in 2008? • A. 7.2% • B. 10.5% • C. 16.2% • D. 20.5%
C. 16.2%
Which of the following statements correctly characterizes the current U.S. Health Care System? A. The Affordable Care Act has resulted in comprehensive reform. B. Government health care spending has been limited to filling in where the private sector has not functioned. C. Because health insurance covers minor services, such as colds, enrollees tend to rely on the system much more than they would if those services were not covered. D. Package pricing covers all services an enrollee may need throughout one year.
C. Because health insurance covers minor services, such as colds, enrollees tend to rely on the system much more than they would if those services were not covered.
Which of the following is a characteristic of a national health insurance system? • A. The government finances health care through general taxes • B. Health care is delivered by private providers • C. Both a and b • D. Neither a nor b
C. Both a and b
Which federal health program was enacted with bipartisan support due to the fact that it provides health insurance for children, who are considered a deserving group? • A. Medicaid • B. Medicare • C. CHIP • D. Affordable Care Act
C. CHIP
Medical care in preindustrial America had a strong _____ character. • A. scientific • B. professional • C. applied • D. domestic
C. applied
How is community-oriented primary care (COPC) different from primary care?
COPC adds a population-based approach to identifying and addressing community health problems
How is community-oriented primary care (COPC) different from primary care?
COPC adds a population-based approach to identifying and addressing community health problems.
The roles of the exchanges
Calculate the amount of subsidy for a given family Explain features of each private insurance offering Link each family to insurance to the insurance option selected
regulatory tools
Call on government to prescribe and control the behavior of a target group by monitoring the group and imposing sanctions if it fails to comply
There are three categories of the cost-effectiveness of medical technologies:
Category I Highly cost-effective for most patients; e.g. antibiotics, improved health behaviors, vaccines Category II Potentially cost-effective depending on patient; e.g. angioplasty, imaging technologies Category III Uncertain cost-effectiveness; e.g. surgeries designed to treat quality of life
The federal agency within the Department of Health and Human Services responsible for administering Medicare programs related to home health is the ____________________________.
Centers for Medicare & Medicaid Services (CMS)
The ACA specifies that ________ can be covered under their parents' health insurance plans.
Children under the age of 26
____ disease are the leading causes of illness (morbidity) & death (mortality).
Chronic
Title IX- Revenue Provisions...addresses how the provisions of the law will be paid for
Close tax loopholes Health industry fees
Insurance requires cost sharing to control health care utilization:
Coinsurance Deductible Copayment Stop-loss provision (out-of-pocket limits)
The ownership of Canada's health care system is best described as:
Combination of private and public
Which particular skill is fundamental to the delivery of patient-centered care?
Communication
EXAMPLES OF FEDERALLY QUALIFIED HEALTH CENTERS (FQHC):
Community health centers Health care for the homeless centers Public housing primary care centers Migrant health centers
When patients have multiple health problems, this is called:
Comorbidity
Initially, what was the main purpose of private health insurance in the US?
Compensate for loss of income during sickness and temporary disability
Which accrediting agency for organizations that provide services to individuals with intellectual disabilities is sponsored by the American Association on Intellectual and Developmental Disabilities, American Network of Community Options and Resources, The Arc, Autism Society of America, Mosaic, National Association of QDDPs, Self Advocates Becoming Empowered, and United Cerebral Palsy Associations, Inc.?
Council on Quality and Leadership
Title I Quality, affordable health care for all Americans
Coverage of preventive services and immunizations Extend dependent coverage up to age 26 Established an internet portal to assist Americans in identifying coverage options (Health Insurance Marketplace- healthcare.gov) Individual mandate Coverage for pre-existing conditions Essential health benefits
______ medicine has decreasing returns in health improvement with increased health care expenditures.
Curative
In the United States, what percentage of health care spending is attributable to people with chronic diseases? • A. 40% • B. 55% • C. 70% • D. 85%
D. 85%
Which system involves the government setting rates of Medicare reimbursement up front so that Medicare pays a fixed amount for a hospital stay of a patient with a specific diagnosis and no more, regardless of the actual cost of care? • A. Fee-for-service • B. Consumer-driven health care • C. Accountable care organizations • D. Diagnosis-related groups
D. Diagnosis-related groups
Which of the following is the most prevalent health care system in the U.S? A. The military medical system B. Medicare C. Medicaid D. Managed care
D. Managed care
Expenditures (E) equal: • A. Price (P) minus Quantity (Q) • B. Price (P) plus Quantity (Q) • C. Price (P) divided by Quantity (Q) • D. Price (P) times Quantity (Q)
D. Price (P) times Quantity (Q)
The phenomenon called 'moral hazard' results directly from • A. the uninsured status of a segment of the U.S. population • B. inadequate payment to providers • C. managed care enrollment • D. health insurance coverage
D. health insurance coverage
How is average length of stay calculated?
Days of care/discharges
Factors leading to the complexity of public health
Decentralization of government (states' authority) Problem-specific focus of laws & organizations Heavy reliance on non-governmental organizations Vague goals & debate over how to achieve them
STEPS IN THE PUBLIC HEALTH PROBLEM-SOLVING APPROACH
Define the problem Identify causes Develop & test interventions Implement interventions Evaluate their effect Revisit & refine
The US Supreme Court decision in Olmstead v. L.C. directed US states to
Deinstitutionalize people with mental illness - not: achieve parity in the delivery of physical and mental health services
controlling total health care expenditures by restricting financing for health insurance
Demand side rationing
Controlling total health care expenditures by restricting financing for health insurance.
Demand-side rationing
Factors affecting a manager's priorities:
Demands- Claims on managers to which they must respond Constraints- What managers are not allowed to do Choices- Areas over which managers have discretion
CHALLENGES OF COVERAGE, ACCESS, AND COST
Despite the ACA, 35 million individuals remained uninsured in 2015 Universal coverage will remain a challenge Health insurance does not guarantee access Supply Issues Supply of nurses, physicians, and direct-care workers Cost Issues Net cost of coverage provisions under the ACA is estimated to be $1.2 trillion between 2016 and 2025 Health Insurance premiums are not moderated under the ACA
Which of the following statement is true regarding the global healthcare workforce crisis?
Developing countries face greater challenge than developed countries in the healthcare workforce crisis
Medical care in preindustrial America had a strong ______ character.
Domestic
national health expenditures E =
E = P x Q
Socioeconomic Status & Morbidity/Mortality
Education Income Occupation status or grade (Whitehall study) Class Race/ethnicity
All of the following were identified by the Institute of Medicine (Crossing the Quality Chasm, 2001) as areas for quality improvement, except:
Efficacy
Medicare is primarily for people who meet the following eligibility requirement:
Elderly
Employer based insurance
Emerged during WWII as an employment benefit Covered 64% of Americans in 2002; 56% in 2012
Medicaid
Enacted as Title XIX (19) of the Social Security Act of 1965 Collection of 50 state-administered programs Health insurance for low-income residents Enrollment & costs skyrocketed in the 1990s Cost containment measures enacted in the 2000s Expansion of program mandated in ACA Supreme court converted mandate to option Covered 60 million Americans in 2012
Medicare
Enacted as Title XVIII (18) of the Social Security Act of 1965 Social insurance for the aged & disabled Administered by federal officials Funded by federal government Limited benefits package In 2013, covered: 43.5 million people over 65 years 9 million young people with disabilities
Public health focuses on:
Entire populations, not individuals Incidence, prevalence & distribution of health problems Action at community or collective level
_____ offer private insurance policies with premium rates subsidized by federal dollars.
Exchanges
What was the main purpose of the 1946 Hill-Burton Act?
Expansion of the availability of health services and improved hospital facilities
Medicaid recipients are classified as medically uninsured t/f
FALSE
A case manager provides therapy to substance abuse clients.
False
A dental assistant typically performs oral and dental exams, cleans teeth by scraping off hardened calculus, polishes teeth, and applies fluoride and sealants to teeth.
False
A family numbering system is a simple way of organizing records because the numbers rarely change.
False
A freestanding dialysis facility that is accredited by the Joint Commission is deemed to meet federal requirements and does not have to be surveyed by the state.
False
A managed care organization that meets TJC or AAAHC standards is deemed to meet NCQA standards.
False
A per diem method of payment means that the provider is paid based on the number of persons the provider agrees to treat.
False
A periodontist specializes in treating the inside of the tooth.
False
A person who has not been sentenced, but is incarcerated while awaiting trial is classified as a prisoner.
False
A personal health record is a paper-based health record that is protected from disclosure to those outside the facility that created it.
False
A physician assistant is a registered nurse who has had additional training in areas such as family or pediatric care.
False
A physician must have a face-to-face encounter with a home health patient within seven days prior to the start of home health care, or within three days after the start of care.
False
Abnormal lesions on the tongue or mucosa are usually x-rayed.
False
Adult Medicaid recipients qualify for routine dental care benefits in all states.
False
All individuals eligible to receive care within the managed care organization (MCO) are referred to as residents.
False
All substance abuse treatment is voluntary; no one can be forced into a substance abuse treatment program.
False
American Association for On-Site Health Care publishes standards for some type of ambulatory health care.
False
Americans have heavily depended on hospitals for life saving health care since 1700's
False
An ICF/IID differs from other health care facilities in that ICF/IID clients receive no training in activities of daily living.
False
An employee who is injuring on the job must receive care from a provider selected by the workers compensation carrier.
False
As a general rule, the regulations affecting veterinary medicine are stricter than the regulations governing human medicine.
False
Because the federal government establishes requirements for licensure of hospitals, the requirements are the same in each state.
False
By definition, the patient's primary caregiver is also the patient's legal representative.
False
CARF accreditation may be sought by substance abuse programs that provide detoxification and partial hospitalization, but not by those that offer only drug court treatment or employee assistance.
False
CQI is a management concept that is at odds with the consumer empowerment movement because of its focus on provider control in planning services and its lack of feedback mechanisms.
