H314 Modules 9 & 10

True

If a state elects to displace competition in a particular market and substitute state government regulation, the federal antitrust laws will NOT apply in that sector of the state's economy.

prior notice to the federal government of certain large mergers.

According to the assigned reading, the Hart-Scott-Rodino Antitrust Improvements Act requires which of the following:

Whether the merger would enable the combined entity to raise its prices above the competitive level.

According to the assigned reading, which of the following best describes the underlying principle of analyzing whether a proposed merger is unlawful?

Approximately 1/3

As discussed in the assigned excerpts from Judge Winmill's opinion, because of the fee-for-service reimbursement system's focus on volume of care provided, approximately how much health spending in the U.S. is unnecessary waste?

Although physicians had discretion regarding where they made referrals, in practice referrals to St. Luke's facilities from these practices increased dramatically and referrals to Saint Alphonsus facilities dropped dramatically.

As discussed in the assigned excerpts from Judge Winmill's opinion, which of the following best describes what has happened in relation to referrals after St. Luke's purchased specialty physician practices?

B. None of the other options are correct; they are all true of PSAs between physicians and St. Luke's.

As discussed in the assigned excerpts from Judge Winmill's opinion, which of the following is NOT true of the professional services agreements ("PSA") entered between St. Luke's and physicians. A. Under a PSA, a physician practice group agrees to provide health care services exclusively on behalf of St. Luke's, and St. Luke's is reimbursed for the practice's services under contracts that St. Luke's enters into with payors. B. None of the other options are correct; they are all true of PSAs between physicians and St. Luke's. C. Although physicians practicing under a PSA do not have a direct employment relationship with St. Luke's, the PSA sets forth the compensation that St. Luke's pays the physician practice for services provided by the physicians on its behalf. D. For purposes of the antitrust case, a PSA arrangement creates a relationship functionally equivalent to employment to the extent that it provides, at the group level, the same clinical and financial alignment that employment provides at the individual level.

In fall 2011, when seven physicians affiliated with Mercy Physicians Group and one other physician employed by Saint Alphonsus decided to join St. Luke's.

At what point did St. Luke's first begin employing (or entering into professional service agreements with) physicians practicing in Nampa?

Where a 61-year-old man is diagnosed with metastatic prostate cancer, and the patient tells the physician he does not intend to tell his wife about the diagnosis.

In Clinical Ethics, the authors discuss the ethical dilemmas created in circustances where there may be a justification to share private health information with third parties against the will of the patient. In which of the following cases would the authors of Clinical Ethics recommend that the provider abide by the patient's will and not share or report the private information to a third-party?

An individual's right to find out who has received information from his or her medical record.

In the HIPAA privacy rule, what is the meaning of "accounting of disclosures"?

To highlight the public opposition to resctrictive HMOs.

In what context was a hollywood movie from the 1990s discussed in this Module?

Immunity from antitrust liability, based on the First Amendment, for activities that involve petitioning an agency of the government for some action, even if the goal in obtaining such governmental action is to harm market competition.

Which of the following best describes Noerr-Pennington Immunity:

HIPAA creates a federal "floor," for minimum standards of health privacy; states may enact laws that afford greater protections of health privacy.

Which of the following best describes how the HIPAA Privacy Rule relates to potentially contradictory state law?

There is no private right of action under HIPAA, but an individual harmed by a disclosure of health information in violation of the HIPAA Privacy Rule may bring a tort claim under state law. In such a case a violation of the HIPAA Privacy Rule would typically constitute a violation of the applicable standard of care.

Which of the following best describes the right of a private party to bring a civil lawsuit for damages alleging a covered entity violated the HIPAA Privacy Rule?

The public policy favoring protection of the confidential character of patient-psychotherapist communications must yield to the extent to which disclosure is essential to avert danger to a specifically identified person.

Which of the following best summarizes the conclusion reached by the court in Tarasoff v. Regents of the University of California?

A. An individual's post to Facebook asking for advice regarding how to treat a rash.

Which of the following is NOT "protected health information" under the HIPAA Privacy Rule? A. An individual's post to Facebook asking for advice regarding how to treat a rash. B. The names and addresses of patients of a fertility clinic. C. A patient's verbal statements to a primary care physician in the course of treatment regarding substance abuse. D. None of the other options are correct; they are all "protected health information" under the HIPAA Privacy Rule.

C. Mergers

Which of the following is NOT one of the types of conduct courts have traditionally considered illegal "per se" under federal antitrust laws? A. market allocation B. price fixing C. mergers D. boycotts

C. The acquisition would remove the discretion of Saltzer physicians regarding where they refer patients, and therefore patients would be referred to only St. Luke's hosptials

Which of the following is NOT true of Judge Winmill's findings regarding the anticompetitive effects of the acquisition between St. Luke's and Saltzer? A. None of the other options are correct; the other options all summarize points from Judge Winmill's findings regarding the anticompetitive effects of the acquisition. B. The acquisition would stregthen St. Luke's market power and weaken Blue Cross of Idaho's ability to negotiate with St. Luke's. C. The acquisition would remove the discretion of Saltzer physicians regarding where they refer patients, and therefore patients would be referred to only St. Luke's hosptials. D. St. Luke's projected it could increase revenue by $1.65 Million after the acquisition by billing for lab and imaging services at higher "hospital-based" rates.

