Question1) An MS-DRG is a refined DRG that includes: patient severity

Question

Question1) An MS-DRG is a refined DRG that includes:

patient severity.

costs incurred in treating a patient.

	adjustment for treating patients on Medicaid.
	adjustment for readmissions within 30 days of discharge.

Question 2

Self-insurance was spurred by:

	employers.
	government policy.

	self-employed people.
	managed care organizations.

Question 3

The phenomenon called "moral hazard" results directly from:

	the uninsured status of a segment of the U.S. population.
	inadequate payment to providers.

	managed care enrollment.
	health insurance coverage.

Question 4

True or False? By law, a health insurance plan must cover work-related injuries.

	True
	False

Question 5

True or False? The government plays a significant role in financing health care services in the United States.

	True
	False

Question 6

True or False? Under the ACA, private health insurance will no longer be the main source of coverage.

	True
	False

Question 7

True or False? The CMS projected US health expenditures for 2020 is estimated at almost $4.2 Trillion with per capita spending of $12,490.

True ppt 7

False

Question 8

True or False? Health insurance coverage provided through Medicare and Medicaid covers the majority of the US population.

	True
	False ------ only covers 1/3

Question 9

Under retrospective reimbursement, a health care organization is paid according to:

	predetermined rates.
	the number of patients served.

	the costs incurred in operating the institution.
	fees established by the organization.

Question 10

What is the incentive under fee-for-service reimbursement?

		Payers have the incentive to reduce reimbursement.
		Patients have the incentive to consume more services than necessary.

	Providers have an incentive to deliver nonessential services.
	Insurers have an incentive to reduce premium costs.

Question 11

What is the Minimum Data Set?

	It is a data collection instrument used mainly for clinical research.
	It facilitates the determination of case-mix groups in rehabilitation hospitals.

	It is a patient assessment instrument for skilled nursing facilities.
	It facilitates the determination of ambulatory payment classifications in outpatient centers.

Question 12

When a fixed monthly fee per enrollee is paid to a provider, it is called:

	bundled fee.
	charge.

	capitation.
	retrospective reimbursement.

Question 13

A patient with special needs could expect to receive efficient, appropriate, team-approach care from which of the following?

	Primary care
	Patient-centered medical home (pg 277)

	Community-oriented primary care
	Outpatient care

Question 14

Countries whose health systems are oriented more toward primary care achieve:

	higher satisfaction with health services among their populations.
	higher expenditures in the overall delivery of care.

	increased ED visits.
	increased hospitalization rates.

Question 15

How is community-oriented primary care (COPC) different from primary care?

	COPC believes in the link between primary and secondary prevention.
	Primary care adheres more strongly to the biomedical model.

	COPC adds a population-based approach to identifying and addressing community health problems.
	Primary care principles in actual practice have not materialized in the United States as of yet.

Question 16

One reason women's health centers were created is:

	women have more money than men.
	women seek care more often than men.

	women have shorter lifespans than men.
	women get sick more often than men.

.

Question 17

The most prominent reason for the decline in the number of procedures performed in hospitals is:

	most of these procedures were shifted to the outpatient setting.
	most of these procedures were deemed outdated.

	most of these procedures were unsafe.

Question 18

True or False? Typically, tertiary care is highly specialized.

	True
	False

Question 19

Primary Care Providers (PCPs) include those physicians in the following specialties:

	Family Practice
	Internal Medicine

	Pediatrics
	Obstetrics and Gynecology

	All of the above. (pg. 280?) PCPS include family practice, internal medicines, and pediatrics BUT some people have obstetrics and gynecology as their PCPS too. https://medlineplus.gov/ency/article/001939.htm
	A, B and C only

Question 20

What does "PPS" stand for?

	Preferred provider system
	Primary physician system

	Private practice system
	Prospective payment system

Question 21

What is palliation?

	Pain and symptom management
	Psychosocial support

	A surgical intervention
	Bed rest

Question 22

True or False? The NCCAM of the NIH which was focused on complementary and alternative medicine is now the NCCIH, the National Center for Complementary and Integrative Health.

	True
	False

Question 23

True or False? Retail primary care clinics offer flexibility and convenience to patients even if they have to pay out of pocket.

True page 288 undr retail clinics

False (?)

Question 24

Which of the following is a reason for the growth in outpatient services?

	The most common surgeries in the majority of the United States were lens and cataract procedures.
	Ambulatory surgeries are more efficient and inexpensive (?)

	Recovery at home prevents complications after surgery.
	Surgeons can charge less money when they perform procedures that do not require inpatient care.

Question 25

According to U.S. law, nonprofit organizations:

	can make only a limited amount of profit.
	are tax exempt.

	cannot have a governing body.
	must pay taxes only if they are profitable.

Question 26

A hospital that is accredited by the Joint Commission:

	is deemed to have met licensure requirements.
	receives the designation of "magnet hospital."

	must comply with the conditions of participation.
	is deemed to have met certification requirements.

Question 27

Magnet hospitals have been found to:

	attract and retain well-qualified nurses.
	attract privately insured patients.

	serve a disproportionately high number of seriously ill patients.
	excel in innovative processes of care delivery.