False
Changes in health care delivery have caused health information management professionals to focus more narrowly on acute inpatient settings.
False
Cheating is allowed and should be accomplished by any means necessary.
False
Children's home-based mental health services are individual-centered rather than family-centered.
False
Contracted providers, such as physical therapists, bill Medicare directly for their services to residents in a skilled nursing facility.
False
Contracted providers, such as physical therapists, bill Medicare directly for their services to residents in a skilled nursing facility.
False
Coordination of benefits (COB) allows excess reimbursement from health plans to providers to be refunded to the patient.
False
Corporatization of medicine has resulted in delivering the same quality of health care at a lesser cost.
False
Decision making based on cost effectiveness about the use of medical technology is more prevalent in the US than in other industrialized countries.
False
Dialysis is a procedure necessary to maintain the life of a person whose liver has failed.
False
ESRD networks treat patients by providing hemodialysis services.
False
Each dialysis patient is assigned to a primary care provider who alone is responsible for the performing a comprehensive assessment and developing a plan of care.
False
Herd health record-keeping means documenting a separate record for each animal in the herd.
False
Hospice benefit periods are categorized as an initial 60-day period, a subsequent 60-day period, then a final 90-day period.
False
Hospice care focuses exclusively on the needs of the patient as the unit of care.
False
Hospices provide curative therapy rather than symptom management
False
Hospital clinics are often organized by medical specialty to facilitate medical education.
False
Hospital observation services may be billed to all payers as outpatient services for observation stays up to72 hours.
False
Hospitals do not have to be licensed to admit patients.
False
Hospitals must be accredited by the Joint Commission.
False
Hospitals must have a hospitalist on staff to qualify for CMS certification.
False
Hospitals receive Medicare reimbursement for ambulatory care through an outpatient prospective payment system (OPPS) based on diagnosis related groups (DRGs).
False
In a prospective payment system, the health care provider charges and is paid for each item of service provided
False
In general, dialysis facilities have been slow to adopt electronic health records.
False
In long-term care facilities such as nursing facilities, records are generally audited for completeness only at the resident's death or discharge.
False
In the United States less than $10 million a year is spent for substance abuse treatment and prevention.
False
In veterinary care, the term "patient" is applied to the animal's owner.
False
Inmates cannot be charged for health care services.
False
It is important to prevent the individual receiving services from participating in interdisciplinary team meetings.
False
It is not necessary for an ambulatory facility to document telephone communication with patients since insurance companies will not pay for telephone consultations.
False
Medicare regulations permit certification of terminal illness with a life expectancy that is unknown and/or unspecified.
False
Most LTC facilities are accredited by The Joint Commission.
False
Most LTC facilities are accredited by the Joint Commission.
False
No more than 50 percent of hospice care can be provided in the patient's place of residence.
False
North American veterinary schools use the current clinical modification of ICD to submit records to the Veterinary Medical Database.
False
Nursing home residents generally have better dental care than elderly persons not living in nursing homes.
False
Often not-for-profit charging reduced fees is a characteristic of Urgent Care Centers.
False
Only clinicians, such as physicians and nurses, may become Certified Correctional Health Professionals (CCHPs); administrative health care workers, such as HIM professionals, are not eligible
False
Partial hospitalization is usually an evening program whereas intensive outpatient treatment is usually a daytime program.
False
Patient-focused care organizes care according to hospital departmental structures.
False
Patients who have kidney transplants generally have lower survival rates, a poorer quality of life, and higher overall medical costs than patients on dialysis.
False
Peritoneal dialysis uses the patient's thoracic cavity to filter out wastes.
False
Personality disorder is a form of serious mental illness in which a person alternates between states of ecstatic mania and severe depression.
False
Physicians private offices are required to be licensed by the state in most states.
False
Quality improvement activities are highly formalized in most veterinary settings.
False
Registered Nurses undergo the same training as Licensed Practical Nurses.
False
Reimbursement for intellectual disabilities services is usually a capitation payment, which is an easily determined amount based on services received.
False
Reimbursement for physicians under Medicare has changed from the resource-based relative value system to the ambulatory payment classification system.
False
Resource Utilization Groups (RUGs) comprise a case-mix methodology based solely on diagnosis and procedure codes submitted on Medicare bills.
False
Resource utilization groups (RUGs) comprise a case-mix methodology based solely on diagnosis and procedure codes submitted on Medicare bills.
False
Standard scheduling assigns all patients Ina large block at the same appointment time.
False
State governments operate jails and local governments operate prisons.
False
T/F A chronic condition is relatively severe, episodic, and often treatable
False
T/F Cultural beliefs have very little to do with health.
False
T/F In a single-payer system, the primary payer usually is an insurance company.
False
T/F Less than 2% of all active physicians are osteopaths (DOs).
False
T/F The ACA is going to reduce the need for primary care providers.
False
T/F The U.S had a mainly public system of financing health care services.
False
T/F Under the medical model, health is defined as a complete state of physical, mental, and social well- being, and not just the absence of disease or infirmity.
False
Telemedicine is an expensive technology that is rarely used in correctional health care because it increases costs.
False
The Affordable Care Act requires that a hospice physician or nurse practitioner have a face-to-face encounter with a hospice patient not more than 15 days prior to the start of the hospice patient's second benefit period.
False
The American Correctional Association's standards and accreditation processes apply only to health care services.
False
The Commission for the Accreditation of Birth Centers publishes the Accreditation Handbook for Ambulatory Health Care.
False
The FIM instrument for measuring independence has not yet been proven reliable or valid.
False
The FIM instrument for measuring independence has not yet been proven reliable or valid.
False
The Glasgow Coma Scale is associated with the assessment of spinal cord injuries.
False
The Glasgow Coma Scale is associated with the assessment of spinal cord injuries.
False
The IPF PPS is Medicare's method of payment for services received by beneficiaries at Community Mental Health Centers (CMHCs).
False
The IRF-PAI utilizes the same coding rules as the UB-92.
False
The Joint Commission accredits ambulatory health care facilities under the same standards as hospitals.
False
The MCO negotiates per diem rates with individual physicians.
False
The Medicare prospective payment system reimburses rehabilitation services under DRGs.
False
The National Commission on Correctional Health Care has standards for correctional health care, but no accreditation process.
False
The PATH audits demonstrated that teaching physician documentation almost always supported the level of service billed to Medicare; therefore, these audits did not result in significant reimbursement of funds to Medicare.
False
The administrative simplification provisions of HIPAA deal with insurance portability, fraud and abuse, and medical liability reform.
False
The categories that form the basis of the inpatient rehabilitation facility prospective payment system are known as Impairments, Disabilities, and Handicaps (IDHs)
False
The categories that form the basis of the inpatient rehabilitation facility prospective payment system are known as Impairments, Disabilities, and Handicaps (IDHs).
False
The field of dental informatics is declining as dentists reject the complexities of expert systems, automated clinical alerts and warnings, and digital information.
False
The group program plan (GPP) is the sole responsibility of the case manager and is a summary of the goals and objectives that the staff will assist the individual to attain.
False
The home care patient's physician must review, update, and recertify (if necessary) the plan of care at least every six months, a timeframe referred to as the certification period.
False
The hospital may be paid for only one APC per day per patient
False
The hospital may be paid for only one APC per patient per 72 hours.
False
The hospital may be paid for only one RBRVS per day per patient.
False
The large prison population in the United States provides a rich source of research subjects for health care and other researchers.
False
The medical program for the indigent is called Medicare.
False
The medical program for the indigent is called Medicare.
False
The only organization that has been actively developing dental practice guidelines is the American Dental Association.
False
The primary teeth are also known as the permanent teeth.
False
The purpose of the Hill-Burton program in the mid-twentieth century was to decrease the number of hospital beds in over-served areas.
False
The resource-based relative value scale (RBRVS) system is an example of per diem reimbursement.
False
The retention period for clinical information on dialysis patients, according to federal statute, is ten years.
False
The term e-health applies only to the electronic delivery of health care by qualified health care professionals.
False
There has been a decreasing number of International Medical Graduates (IMGs) in the U.S. Since 1980.
False
There is no voluntary accreditation organization with deeming authority for hospice programs and facilities.
False
Tocology is the study of animal reproduction.
False
True or False: Historically, cultural beliefs have had little bearing on the structure of the health care system.
False
Under HIPA{, correctional institutions must provide current inmates with a "notice of privacy practices."
False
Underutilization of health care services is not a problem in the U.S.
False
V represents those services which are not billable under the OPPS.
False
Volunteers may be paid at a lower hourly rate than other hospice employees.
False
When a consumer fails to abide by the stipulations of an outpatient commitment, it rarely results in involuntary commitment to an inpatient facility.
False
When a hospice patient is admitted to the hospital for pain and symptom management, the hospital is reimbursed by Medicare for the DRG and the hospice receives a reduced per diem payment for each day of the patient's stay.
False
When a resident, as part of his or her graduate medical education, participates with a teaching physician in providing a service, the teaching physician cannot receive reimbursement for the service from Medicare under any circumstances.
False
When federal and state laws conflict, the facility is required to follow federal law.
False
With regard to Medicare, hospitals should bill separately any charges for ancillary services provided on an outpatient basis within 72 hours prior to an inpatient admission.
False
Women should avoid dental treatment during pregnancy.
False
Medical Health: Obesity
Family History Diet & activity history Lab tests to rule out: Hormonal causes Other physiological causes Diabetes Referral to nutritionist Diet& exercise prescription Bariatric surgery
_____ reimbursement is based on the assumption that health care is provided in a set of identifiable and individually distinct units of services
Fee-for-Service
What is the role of states in U.S. health policy?