D. The reputation for poor quality care for that St. Luke's and Saltzer had in the past raised concerns that after the Acquisition patients in Nampa would have fewer options for care from providers with more sterling reputations.

Which of the following is NOT true of the circumstances prompted the Federal Trade Commission and Saint Alphonsus and Treasure Valley Hospital to bring a lawsuit alleging violation of the antitrust laws? A. After the Acquisition of Saltzer by St. Luke's, the combined entity includes 80% of the primary care physicians in Nampa. B. None of the other options are correct; they are all true of the circumstances that gave rise to the antitrust lawsuit being filed. C. There was concern that after the Acquisition, St. Luke's would be the dominant provider in the Nampa area for primary care, and thereby have significant bargaining leverage over health insurance plans. D. The reputation for poor quality care for that St. Luke's and Saltzer had in the past raised concerns that after the Acquisition patients in Nampa would have fewer options for care from providers with more sterling reputations.

D. Because Blue Cross of California had a relatively small proportion of the private insurance market in the Bay Area in 2000, its executives were not surprised when Sutter Health demanded substantial rate increases.

Which of the following is NOT true of the rate negotiations between Sutter Health and Blue Cross of California, as discussed in the assigned This American Life podcast segment? A. As a pressure tactic, Sutter Health urged its patients to call Blue Cross's customer service line and complain about Sutter potentially being excluded from Blue Cross's network of providers. B. With its hundreds of facilities and two dozen hospitals in norther California, Sutter Health enough of the the health care market to have a geographic lock on the Bay Area. C. Sutter Health was demanding huge rate increases of averaging around 1/3 from Blue Cross of California. D. Because Blue Cross of California had a relatively small proportion of the private insurance market in the Bay Area in 2000, its executives were not surprised when Sutter Health demanded substantial rate increases.

In order to encourage individuals to seek treatment, patient-provider confidentiality must be treated as unlimited and absolute.

Which of the following is NOT true regarding a clinician's ethical obligation of patient confidentiality, as explained in the Clinical Ethics? A. Confidentiality is a strict, but not unlimited, ethical obligation. B. The ethical issue is determining what circumstances and principles justify an exception to absolute patient confidentiality. C. In order to encourage individuals to seek treatment, patient-provider confidentiality must be treated as unlimited and absolute. D. In general, the grounds for exception to patient confidentiality are concerns for the safety of other specific persons and concern for public health

D. Certain provisions in the PSA expressly tied physician compensation level above the guaranteed minimum to where physicians made referrals and the revenue generated from laboratory and imaging services.

Which of the following is NOT true regarding the professional services agreement (PSA) that Saltzer physicians in Nampa entered into with St. Luke's as part of the Acquisition that was the subject of the antitrust case assigned in this Module? A. he PSA guaranteed physicians' annual compensation for physicians for the first two years after the agreement would be no less than the average for the three years ending September 30, 2011. B. The PSA contained an exclusivity provision that prohibited physicians from becoming employed by or financially affiliated with other health systems or hospitals during the term of the PSA. C. The parties in the lawsuit all agree that the PSA would provide Saltzer physicians with complete freedom to refer patients to any practitioner or facility regardless of its affiliation with St. Luke's. D. Certain provisions in the PSA expressly tied physician compensation level above the guaranteed minimum to where physicians made referrals and the revenue generated from laboratory and imaging services.

C. The PSA Salzter physicians entered into as part of the acquisition contains an "exclusivity" provision that prohibits Saltzer physicians from maintaining privileges at other hospitals.

Which of the following is NOT true regarding the terms of St. Luke's acquisition of Saltzer? A. The five-year PSA Saltzer physicians entered into as part of the acquisition guarantees these physicians' annual compensatation will be at least a certain amount during hte first two years of the PSA. B. Saltzer received a payment of almost $9 Million from St. Luke's in payment for goodwill and intangibles, and this payment does not need to be paid back to St. Luke's if the acquisition is undone. C. The PSA Salzter physicians entered into as part of the acquisition contains an "exclusivity" provision that prohibits Saltzer physicians from maintaining privileges at other hospitals. D. The PSA Saltzer physicians entered into as part of the acquisition does not expressly tie physician compenstation to where they make referrals or the volume or revenue generated by ancillary services, such as laboratory or imaging services.

The HITECH and GINA acts

Which of the following is a federal law that affects the use or privacy of health information?

C. Both A and B are correct

With regard to state laws about the privacy of healthcare information, which of the following statements is correct? A. Healthcare providers may be held liable under state law for improperly disclosing patient information. B. Healthcare providers may be held liable under state law for improperly failing to disclose patient information. C. Both a. and b. are correct D. None of the above are correct.

The privacy rule adopted by HHS does not supersede or preempt state laws that provide a higher level of protection for the privacy of healthcare information.

With regard to the federal HIPAA privacy rule, which of the following statements, if any, is correct?