Week 4 Chapters 3 and 4
The Patient Protection and Affordable Care Act had as a goal enhanced access to health insurance. Which of the following mechanisms were used? Select all that apply. A. Insurance companies can no longer deny health insurance to people with pre-existing health conditions. B. Young adults can remain on their parent's health insurance plan, as long as they are unmarried and dependent on their parent's income tax. C. Insurance companies cannot enforce lifetime caps on reimbursement. D. Gender cannot be used as a rating factor.
A,C,D -----note the first part of B is true, but not the latter. Children can stay on their parents health insurance until age 26, even if they are married and no longer listed as dependents on their parents income tax returns
In which of the following health insurance plans, would you pay the most out-of-pocket when using health services? A. Bronze B. Silver C. Gold D. Platinum E. In each of these, you would pay the same amount out-of-pocket when using health services
A. Bronze
Fee-for-service reimbursement A. Creates strong incentives for care coordination B. Contributes to the nation's difficulty containing health care costs C. Both A and B D. Neither A nor B
B. Contributes to the nations difficulty containing health care costs
ACO shared savings programs A. Create opportunities for nurses to influence the value of care provided through care coordination and care redesign B. Require that quality thresholds be met before savings from expected expenditures are shared among the payer and the ACO C. Both A and B D. Neither A nor B
C. Both A and B
Global budgets in health care A. Create financial incentives to reduce avoidable health care utilization B. Create financial incentives to coordinate care C. Both A and B D. Neither A nor B
C. Both A and B
In addition to employing physicians and nurses, patient-centered medical homes rely on A. Community health teams B. Health coaches C. Both A and B D. Neither A nor B
C. Both A and B
Linking reimbursement to achievement of quality metrics A. May result in better health care outcomes B. May create metric-driven behavior that creates metric-driven patient harm C. Both A and B D. Neither A nor B
C. Both A and B
One of the ways ACOs differ from HMOs is A. Generally there are no gatekeepers in ACOs B. ACOs do not limit beneficiaries' access to health care or choice of providers C. Both A and B D. Neither A nor B
C. Both A and B
Nursing skills valued in a reformed health care system include A. Care process reengineering B. Care coordination C. The use of data D. All of the above
D. All of the above
Which of the following statements about the Patient Protection and Affordable Care Act of 2010 is NOT true? A. It represents the most sweeping health reform law since the introduction of Medicare and Medicaid in 1965. B. It includes a tax on tanning beds. C. It includes payment reform that attempts to remove perverse incentives for higher cost, lower quality care. D. It includes a public option whereby people can opt-in to Medicare, regardless of age.
D. It includes a public option whereby people can opt-in to Medicare, regardless of age.
Fee-for-service reimbursement A. Creates financial incentives to reduce avoidable health care utilization B. Creates financial incentive to coordinate care C. Both A and B D. Neither A nor B
D. Neither A nor B
In which of the following health insurance plans, would you pay the least out-of-pocket when using health services? A. Bronze B. Silver C. Gold D. Platinum E. In each of these, you would pay the same amount out-of-pocket when using health services
D. platinum
Which of the following statements about the Patient Protection and Affordable Care Act of 2010 is TRUE? A. As passed, included an individual mandate, which was deemed unconstitutional in 2012. B. As passed, included an employer mandate, which was deemed unconstitutional in 2012. C. As passed, included provisions to merge Medicare and Medicaid. D. As passed, included strategies to stabilize the health insurance market.
D.As passed, included strategies to stabilize the health insurance market.
All forms of reimbursement create the same treatment incentives and disincentives. T/F
False
The Patient Protection and Affordable Care Act of 2010 is a form of socialized medicine. T/F
False
The Patient Protection and Affordable Care Act of 2010 remains intact exactly as passed. T/F
False
The Patient Protection and Affordable Care Act of 2010 replaced Obamacare. T/F
False
The Patient Protection and Affordable Care Act of 2010 requires that a person select a bronze plan on the exchange to receive a subsidy. T/F
False
The acronym P4P refers to a form of health care financing termed preferred for payment. T/F
False
The optimal configuration of team members in a patient-centered medical home has been defined and is firmly supported by empirical evidence. T/F
False
An ACO may be defined as a group of providers who agree to be accountable for the cost and quality of the care provided. T/F
True
Another term for patient-centered medical homes is advanced primary care. T/F
True
Bundled payments create a financial incentive to coordinate care across the entire episode of illness or condition management. T/F
True
Hospital global budgets provide hospitals with a predictable revenue outlook.T/F
True
The Affordable Care Act defined potential members of the community health team. T/F
True
The Patient Protection and Affordable Care Act of 2010 required Medicaid expansion, which was deemed unconstitutional by the U.S. Supreme Court in 2012. T/F
True
The term superutilizer refers to individuals who use a disproportionally high amount of health care. T/F
True
Under fee-for-service reimbursement, nurses are often viewed by management as a labor cost. T/F
True