Financial support for the care and treatment of the poor Oversight of health care practitioners and facilities Quality assurance
Insurance Payments
Fixed rates from Medicare & Medicaid Negotiated rates from private insurers Physicians are often at a disadvantage Hospitals are able to negotiate better rates Private insurers pay the best rates Medicaid pays the lowest rates MDs driven to join Preferred Provider Organizations (PPOs) or take salaried positions
Population Health: obesity
Focus on obesity epidemic Race, income as risk factors Reasons for noncompliance Multiple factors Zoning law changes Menu labeling Challenging food industry Education
THE MEDICAL MODEL
Focuses on individuals Explores pathophysiology Searches for cellular mechanisms of disease Attempts to find cures Views risk factors in disease-specific pathways Considers how biological systems interact Tends to be "reactive" to disease
Private & Market-Based
Found in the United States (U.S) & Switzerland
In 1984, Australia switched:
From privately financed system to the Medicare program
What is the central role of health services financing in the US
Fund health insurance
What is the central role of health services financing in the US?
Fund health insurance
Title V- Health Care Workforce
Fund scholarships and loan repayment programs for individuals going to school for healthcare-related careers Fund and expand community health centers
FINANCING OF HEALTH SERVICES
General revenue through fiscal tax system Compulsory payroll tax (Social Security) Voluntary premiums to private insurers Individuals out-of-pocket payments Direct employer contributions Philanthropic funds
New frontiers in clinical technology
Genetic mapping Personalized medicine and pharmacogenomics Drug design and delivery Imaging technologies Minimally invasive surgery Vaccines Blood substitutes Xenotransplantation Regenerative medicine
In which country are employers required by law to contribute toward health insurance for their employees?
Germany
National health care programs in other countries often use the following mechanism to control total health care expenditures?
Global budgets
Which of the following countries has a National Health System (NHS)?
Great Britain
Which of the following countries has a National Health System (NHS)?
Great Britian
Software available from CMS which can be used for data entry, editing, and validation of OASIS data is called ________________.
HAVEN
____________ are the basis for home health reimbursement under Medicare.
HHRGs
Who was the first American president to make an appeal for national health insurance?
Harry Truman
WHAT IS HEALTH POLICY?
Health policies are public policies that pertain to or influence the pursuit of health.
Inpatient care consists of
Healthcare delivered in conjunction with an overnight stay in a facility.
Characteristic of a socialized health insurance system
Healthcare is financed through government-mandated contributions by employers and employees
Which of the following will the course provide an overview of:
Healthcare priorities (cost, quality, and access) Financing components (public and private sources, healthcare costs and reimbursement) Current health policy issues
On what grounds have middle-class Americans generally opposed proposals for a national health insurance program?
Higher taxes
The main culprits for the recent rise in expenditures:
Hospital services Prescription drugs Physician services
____________ scores provide a reliable and valid method of documenting the severity of disabilities as well as outcomes in rehabilitation. Scores are assigned in 13 motor areas and five cognitive areas.
ICF
Delivery of community-oriented primary care requires all of the following except:
Improvements in secondary and tertiary care delivery
The primary functions of managed care include all of the following except:
Improving quality
How does ACA improve quality?
Incentives for performance transparency Pay for reporting Value-based purchasing Center for Innovation at the CMS New approaches to financing and quality requirements Bundled payments and Accountable Care Organizations (ACOs) Patient-centered medical homes
Increase in vulnerable populations may be due to:
Increased prevalence of chronic conditions Shifting demographics in the U.S. population Increasing income inequality Aging baby boomers Shrinking and strained supportive services in low-income communities. Public Hospitals Federally Qualified Health Centers (FQHCs)
Key components of the ACA:
Individual mandate Creation of state insurance exchanges Employer mandate Elimination of discrimination based on preexisting conditions Expansion of Medicaid
Which of the following is NOT a factor in determining the case-mix group (CMG)?
International Classification of Functioning, Disability and Health (ICF) codes
Allocative tools
Involves the direct provision of income, services, or goods to a group of individuals or organizations There are two main types of allocative tools: distributive- spread benefits through society redistributive- take money or power from one group and gives it to another
Title VI- Transparency and Program Integrity
Keep Americans informed about healthcare Transparency in nursing homes by way of regulations and incentives to improve quality States given authority to prevent providers to practice in other states if they have been penalized elsewhere
The basic source of the physician distribution problem in the US is:
Lack of health care coverage for all
The roles and responsibilities of health services administrators include:
Leadership and strategic direction Departmental management Program oversight
Universal coverage requires:
Legal compulsion to obtain coverage Increasing government subsidies Economic evaluation of health technology Price regulation & system-wide budget targets
According to the CDC, which factor contributes most to premature death in the U.S. population?
Lifestyle and Behaviors
According to the CDC, which factor contributes to premature death in the US population?
Lifestyle and behaviors
Medicaid is primarily for people who meet the following eligibility requirement:
Low-income
MCO stands for
Managed Care Organization
How has Medicaid created a two-tier system of medical care delivery in the US?
Many physicians do not serve medicaid patients - not: funding for the program is uniformly shared by both federal and state governments
Title II of the ACA- The Role of Public Programs
Medicaid expansion & CHIP preservation Simplified enrollment for Medicaid and CHIP Improve community-based care for disabled Americans
Which major public insurance program was legislated in 1965?
Medicare Medicade
1965
Medicare & Medicaid passed under Johnson
In long-term care, CPT codes are used most commonly to bill for:
Medicare Part B services
Title X- Reauthorization of the Indian Health Care Improvement Act (IHCIA)
Modernize the trible health care system Improve health care for Native Americans and Alaska Natives
The most prominent reason for the decline in the number of procedures performed in hospitals is
Most of these procedures were shifted to outpatient setting
The most prominent reason for the decline in the number of procedures performed in hospitals is:
Most of these procedures were shifted to outpatient setting
FEDERALLY QUALIFIED HEALTH CENTERS (FQHC) QUALIFICATION CRITERIA:
Must provide services to the medically underserved Must offer required primary and preventive services Must meet staffing requirements Offer a sliding-fee payment scale Participate in ongoing quality assurance program Include population representatives on board of directors
Part C of Medicare specifically covers
NONE OF THESE CHOICES: preventive care rehabilitation services prescription drugs
Which choice most accurately describes a hybrid of an HMO and a PPO?
NOT: mixed model HMO
Part C of Medicare specifically covers
None of the listed choices: - preventive care - rehabilitation services - prescription drugs
Supply-side rationing is also referred to as:
Nonprice and planned rationing
Types of Health Care Organization Ownership:
Nonprofit: chartered & regulated by the state Public: accountable to elected public officials For-profit: accountable to investors
Which age group in the U.S. has had the highest average annual percent growth over the past 30 years?
Not: 25-44
What is the role of an institutional review board (IRB)?
Not: All of the choices
When patients have multiple health problems, this is called:
Not: Coaffliction
How has Medicaid created a two-tier system of medical care delivery in the US?
Not: Funding for the program is uniformly shared by both federal and state governments
What is an interest group?
Not: None of the listed answers A group of lawmakers within Congress with a particular area of interest A group of appointed judges with a particular political view point An independent, non-governmental group united by a policy area, which lobbies and advocates its point of view to lawmakers
Which of the following is necessary for achieving universal coverage in the US?
Not: The Patient Protection and Affordable Care Act
The US Supreme Court decision in Olmstead v. L.C. directed US states to
Not: achieve parity in the delivery of physical and mental health services
Evidence-based medicine proposes to incorporate _____ in medical care delivery
Not: clinical trials
Insurance underwriting without risk rating
Not: enables people with preexisting medical conditions to obtain health insurance at a reasonable cost
Which HMO model is likely to provide the greatest control over the practice patterns of physicians?
Not: group model
What has been identified as one of the main reasons for the shortage of physicians who are trained in geriatrics?
Not: lack of demand
What is the Health Plan Employer Data and Information Set (HEDIS)?
Not: none of the above: A government database on health plans A cost report card A quality report card
The Health Insurance Portability and Accountability Act requires
Not: nontransmittal of individual health information over the Internet
Which of the following has the greatest impact on system-wide health care costs?
Not: purchase price of new technology
Which aspect of health care policy has received the most attention during the past several decades?
Not: quality improvement
How did Americans with preexisting medical conditions obtain health insurance before the passage of the Patient Protection and Affordable Care Act?
Not: they could not get health insurance
During the World War II period, health insurance became employer-based because of
Not: union demands
_____________ is a data set that is a requirement under Medicare for home health.
OASIS-1
Challenges managers face:
Obtaining resources to support clinicians Measuring processes and outcomes to improve Creating an environment of excellent care Motivating and supporting staff Establishing standard of performance Communicating to team members
LOCAL GOVERNMENT'S ROLE IN THE HEALTHCARE SYSTEM
Own and operate public hospitals and public health clinics Develop and enforce public health codes
National health expenditures (E) =
P x Q
National health expenditures (E)=
P x Q
A comprehensive outpatient rehabilitation facility receives reimbursement from Medicare under ________________.
Part A
Reasons for High Prices
Patients not sensitive to price patients don't exert "market power" barriers to entry in healthcare employers nonaggressive in negotiating with insurers multipayer system and admin costs increasing elderly technology
Reimbursement is associated with which of the quad functions?
Payment
Nonphysician practitioners (NPPs) include:
Physician assistant
Which type of healthcare facility employs the most people in the US?
Physician assistants
Governing boards/owners include:
Physicians Cooperatives Government Religious organizations Investors Employers Unions Philanthropists
FUNCTIONS OF MANAGERS:
Planning: determination of goals and objectives Organizing: structuring resources to meet objectives Directing: motivating workers to meet objectives Coordinating: assembling and synchronizing diverse activities & participants Controlling: comparing actual results with objectives
All of the following are elements of the policy cycle, except:
Policy evaluation
The Stages of Change/Transtheoretical Model
Precontemplation Contemplation Preparation Action Maintenance Relapse
TYPES OF RISK FACTORS ASSOCIATED WITH VULNERABILITY
Predisposing Propensity for vulnerability Example: race/ethnicity Enabling Resources available to overcome consequences Example: insurance status Health Need Direct implication of vulnerability Example: presence of a chronic condition
In what way does research influence policymaking?
Prescription Documentation Analysis
Title III- Improving the Quality and Efficiency of Health Care
Preserve and reform Medicare (e.g. Center for Medicare and Medicaid Innovation) Close the coverage gap "donut hole" for drug costs under Medicare Health care providers incentivized to improve care (e.g. Accountable Care Organization) Additional health services for rural America
EXAMPLES OF PUBLIC HEALTH
Preventive dental care Hand-washing guidelines Safe, fluoridated water supply Travel precautions Sewer and waste disposal services Educational programs on STIs & condom use Nutrition labels Community exercise programs Regulations on food processing & safety Safety belt regulations Flu shots & other vaccinations Occupational safety regulations
Demand-side rationing is the same thing as:
Price rationing
"Cost" has three different perspectives:
Price: a physician's bill or health care premium Health care expenditures or spending where Price(P) * Quantity(Q)= Expenditure(E) Reflects the consumption of economic resources (such as health insurance, skills, pharmaceuticals, medical equipment) in health care delivery Physician's perspective includes staff salaries, capital, rental and supplies
How are preexisting medical conditions covered under the ACA?
Private insurance plans are required to cover them.
What are the main activities of risk management?
Proactive efforts to prevent adverse events related to clinical care and facilities operations
What is the main intent of the Stark laws?
Prohibit self-referral by physicians to facilities in which they have an ownership interest
What does "PPS" stand for?
Prospective Payment System
In the general sense, what is the primary purpose of insurance?
Protection against risk
Supplier-induced demand is created by:
Providers
What is likely to be the biggest obstacle to the delivery of cost-efficient care?
Public Attitudes
National health expenditures (E) =
PxQ
Which of the following is a major criticism of managed care?
Quality of care may be sacrificed
CMS provides free software for entering and transmitting MDS assessment data. This software is called ________________.
RAVEN
EXAMPLES OF VULNERABLE POPULATIONS
Racial and ethnic minorities Uninsured children and adults Women Residents of rural areas Homeless Mentally ill Chronically ill and disabled HIV/AIDS patients
Title IV- Prevention of Chronic Disease and Improving Public Health
Recommended preventative services covered without patient cost-sharing Promote prevention, wellness and public health through increased funding Increased preventative services for women
ACA goals
Reduce number of uninsured Pay for coverage without increasing deficit Slow rising cost of health care Encourage a more efficient delivery system
COBRA
Reduces gaps in insurance coverage between jobs Employer must extend insurance for up to 18 months after employee leaves
Reducing costs and increasing value
Reforming medical malpractice Choosing less costly treatments Paying fixed amounts for procedures Using electronic medical records Using value-based purchasing Reducing the cost of end-of-life care Self-responsibility for one's health
What is tertiary prevention?
Rehabilitative therapies and monitoring of health to prevent complications or further illness, injury, or disability
Boards face difficulties in ensuring that:
Revenues cover operating costs Services are delivered with high quality Patient health outcomes are optimal Staff tracks metrics to allow for evaluation Meeting the needs of the broader community Setting and overseeing strategy for institution Holding managers accountable for quality
What is the main advantage of group insurance?
Risk is spread out among a large number of insured
Six dimensions of quality:
Safe Effective Patient-centered Timely Efficient Equitable
Boards :
Select, encourage, advise, evaluate, compensate, and replace CEO Discuss, review, and approve strategic directions Ensure resources are available to pursue strategies and achieve objectives Monitor performance Ensure organization operates responsibility and effectively Act on specific policy recommendations Mobilize support for decisions taken Provide a buffer for president or CEO Nominate candidates for election to board Establish and carry out effective board governance
Compared to metropolitan and suburban areas, there is a/an _________ of physicians in rural areas.
Shortage
Factors is the leading cause of preventable disease and death in the US
Smoking
Which of the following factors is the leading cause of preventable disease and death in the United States?
Smoking
Domains of health determinants
Social & economic environment Physical environment Genetics Medical care Health-related behaviors
Healthcare is considered a social good to:
Social justice
The ACA is an example of?
Social justice
1800s
Social welfare a local responsibility Almshouses & public hospitals treated the poor Allopathic physicians became dominant U.S. hospital industry & costs grew rapidly
FORCES OF FUTURE CHANGE
Social, demographic and cultural trends: A growing elderly population and dropping birth rates Social changes such as drops in employment, rise in welfare and disability rolls, and rise in illegal immigration Economic forces: Both employment and personal income depend on the nation's economic health Political will, ideologies, and legal rulings Affects how critical issues get addressed in the future Technological innovation Favored by Americans, but tends to increase costs Global Health Issues Challenges and opportunities will arise due to globalization Ecological Events Emerging diseases, new strains of influenza, bioterrorism, etc.
The elements of the Epidemiology Triangle of disease occurrence include all of the following except:
Society
A multiple payer system is more cumbersome than a single player system for all of the following reasons except:
Some healthcare services are covered fro people in the north, but not in the south.
Physician maldistribution occurs by:
Speciality and Geography
Holistic health adds which element to the World Health Organization definition of health?
Spiritual
What was the main consequence of early proprietary medical schools, as opposed to state-sponsored schools, in the preindustrial era?
Standards were low
PUBLIC HEALTH SERVICES
State responsibilities Ten essential services Public health emergencies New training, competencies, & accreditation
THE POPULATION HEALTH MODEL
Studies the causes of health discrepancies/disparities Analyzes health patterns among groups Identifies factors leading to poor outcomes Employs an integrative model (multiple factors) Views health as a result of many determinants Considers outcomes that affect determinants (reverse causality)
What day of the week are weekly quizzes and the midterm due on?
Sunday
In national health care systems, total expenditures are controlled mainly through
Supply-side rationing
FEDERAL GOVERNMENT'S ROLE IN THE HEALTHCARE SYSTEM
Tax incentives (e.g. to encourage employers to offer health insurance) Provides health insurance to the poor, aged and the disabled Operates healthcare facilities for veterans Provides support for the training of doctors and other health professionals ERISA (Employee Retirement Income Security Act of 1974) establishes minimum standards for retirement and employer-sponsored health insurance offered by private employers.
Which of the following is a list of organizations that have deeming authority for home health care with regard to Medicare certification and the Conditions of Participation?
The Accreditation Commission for Health Care (ACHC), the Community Health Accreditation Program (CHAP), and The Joint Commission
Title VIII- Community Living Assistance Services and Supports Act (CLASS Act)
The CLASS Act was repealed on January 1, 2013
How is reimbursement to the ICF/IID handled in most states?
The ICF/IID receives a per diem payment for each day of service to each individual resident.
What is the primary reason that a segment of the U.S. population is uninsured?
The U.S. has a voluntary system of health insurance
A major factor influencing growth in the health care sector of the U.S. economy is:
The aging of the population
A major factor influencing growth in the health care sector of the US economy is:
The aging of the population
What criterion does the ACA uses to classify an employer as large employer?
The employer has 50 or more full-time-equivalent employees
Which of the following is a characteristic of a national health insurance system?
The government finances health care through general taxes and healthcare is delivered by private providers
Who determines how long-term care facilities are reimbursed under the Medicaid program?
The individual state agency through state legislation
Incidence is
The number of new cases occurring during a specified period divided by the population at risk
In health care delivery, high unemployment mainly determines
The number of uninsured
What is gatekeeping
The process by which primary care physicians refer patients to specialists
What is gatekeeping?
The process by which primary care physicians refer patients to specialists
What is the main application of quality-adjusted life years?
They are used as a measure of health benefits
ACA Titles
Title I Quality, affordable health care for all Americans Title II The role of public programs Title III Improving the quality and efficiency of healthcare Title IV Preventing chronic disease and improving public health Title V Health care workforce Title VI Transparency and program integrity Title VII Improving access to innovative medical therapies Title VIII Community living assistance services and supports Title IX Revenue Provisions Title X Reauthorization of the Indian Health Care Improvement Act
Why was SCHIP created?
To provide health insurance to low-income children who do not qualify for Medicaid
What is the main use of regenerative medicine?
To repair damaged organs and tissues
The behavioral risk factors most associated with mortality:
Tobacco use Alcohol use Sedentary lifestyle Unhealthy diet Overweight & obesity
Steps in evidence-based management process:
Translating a management challenge into research questions Acquiring relevant research findings/evidence Presenting evidence in a useful way Including all stakeholders in decision making
A Health Information Exchange links data provided by various health care providers.
Trua
A care area may be triggered by data entered on the minimum data set (MDS) and if so, the interdisciplinary team must document the outcome of their assessment process for that care area.
True
A care area may be triggered by data entered on the minimum data set (MDS) and, if so, the interdisciplinary team must document the outcome of their assessment process for that care area.
True
A dentist must have a valid Drug Enforcement Agency (DEA) number for his patients to be able to fill prescriptions for narcotics at a pharmacy.
True
A dually diagnosed substance abuse client has both a substance-related disorder and a chronic mental illness.
True
A hallucination is a false sensory perception, such as seeing, hearing, smelling, or feeling things that are not real.
True
A health information manager practicing in the veterinary setting may find it helpful to join the American Veterinary Health Information Management Association.
True
A home care agency that opts to be surveyed for Medicare certification by The Joint Commission would be deemed to be in compliance with the Conditions of Participation upon accreditation by the commission.
True
A hospice program is licensed by the state in which it is located.
True
A hospital compliance officer may be concerned with avoiding fraudulent coding and billing as well as with monitoring compliance with federal regulations such as HIPAA.
True
A hospital would likely be reimbursed for more than one APC for an emergency department patient whose visit includes evaluation and management, X-Rays, and a procedure,
True
A hospitality is a physician who provides comprehensive care to hospitalized patients, but who does not ordinarily see patients outside of the hospital setting.
True
A life-care plan lists the items required over a lifetime for the individual, their cost, and the frequency of replacement and serves as a medical legal document that may guide court decisions regarding a settlement.
True
A mental health program could be accredited by the Joint Commission, CARF, or NCQA.
True
A partial hospitalization program is considered to be a type of hospital outpatient program.
True
A person with end-stage renal disease can become eligible for Medicare on the basis of the ESRD diagnosis.
True
A provider's panel is the group of patients who have chosen the provider as their primary care provider.
True
A qualified developmental disabilities professional (QDDP) is responsible for coordinating and monitoring each individual's
True
A revenue code appropriate to the HCPCS code listed with it must be included on the bill for outpatient services or the claim may be rejected.
True
A risk management area of concern in dentistry is injury to patients or practitioners, including instrument trauma from needles, drills, and probes.
True
According to the Joint Commission, the records of patients receiving continuing ambulatory care services must contain a summary list of known significant diagnoses, conditions, procedures, drug allergies, and medications.
True
Accreditation agencies recommend that an independent physician, rather than one employed by the correctional system, judge an inmate's competency for execution.
True
Advocates of the juvenile justice system consider counseling and mental health services critical for juvenile offenders.
True
American beliefs and values favor the development and use of new medical technology despite its cost.
True
Animal blood donors sometimes reside at the hospital to be available on short notice and are often long-term residents whose health records become quite bulky.
True
Because of their knowledge of coding, health information managers can help review, revise, and maintain the hospitals chargemaster.
True
Both dialysis and kidney transplant are forms of renal replacement therapy (RRT).
True
Capitation is the payment of a fixed dollar amount for each covered person for the provision of a predetermined set of health care services for a specific period of time.
True
Charges for ancillary services, such as laboratory and radiology charges, are usually captured through the hospital chargemaster.
True
Clients with acute problems may be seen in a medically managed intensive inpatient treatment program, such as that found in an acute care general hospital.
True
Community health centers were designed to meet the medical needs of people who, because of their location and their inability to pay, we're not receiving the care they needed in the traditional physicians office.
True
Compared to other nations, the U.S. uses a larger share of its economic resources for health care.
True
Critical pathways are outcome-based and patient-centered case management tools that facilitate coordination of care.
True
DSM-5 recognizes four degrees of severity of intellectual disabilities: mild, moderate, severe, and profound.
True
Dialysis patients see the following caregivers at regular intervals: physicians, nyzs6s, social workers, and dietitians.
True
Digital radiographs allow for compact and safe storage of dental x-rays and allow the dentist to share a copy of the x-ray with a specialist or an insurance company electronically.
True
Documentation of telephone calls is an important element in good risk management for ambulatory care
True
Equity requires distributional efficiency
True
Estelle v. Gamble created a right to health care for inmates which could be violated if officials showed a deliberate indifference to inmates' serious medical needs.
True
Federal and state governments jointly fund the Medicare program.
True
Federal law mandates strict confidentiality guidelines for substance abuse facilities.
True
For referred outpatients, the hospital provides diagnostic or therapeutic services, but it does not take responsibility for evaluating or managing the patients care.
True
HIM home care positions require knowledge of finance, quality improvement, utilization review, and information systems.
True
Habilitation is a process by which a person is assisted to acquire and maintain life skills that enable him or her to cope more effectively with personal and environmental demands and to raise the level of physical, mental, and social efficiency.
True
Health care costs for the elderly are nearly 3 times more than those for the non-elderly.
True
Home Health Resource Groups (HHRGs) are based on assessment data in three areas—clinical, functional, and service utilization.
True
Home health care is a service provided to recovering, disabled, or chronically ill patients who receive treatment in their homes.
True
Hospice services require little out-of-pocket expense and paperwork on the part of the patient and/or family.
True
Hospitals must be licensed by the state in which they are located.
True
Hospitals that meet the standard of the Joint Commission, HFAP, or DNV are deemed to meet the Conditions of Participation.
True
ICF/IID client records are often divided into three sections—administrative, health, and habilitation/training sections.
True
Impaction refers to an unerupted or partially erupted tooth that will not fully erupt because it is obstructed by another tooth, bone, or soft tissue.
True
In addition to clinical staff, the interdisciplinary team includes a pastoral or other counselor who offers spiritual support and comfort.
True
In correctional facilities, custody and security are the primary concerns, and health care is provided in a manner that does not compromise those primary concerns.
True
In hemodialysis, the patient's blood circulates outside the body through an artificial kidney that removes metabolic wastes and helps to maintain homeostasis.
True
In the preindustrial era, much of the medical care in the US was provided by nonphysicians.
True
In the staff model HMO, the HMO entity owns the facilities and arranges for health care through employed physicians, who are allowed to see only the particular HMOs patients.
True
Industrial health centers provide care to employees at their places of work or at employer contracted sites.
True
Intensive outpatient treatment requires a minimum of 9 treatment hours per week within a structured program.
True
Involuntary commitment is a legal process by which individuals who are deemed to be a danger to themselves or to others may be admitted to a facility even though they refuse or cannot consent to the treatment.
True
It is generally thought that persons with serious mental illness who are in a stable mental state do not benefit greatly from traditional talk therapy, and that in fact it may sometimes produce negative effects by increasing stress when discussion turns to unhappy events.
True
Long term care patients are commonly called residents.
True
Many substance abuse agencies and treatment facilities have established employee assistance programs to serve working adults and their employers.
True
Medicaid (Title XIX) provides most funding for ICF/IIDs.
True
Medicaid and the Children's Health Insurance Program (CHIP) offer some dental benefits for children.
True
Medicare certification of rural health clinics permits cost-based reimbursement as part of the effort to increase access to primary care in medically underserved rural areas.
True
Medicare managed care plans receive payments under the Medicare Advantage program for enrollee so who have both Part A and Part B coverage.
True
Medicare pays skilled nursing facilities, home health providers, inpatient rehabilitation hospitals, and long-term care hospitals under prospective payment systems.
True
Medicare will only pay for home health services for persons who are homebound.
True
More than half of MDs are specialists?
True
More than half of Ostepathic (DOs) Physicians are Generalists?
True
NDCs list diagnosis codes that Medicare considers evidence that a particular procedure is medically necessary.
True
National databases maintained on spinal cord and traumatic brain injuries facilitate research in rehabilitation and promote uniform treatment, leading to improved functional outcomes.
True
National databases maintained on spinal cord and traumatic brain injuries facilitate research in rehabilitation and promote uniform treatment, leading to improved functional outcomes.
True
One of the major responsibilities of an ESRD network is to evaluate and resolve patient grievances.
True
P represents a partial hospitalization service.
True
Part A of Medicare pays for hospital inpatient care, home health care, skilled nursing care, and hospice care.
True
Patients requiring services from occupational therapists need help performing tasks in their daily living and working environments.
True
Physicians are considered the main caregiver in ambulatory care.
True
Potentially compensate events (PCEs) are occurrences that may result in litigation against the health care provider or that may require the health care provider to compensate an injured party.
True
Preventative care and wellness are a central focus of a health maintenance organization and most managed care organizations.
True
Risk management, in general terms, is a program that monitors the liability and accountability of home care services delivered to customers.
True
S represents a significant service that is not discounted when more than one APC is present on a claim.
True
Some correctional facilities allow for compassionate release when an inmate is known to be terminally ill.
True
Standard surveys of long-term care facilities are unannounced and conducted at least every fifteen months.
True
Studies have shown a correlation between animal abuse and child or adult abuse.
True
Substantial noncompliance and substandard quality of care findings at a long term care facility can result in fines of up to $10,000 per day.
True
Substantial noncompliance and substandard quality of care findings at a long-term care facility can result in fines of up to $10,000 per day.
True
T represents a significant procedure that is discounted when other procedures are performed with it.
True
T/F Capitation is a payment mechanism in which all health care services are included under one set fee per covered individual.
True
T/F Fee-for-service reimbursement favors specialist practices.
True
T/F Generally, people with better education have higher incomes and better health status.
True
T/F More than half of MDs are specialists
True
T/F More than half of osteopaths (DOs) are generalists
True
T/F The number of active physicians has steadily increased over time.
True
T/F There is an imbalance between primary and specialty care services in the US health care delivery system.
True
Technology has been credited with the overall reduction in the average length of inpatient hospital stays.
True
Telemedicine involves transmitting medical information back and forth between patient and physician separate locations by electronic means such as video, electronic mail, telephone, or satellite.
True
The Accreditation Commission for Health Care (ACHC) has deeming authority for Medicare in home health, hospice, and DMEPOS (durable medical equipment, prosthetics, orthotics, and supplies)
True
The Addiction Severity Index calculates a severity rating, or score, that can be used as an outcomes measure in research studies.
True
The American Animal Hospital Association sponsors a voluntary accreditation program for companion animal hospitals.
True
The American College of Surgeons was one of the first organizations to establish standards for hospitals
True
The American Society of Addiction Medicine identified two levels of outpatient care and two levels of inpatient care in substance abuse treatment settings.
True
The American Veterinary Medical Association publishes policy statements and guidelines that support the maintenance of veterinary health records in the AVMA Membership Directory and Resource Manual.
True
The Child and Adolescent Service System Program (CASSP) began as a federal initiative in the 1980s to create a comprehensive network of services for emotionally disturbed children and adolescents, now known as systems of care.
True
The Clinical Laboratory Improvement Amendments (CLIA) require that every laboratory possess a certificate to operate and that laboratories that fail to meet the operational standards or proficiency testing guidelines be sanctioned.
True
The Council on Quality and Leadership publishes its accreditation standards for facilities for individuals with intellectual disabilities in a document called Personal Outcome Measures.
True
The Forum of ESRD Networks has developed a medical record model outlining recommended practices for medical record documentation in ESRD facilities.
True
The IMPACT Act of 2014 requires post-acute care providers to report standardized assessment data across post-acute settings for the purposes of patient assessment, quality comparisons, resource use measurement, and payment reform.
True
The Inventory for Client and Agency Planning (ICAP) is an assessment instrument used by some states that provides service scores that can be used to adjust payments to providers.
True
The Joint Commission and CARF are the nationally recognized agencies that review care provided in rehabilitation facilities for accreditation purposes.
True
The Joint Commission and CARF are the nationally recognized agencies that review care provided in rehabilitation facilities for accreditation purposes.
True
The Joint Commission has a separate accreditation program for behavioral health care programs like non-hospital substance abuse facilities.
True
The Kidney Disease Outcomes Quality Initiative (KDOQI) includes the development of clinical practice guidelines and CMS has incorporated some of the outcome measures from these guidelines into their clinical performance measures projects.
True
The Orthopedic Foundation for Animals (OFA) provides registries for standardized evaluation for canine hip and elbow dysplasia
True
The Patient Protection and Affordable Care Act enacted a "National Pilot Program on Payment Bundling" designed to test the feasibility of bundling payments for post acute care providers (such as rehabilitation providers) with the acute care hospital payment for a given episode of care.
True
The Rancho Los Amigos Scale is beneficial in communicating to other members of the rehabilitation team the level of recovery of a patient with traumatic brain injury.
True
The Rancho Los Amigos Scale is beneficial in communicating to other members of the rehabilitation team the level of recovery of a patient with traumatic brain injury.
True
The Uniform Reporting System (URS) is a system by which each State Mental Health Authority (SMIIA) reports aggregate data to SAMHSA
True
The United States Supreme Court has ruled that the Americans with Disabilities Act may require states to provide community-based services rather than institutional placements for individuals with disabilities.
True
The Veterinary Medical Database began as a means of collecting information on animal cancer, which is also relevant to the study of cancer in humans.
True
The admission history and physical performed on a rehabilitation patient includes a functional history, which covers the patient s functional status prior to the onset of illness or injury.
True
The admission history and physical performed on a rehabilitation patient includes a functional history, which covers the patient's functional status prior to the onset of illness or injury.
True
The fee schedule is a flat rate per procedure,visit, or service. Negotiating a fee schedule allows more consistent budgeting of payment dollars by the managed care organization.
True
The hospital may be paid for more than one APC per patient visit.
True
The individualized treatment plan (ITP) includes both proposed treatment processes and treatment goals and objectives.
True
The individualized treatment plan must be based on the client s comprehensive clinical assessment.
True
The managed care organization (MCO) produces its revenue by selling an insurance product and must reimburse providers for services delivered to members.
True
The placement of a prison health services program under a state Department of Corrections rather than under individual prison wardens may be an indication of the perceived importance of health services.
True
The primary caregiver is the person designated to provide care for the hospice patient when hospice staff is not available.
True
The principal sources of funding for CMHCs are client fees, Medicaid, Medicare, and block grant funding for special projects.
True
The utilization of technology has a greater impact on total health care expenditures than the cost of acquiring technology.
True
True or False: To counteract the buying power of MCO's, health care providers have responded by creating alliances that, in some geographic areas, have developed into huge systems that are forcing out competition.
True
Two approaches to utilization management in ambulatory care are prospective and retrospective review.
True
Under Medicare regulations, both the attending physician and the hospice medical director must certify that the patient is terminally ill.
True
Under Part C, beneficiaries pay a monthly premium for the insurance plan, in addition to their Part B premium.
True
Urgent care centers arose to meet the need for care outside regular physicians office hours.
True
Voice recognition systems are becoming more common in hospital emergency departments.
True
When a provider agrees to see managed care organization (MCO) patients and to subtract a certain percentage from the regular fee-for-service rate, this is called discounted charges.
True
When the state agency receives notification of a complaint about a long-term care facility, the result is an investigation of the facility.
True
When the state agency receives notification of a complaint about a long-term care facility, the result is an investigation of the facility.
True
What day of the week is the final exam due on?
Tuesday
U.S. expenditures on health care:
Two thirds (approx. 66.7%) spent treating preventable diseases 5% spent on prevention of preventable diseases 95% spend on direct medical care
Which of the following factors was particularly important in promoting the growth of office-based medical practice in the postindustrial period?
Urbanization
Which of the following has the greatest impact on system-wide health care costs?
Utilization of technology once it becomes available - not purchase price of new technology
Medicare and Medicaid programs were created for population groups regarded as
Vulnerable
What was the main reason for initiating national health care in countries such as Germany and England?
Ward off political instability
One reason women's health centers were created is:
Women seek care more often than men
how is case mix determined for an inpatient facility
a comprehensive assessment of each patient is done
an MS-DRG method of reimbursement an acute care hospital is paied
a fixed amount for a particular DRG classification
A DRG represents
a group of principal diagnoses
a DRG represents
a group of principal diagnoses
what is the minimum data set (MDS)
a patient assessment instrument for skilled nursing facilities
under the DRG method of reimbursement a psychiatric hospital is paid
a per diem rate based on psychiatric DRG's
Employer provided health insurance benefits arose in the mid 20th century as a result of: a. A Supreme Court ruling that the health insurance could be included in the collective bargaining process. b. Legislation which legalized this process c. An executive order requiring employers to provide health insurance to employees d. None of the above
a.
How did Americans with preexisting medical conditions obtain health insurance before the passage of the Patient Protection and Affordable Care Act? a. Through state high risk pools b. Through a special federal program c. Through insurance exchanges D. They could not get health insurance
a.
In health care delivery, high unemployment mainly determines a. the number of uninsured b. the amount of government spending c. the availability of qualified workers d. the extent of globalization
a.
In the term, managed care, 'manage' refers to a. management of utilization b. management of premiums c. management of risk d. management of the supply of services
a.
The biggest share of national health spending is used by a. hospitals b. physicians c. prescription drugs d. nursing home care
a.
Under the fee-for-service system, providers had the incentive to a. deliver more services than what would be medically necessary because a greater volume would increase their incomes b. use less technology because they could increase their incomes by not using costly procedures c. indiscriminate cost increases because they could get paid whatever they would charge d. increase the level of quality in order to attract more patients
a.
What are administrative costs? a. Costs associated with management of the financing, insurance, delivery, and payment functions of health care b. Costs associated with financing and insurance only c. Costs associated with delivery and payment functions only d. None of the above
a.
What is Gross Domestic Product (GDP)? a. A measure of all the goods and services produced by an nation in a given year b. A measure of all the goods and services produced by a nation in a given year, divided by the population c. A measure of all the goods and services produced by a nation in a given year, minus the amount of money spent by the government. d. A measure of all the goods and services produced by a nation in a given year, divided by the amount of money spent by the government.
a.
What is the goal of long term care? a. Promote functional independence b. Return a person to independent living c. Reverse the decline in activities of daily living d. Cope with multiple chronic conditions
a.
What was the main purpose of the 1946 Hill_Burton Act? a. Expansion of the availability of health services and improved hospital facilities b. Creation of a national health insurance plan c. Regulation of physicians' salaries d. Raising the legal drinking age to 21 years
a.
Which of the following can contribute positively to a person's quality of life? a. Palliation b. Assessment c. Plan of care d. Total care
a.
Which particular skill is fundamental to the delivery of patient centered care? a. Communication b. Decision making c. Coordination d. Analytical
a.
Which racial/ethnic group is most likely to drink alcohol? a. White b. Black or African American c. Asian or Pacific Islander d. Hispanic
a.
2. Approximately how many Americans are uninsured?
a. 46 million
16. Medicare is based on which international model of health care
a. A combination of the Bismark and Beveridge models
22. Why should health care costs be controlled?
a. Americans will have to forgo other goods and services when more is spent on health care OR Total health care expenditures will exceed what they would be under free-market conditions
17. The U.S Veterans Health Administration (VHA) is based on which international model of health care
a. Beveridge model
8. A Diagnosis Related Group (DRG) represents this type of diagnosis
a. Principal diagnosis
10. Hospital Quality Initiatives (HQI) and Hospital Acquired Conditions (HAC) assists in what?
a. Providing hospital quality measures OR Facilitating patient decisions about their care OR Eliminating specific problems created in the hospital environment
9. The value of health care is measured by this
a. QALY (Quality Adjusted Life Years)
7. This type of reimbursement pays a health care organization according to the costs incurred in operating the institution
a. Retrospective
13. Healthcare Organizations are more likely to use evidence-based management when
a. There are strong incentives OR When insurance pays for performance
1. Adults are more likely to be uninsured when compared to the elderly and children. a. True b. False
a. True
11. Board members from both for-profit and not-for-profit institutions are not paid for their work...True/False a. True b. False
a. True
12. Hiring of the CEO should be performed by the Board of Directors...True/False a. True b. False
a. True
21. Access to health care can be considered an environmental factor contributing to health status...True/False a. True b. False
a. True
what makes up the "Iron Triad" of healthcare?
access, cost, quality
which method of risk assessment is required by ACA for individual and small group health insurance
adjusted community rating
Individual records at an ICF/IID facility are often divided into sections, as follows:
administrative, health, and habilitation/training
Cultural authority was conveyed to the medical profession mainly through
advances in medical science
main function of Medicare payment advisory commission MedPAC
advise the US congress on carious issues affecting the medicare program
Fill in the blank: Historically, inpatient care developed ________ outpatient care.
after
To finance Medicare Part A,
all income earned by a working person is subject to Medicare tax
to finance medicare part A
all income earned by a working person is subject to medicare tax
In-home respite care __________________________________________.
allows the primary caregiver to have some free time
Hospitals in the US evolved from
almshouses
What is the role of an institutional review board (IRB)?
approve and monitor research that involves human subjects
In the delivery of long term care, customized interventions are carried out according to a. an individual assessment b. a plan of care c. weekly evaluation by the patient's physician d. the philosophy of total care
b.
Low cognitive functioning places an elderly person at a high risk for a. clinical depression b. functional decline c. chronic ailments d. acute ailments
b.
Rational integration between long term care and non long term care services a. helps individualize a plan of care b. facilitates the delivery of total care c. establishes better working relationships between the various partners of care d. helps identify the level of long term care that is most appropriate for the patient
b.
What does the Consumer Price Index (CPI) measure? a. Medical inflation b. General inflation c. Health care expenditures d. Overall government expenditures
b.
What has been identified as one of the main reasons for the shortage of physicians who are trained in geriatrics? a. Lack of interest among medical students b. Shortage of faculty in colleges and universities c. Lack of government initiatives d. Lack of demand
b.
What has been identified as the main obstacle to uniformity in the scope of practice for advance practice nurses? a. Deficits in education and training b. Different licensing and practice rules across states c. Lack of partnership with physicians d. Inadequate information systems
b.
Which racial/ ethnic group has the highest rate of low birth weight infants? a. White b. Black or African American c. Asian or Pacific Islander d. Hispanic
b.
Why was SCHIP created? a. To provide health insurance to the elderly who do not qualify for Medicare b. To provide health insurance to low-income children who do not qualify for Medicaid c. To provide health insurance to immigrants who qualify for neither Medicare nor Medicaid d. All of the above
b.
14. Patient satisfaction scores are effective measures of comparative health systems...True/False a. True b. False
b. False
15. Total healthcare spending is an effective measure of international health comparisons...True/False a. True b. False
b. False
18. Among American Indians mortality caused by several chronic conditions has been reduced due to intervention by the healthcare system...True/False a. True b. False
b. False
3. White are more likely to be uninsured than minorities. a. True b. False
b. False
4. People with education and incomes have worse health status a. True b. False
b. False
6. Medical cost inflation is influenced by a decrease in the uninsured a. True b. False
b. False
In the preindustrial era, _____ often functioned as surgeons.
barbers
One of the criteria for receiving Medicare payment for home care is that the patient being served must ____________________.
be homebound
under community rating
both high and low risk people are charged the same premium
in general prospective payment systems establish reimbursement for
bundled services
Inpatient care consists of a. Services delivered by a hospital. b. Treatment of acute conditions. c. Health care delivered in conjunction with an overnight stay in a facility. d. Care delivered in a licensed facility.
c
Approximately how many American are uninsured? a. 16 million b. 26 million c. 46 million d. 66 million
c.
Health policies are used in what capacity? a. Regulation of behaviors b. Allocation of income, services or goods c. Both a and b d. Neither a nor b
c.
Insurance underwriting without risk rating a. makes health insurance premiums more affordable b. enables people with preexisting medical conditions to obtain health insurance at a reasonable cost c. raises the cost of health insurance premiums for everyone d. is not permitted under the Patient Protection and Affordable Care Act
c.
Long term care should be delivered according to a. the biomedical model of health b. a person's ability to perform his or her social roles c. holistic model of health d. guidelines established by the World Health Organization
c.
Medical cost inflation is influenced by all of the following factors except: a. Waste and abuse b. Increase in elderly population c. Decrease in uninsured d. Growth of technology
c.
Patient activation is the lowest among people a. insured by managed care plans b. enrolled in a medical home c. enrolled in Medicaid d. enrolled in Medicare
c.
Under which payment method is a fee schedule used? a. prospective payment b. capitation c. discounted fees d. fee for service
c.
What is a PRO? a. Price Rationing Organization b. Political Review of Outcomes c. Peer Review Organization d. President's Review of Organizations
c.
What is an interest group? a. A group of lawmakers within Congress with a particular area of interest b. A group of appointed judges with a particular political view point c. An independent, non governmental group united by a policy area, which lobbies and advocates its point of view to lawmakers d. None of the above
c.
What is incrementalism? a. the fact that in the U.S., health care is financed by multiple entities b. The fragmented, uncoordinated delivery of health services c. Small policy changes that reflect a compromise amongst different groups demands d. None of the above
c.
Which major public insurance program was legislated in 1965? a. Medicare B. Medicaid c. both a and b d. Neither a nor b
c.
Which of the following plays a primary role in individualizing long term care services to the patient's needs? a. coordination of various services b. physician's orders c. an individual assessment d. a discharge report from the hospital
c.
Why should rising health care costs be controlled? a. Americans have to forgo other goods and services when more is spent on health care. b. Unless we control costs, total health care expenditures will far exceed what they would be under free-market conditions. c. Both a and b d. Neither a nor b
c.
the institutional infrastructure of long term care delivery is going through a cultural change that emphasizes a. improved quality of care b. evidence based care c. enriched living environments d. higher staff to patient ratios
c.
when a fixed monthly fee per enrollee is paid to a provider its called
capitation
Which of the following provide(s) structure for assessing social, medical, and psychological problems by providing a systemized method of reviewing key components of the minimum data set and directing caregivers to evaluate causes, interrelationships, and particular strengths that affect development of the care plan?
care area assessment process
Developed by an interdisciplinary team, the ________________________ includes measurable objectives and timetables to meet a resident's medical, nursing, mental, and psychosocial needs.
care plan
The prospective payment system for inpatient rehabilitation is based on ________________.
case mix groups (CMGs)
What does 'CON' stand for?
certificate of need
the ACA specifies that ____ can be covered under parents insurance plans
children under 26
to receive payment for services delivered providers must file a ___ with third party payers
claim
Organized medicine
concerted activities of physicians through the American Medical Associaton
what was the main conclusion of the rand health insurance experiment
cost sharing lowered health care utilization without any significant health consequences
Cost-control efforts in the U.S. have not been successful due to ______.
cost shifting
what is not a type of prospective reimbursement methodology
cost-plus
Delivery of community- oriented primary care requires all of the following except: a. Training of physicians in primary care b. Supplementing the biomedical model with social and behavioral sciences c. Strengthening of public health functions d. Improvements in secondary and tertiary care delivery
d.
Expenditures (E) equal: a. Price (P) minus Quantity (Q) b. Price (P) plus Quantity (Q) c. Price (P) divided by Quantity (Q) d. Price (P) times Quantity (Q)
d.
Most uninsured adults are employed but are not covered because: a. Their employer does not offer health benefits b. They do not qualify because they do not work an adequate number of hours or have not been with the employer long enough c. They cannot afford to pay their portion of the premium or purchase insurance on their own d. Any of the above could be a reason
d.
The elderly to not constitute a homogeneous group; hence a. they have more chronic ailments than acute episodes b. the LTC system must be integrated with the rest of the health care delivery system c. most elderly people live independently d. a variety of long term care services are necessary
d.
Under capitation, risk is shifted a. from the insured to the employer b. from the provider to the MCO c. from the employer to the MCO d. from the MCO to the provider
d.
What is meant by the term "health care costs"? a. The price of health care b. How much a nation spends on health care c. Cost of producing health care d. All of the above
d.
What is the key determinant of the need for long term care? a. A disabling accident b. An acute episode c. Presence of multiple chronic conditions d. Limitations in a person's ability to perform tasks of daily living
d.
What is the role of states in U.S. health policy? a. Financial support for the care and treatment of the poor b. Oversight of health care practitioners and facilities c. Quality assurance d. All of the above
d.
Which of the following branches of government is a supplier of policy? a. Executive b. Legislative C. Judicial D. All of the above
d.
Which of the following is a power of Congress? a. Power of taxation b. Power to use any reasonable means not prohibited by the Constitution to carry out the will of the people c. Power to spend d. All of the above
d.
Which of the following is necessary for achieving universal coverage in the US? a. The Patient Protection and Affordable Care Act b. Employer mandates c. E-health plans d. Single-payer plans
d.
Which racial/ethnic group has the highest rate of uninsurance? a. White b. Black or African American c. Asian or Pacific Islander d. Hispanic
d.
Which racial/ethnic group is growing the fastest? a. White b. Black or African American c. Asian or Pacific Islander d. Hispanic
d.
Which racial/ethnic group is least likely to use mammography? a. White b. Black or African American c. Asian or Pacific Islander d. Hispanic
d.
the first voluntary hospitals in the United States were financed a. through general taxes b. by physicians c. by private insurers d. through local philanthropy
d.
The U.S. healthcare system can best be described as: •A. Expensive • B. Fragmented • C. Market-oriented • D. All of the above
d. all of the above
Fill in the blank: The percentage of medical school graduates choosing careers in primary care is ______________.
decreasing
health insurance pays for medical care after insured pays first 1000
deductible
When providers deliver unnecessary services with the objective of protecting themselves against lawsuits, the practice is called
defensive medicine
Physical therapy, occupational therapy, speech-language pathology, medical social services, and respiratory therapy are all examples of the various _________________________ that may provide services to home health patients.
disciplines
The Health Insurance Portability and Accountability Act requires
disclosure of personal health information -not: nontransmittal of individual health information over the internet
Medical care in preindustrial America had a strong _____ character.
domestic
A copayment is generally paid
each time the insured receives health care services
A copayment is generally paid...
each time the insured receives health care services
copayment is generally paied
each time the insured revives health care services
majority of beneficiaries reviving health care through medicare are
elderly
For most privately insured Americans health insurance is
employer-based
The managed care phenomenon was welcomed mostly by
employers
During the World War II period, health insurance became employer-based because of
endorsement from Blue Cross and Blue Shield plans - not union demands
the employee retirement income security act
exempts self insured plans from certain mandatory benefits
Corporatization of medicine has resulted in delivering the same quality of health care at a lesser cost
false
Decision making based on cost effectiveness about the use of medical technology is more prevalent in the US than in other industrialized countries.
false
Registered Nurses undergo the same training as Licensed Practical Nurses.
false
The U.S. has never imposed price controls on the health care industry.
false
The term e-health applies only to the electronic delivery of health care by qualified health care professionals.
false
There has been a decreasing number of International Medical Graduates (IMGs) in the U.S. Since 1980
false
True or False: Medicare coverage excludes nursing care after a patient has been discharged from the hospital.
false
Your Healthcare Around the World project is a group assignment.
false
by law a health insurance plan must cover work related injuries t/f
false
health insurance plans are allowed to have annual dollar limits on a persons medical benefit t/f
false
long term care services for the elderly are covered under medicare
false
part D of medicare does not require the payment of a premium t/f
false
the ACA requires that employers provide health insurance to part time workers if the employer has 50+ woerks
false
under the ACA private health insurance will no longer be the main source of coverage t/f
false
under the medicaid program eligibility criteria and benefits are consistent throughout the us t/f
false
under experience rating
favorable risk groups pay a lower premium than high risk
_____ reimbursement is based on the assumption that health care is provided in a set of identifiable and individually distinct units of service
fee for servce
_____ reimbursement is based on the assumption that health care is provided in a set of identifiable and individually distinct units of services
fee-for-service
The primary criterion to become eligible for Medicaid is
financial status
the primary criterion to become eligible for medicaid
financial status
Healthy People 2020 is the 1st national initiative to advocate
focusing on a broad array of health determinants
The delivery of medical care in preindustial America was governed mainly by
free market conditions
What does the Consumer Price Index (CPI) measure?
general inflation
Self insurance was spurred by
government policy
self insurance was spurred by
government policy
By definition, a(n) _____________________ limits or prevents the fulfilment of one or several roles that are regarded as normal (depending on age, sex, social, and cultural factors) for a given individual.
handicap
Who was the first American president to make an appeal for national health insurance?
harry truman
The use of fee-for-service reimbursement
has been greatly reduced
the use of fee for service reimbursement
has been greatly reduced
if national health expenditures amount to 18% of the GDP
health care consumes 18% of the total economic production
What is the primary mechanism that enables people to obtain health care services
health insurance
What is the primary mechanism that enables people to obtain health services
health insurance
The phenomenon called 'moral hazard' results directly from
health insurance coverage
the phenomenon called moral hazard results directly from
health insurance coverage
Computers that control environments and wheelchairs are ____________________.
high-technology assistive devices
In an ICF/IID, the most active portion of the individual's record is ___________________.
housed on the living unit.
Medicare part B premiums are
income-based
liberal reimbursement for a given technology will ____ innovation/diffusion of that technology
increase
In an ICF/IID, the individualized program plan is developed by the ___________________.
interdisciplinary team
Typically, tertiary care:
is highly specialized
According to the CDC, which factor contributes most to premature death in the U.S. population?
lifestyle and behavior
Two organizations cease to exist, and a new corporation is formed.
merger
The ____________________________ (is/are) a core set of screening and assessment elements, including common definitions and coding categories forming the foundation of the comprehensive resident assessment of residents in long-term care facilities, such as skilled nursing facilities (SNFs).
minimum data set
Wheeled chairs that assist those for whom ambulation is difficult or not possible are ______________.
mobility devices
preferred providers are paid
negotiated discounted fees
Which of the following is a facility in which the majority of patients are regarded as permanent residents?
nursing facility
for hospitalizations medicare beneficiaries must pay a deductible
once per benefit period
External appliances that supplement an extremity's function or improve stability and positioning are ___________________.
orthotic devices
POPULATION-BASED INTERVENTION MODEL
page 133
skilled nursing care is covered under _____ of medicare
part A
the SMI trust fund is for
parts B an D
reimbursement is associated with which of the quad functions?
payment
The HI portion of Medicare is financed through
payroll taxes
the HI portion of medicare is financed through
payroll taxes
the largest share of national health expenditures is attributed to
personal health care
Nonphysician practitioners (NPPs) include:
physician assistant
SMI provides
physicians services
In the US, public health and private practice of medicine developed separately because
physicians were skeptical of the govt taking control of medical practice
Based on underwriting, the insurer or underwriter determines a fair price in order to insure against risks and charges a _____ to be paid every month.
premium
Cost is shifted from people in poor health in the healthy when
premiums are based on community rating
cost is shifted from people in poor health to the healthy when
premiums are based on community rating
The Baylor Hospital plan, started in1929, laid the foundation for the modern health insurance in the US. This a ______ plan.
prepaid
Gatekeeping empasizes
preventive and primary care
medical policies are sold by
private insurance companies
how are preexisting medical conditions covered under the ACA
private insurance plans have to cover them starting 2014
Development of the hospital and ___________ happened almost hand in hand in a symbiotic relationship between two.
professionalization of medical practice
What does "PPS" stand for?
prospective payment system
The amount of reimbursement is determined before the services are delivered.
prospective reimbursement
the amount of reimbursement is determined before the services are delivered
prospective reimbursement
A device that is designed to replace a missing extremity or partially missing extremity is a(n) ___________________.
prosthesis
Devices that replace missing body parts are ______________.
prosthetics
in general sense what is primary purpose of insurance
protection against risk
capitation removes the incentive to
provide unnecessary services
wheat perverse incentive is present in retrospective reimbursement
providers can increase their profits by increasing costs
what is the incentive under fee for service reimbursement
providers have an incentive to deliver nonessential services
the donut hole in medicare prescription drug coverage
provides no benefits until the beneficiary qualifies for the catastrophic level
Health policies may serve as ______ tools.
regulatory and allocative tools
The Hill-Burton Act was passed to
relieve shortage of hospitals
RVU's reflect
resource inputs
Insurance protects the enrollee/member or beneficiary against ______
risk
what is the main advantage of group insurance
risk is spread out among a large number of insured
Studying incident and accident reports to identify patterns and reduce hazards is a function of ______________________.
risk management
In the US, federal qualified health centers are funded to
serve as a safety-net to those who have difficulty getting needed primary care.
A typical health insurance plan pays only for
services considered medically necessary
One difference in the way that services rendered to an ICF/IID client differ from those in other settings is that in the ICF/IID setting, __________________.
services must include training
Medical-surgical nursing, intravenous therapy, and restorative nursing care are ___________________.
skilled nursing services
20. ______ is the leading cause of preventable disease and mortality in the United States
smoking
The elements of the Epidemiology Triangle of disease occurrence include all of the following except:
society
A _____________________________________ is a record organized in sections according to patient care departments and/or disciplines.
source-oriented record
The Flexner Report, published in 1910, reported on
standards of training in medical schools
What was the main consequence of early proprietary medical schools, as opposed to state-sponsored schools, in the preindustrial era?
standards were low
Which entity oversees the licensure of health care facilities?
state government
Which of the following would initiate a complaint investigation in response to a hotline call concerning alleged abuse or neglect?
state licensing agency
in national health care systems total expenditures are controlled mainly by
supply side rationing
In national health care systems, total expenditures are controlled mainly through
supply-side rationing
A major factor influencing growth in the health care sector of the U.S. economy is:
the aging of the population
under retrospective reimbursement a health care organization is paid according to
the costs incurred in operating the institution
In an inpatient rehabilitation facility, the IRF-PAI differs from the UB-04 in that it requires submission of ___________________.
the etiological diagnosis (what caused the disability)
The private medical sector in the US has been heavily regulated by the govt mainly because
the govt finances Medicare and Medicaid
With regard to development of forms for the ICF/IID record,
the health information director should be an active participant in the establishment of standardized forms
The resource utilization group (RUG) that applies to a given resident is based on __________________.
the minimum data set
Quality equals:
the sum of multiple individual interactions between clinicians and patients
When a care area is triggered, the long-term care interdisciplinary team documents the outcome of the assessment process for that particular care area and ___________________.
their decision regarding care planning for a particular problem or need
under ACA what purpose do the exchanges serve
they allow individuals and small businesses to purchase health plans
What is the main application of quality-adjusted life years?
they are used as a measure of health benefits
in general how do bronze, silver and gold health plans differ
they differ according to cost sharing
adverse selection makes health insurance less affordable for
those in good health
why was medicare part C created
to channel beneficiaries into managed care programs
What was the function of a pesthouse in the preindustrial period?
to house people who had a contagious disease
What is a major objective of the Affordable Care Act?
to provide insurance coverage
the insurance arm of military health care is called
tricare
American beliefs and values favor the development and use of new medical technology despite its cost.
true
Health insurance increases the demand for heath care services t/f
true
In the preindustrial era, much of the medical care in the US was provided by nonphysicians.
true
More than half of MDs are specialists?
true
More than half of Ostepathic (DOs) Physicians are Generalists?
true
Patients requiring services from occupational therapists need help performing tasks in their daily living and working environments.
true
Technology has been credited with the overall reduction in the average length of inpatient hospital stays.
true
The book used for your course is: Shi, L. and D. Singh. 2012. Delivering Health Care in America - A Systems Approach (5th edition). Burlington, Massachusetts: Jones & Bartlett Publishers. ISBN: 978-1-4496-2650-1.
true
The final is cumulative.
true
The utilization of technology has a greater impact on total health care expenditures than the cost of acquiring technology.
true
Your Healthcare Around the World Project will be submitted to turnitin.com.
true
according to a US supreme court decision individual states can decide whether or not to expand their medicaid programs to comply with ACA
true
health insurance plans are prohibited from having lifetime dollar limits on medical benefits t/f
true
it is illegal for an insurance company to sell a medical plan to someone who is covered by medicaid t/f
true
people in older age groups represent a higher risk than those in lower age groups t/f
true
research shows that prospectively set bundled payment methods are effective in reducing health care t/f
true
state governments are required to partially finance the medicaid program t/f
true
tax policy in the us provides an incentive to obtain employer based health insurance t/f
true
the government plays a significant role in financing health care services in the united states t/f
true
today the majority of health insurance exists in the form of managed care plans t/f
true
under community rating people are charged in the same regardless of health risk t/f
true
undr medicare program, eligibility criteria and benefits are consistent throughout the US t/f
true
Which of the following factors was particularly important in promoting the growth of office-based medical practice in the postindustrial period?
urbanization
Labor costs and transportation costs associated with home care visits are examples of ______________________.
variable costs
Which of the following is NOT a reliable way to contact your professor:
visiting professor's home
private health insurance is also called
voluntary insurance
During the WWII period, health insurance became employer-based because of
wage freezes
The inception of _________ was used as trial balloon for the idea of govt-sponsored universal health insurance
workers' compensation
A(n) __________________ is any temporary or permanent loss or abnormality of a body structure or function, whether physiological or psychological.
impairment
The phrase private payin the long-term care setting denotes payment by _______________.
the individual or family