Question 28

The ethical principle of fidelity requires a medical practitioner to:

	keep all patient information confidential.
	perform his or her duty(page 349).

	seek consent for treatment.
	tell the truth.

Question 29

True or False? In recent years, the nonprofit hospital sector has continued to gain market share.

	True
	False

Question 30

True or False? The affluent use hospital services more intensively than the poor.

True I think its false but people say they found “true” on (page 318)

False

Question 31

An anchor institution (such as a hospital or educational institution) approach can bring economic “health” supportive of community health and well-being by:

	Investing assets into hiring local workforce.
	Development of new businesses and social enterprises.

	Use real estate holdings to develop housing.
	All of the above.

A and B only.

Question 32

True or False? EMTALA was important to ending the practice of denying life-saving emergency care because of a lack of ability to pay.

	True
	False

Question 33

Use of both hospitalists and a rapid response team have improved the quality of care and avoided medical errors at Johns Hopkins University Hospital.

	True https://hub.jhu.edu/2016/05/03/medical-errors-third-leading-cause-of-death/
	False Did not find it inside the text.

Question 34

Unlike the United States, the first hospitals in Europe were established by:

	the government.
	religious orders.

	rich donors.
	trade unions.

Question 35

What is the main drawback of a living will?

	It cannot cover all possible situations.
	The patient's agent may not act in the patient's best interest.

	The person formulating a living will must have a court-appointed guardian.
	It becomes invalid when the patient becomes incompetent.

Question 36

Which entity in hospital governance is legally responsible for the hospital's operations?

	The CEO
	The board of trustees

	The chief of staff
	The chief operating officer

Question 37

Which principle of ethics requires caregivers to involve the patient in medical decision making?

	Paternalism
	Fidelity

	Beneficence
	Autonomy

Question 38

Antitrust legislation is intended to provide checks against:

	anticompetitive behavior.
	fraud and abuse.

	self-referral of patients.
	payments for patient referrals.

Question 39

Capitation is best described as: (pg. 250)

	a monthly lump sum payment regardless of utilization.
	a monthly lump sum payment regardless of cost.

	a fixed monthly fee per member.
	payments capped to a maximum cost for delivering services.

Question 40

Sharing of existing resources without joint ownership of assets describes a(n):

	acquisition.
	merger.

	joint venture.
	alliance.

Question 41

True or False? A triple-option plan includes indemnity insurance as an option.

	True
	False

Question 42

True or False? Utilization is better controlled under a closed-panel plan than under an open-panel plan.

	True
	False

Question 43

What is the purpose of risk sharing with providers?

	It makes providers immune to costs.
	It makes providers cost-conscious.

	It rewards providers for quality.
	It keeps insurance premiums low.

Question 44

True or False? Patients, not just providers, are also expected to play a role in risk sharing. (pg. 378 in ebook), “hence no direct risk sharing with providers is involved)

	True
	False Did not find anything about patients, but a double check might help.

Question 45

What type of integration is represented by a chain of nursing homes?

	Vertical integration
	Network

	Horizontal integration
	Diversification

Question 46

When an organization ceases to exist as a separate entity and is absorbed into the purchasing corporation, this is called a(n):

	acquisition.
	merger

	joint venture.
	alliance.

Question 47

When two organizations cease to exist and a new corporation is formed, this is called a(n):

	acquisition.
	merger.

	joint venture.
	alliance.

Question 48

Which of these organizations was specifically created to bring management expertise to physician group practices?

	Virtual organizations
	Physician-hospital organizations

	Provider-sponsored organizations
	Management services organizations

Question 49

Which of the following are true about use of PDSA for quality improvement?

	PDSA stands for Plan Do Service Act. (Plan Do Study Act)
	It is the basis for other quality improvement approaches

	Act is the step that implements changes for the next cycle based on the analysis conducted under Do.(?) https://www.acponline.org/system/files/documents/practice-resources/quality-improvement/pdsa/psda-overview.pdf
	None of the above.

B. only.

Question 50

A facility that is certified as SNF can admit only Medicare patients.

	True
	False

Question 51

A long-term care facility must be certified in order to:

	operate as a nursing home.
	comply with national fire and safety codes.

	obtain deemed status.
	admit Medicare and/or Medicaid patients. on page 422 of ebook(Source: https://quizlet.com/62382928/special-populations-flash-cards/)

Question 52

Hospital-based transitional care units must be certified as:

	an acute care hospital.
	an SNF.

	an NF.
	both an SNF and an NF.

Question 53

In the delivery of long-term care, customized interventions are carried out according to:

	an individual assessment.
	a plan of care.

	weekly evaluations by the patient's physician.
	the philosophy of total care.

Question 54

True or False? The “On Lok” or PACE model became institutionalized nationally to serve frail clients with a comprehensive set of services in SNFs to avoid expensive hospitalizations.

True

False (pg. 419?)

Question 55

True or False? One of the ways informal care is supported is the FMLA, Family Medical Leave Act.

	True (ppt session 11 slide 31)
	False

Question 56

True or False? A continuing care retirement community (CCRC) provides different levels of long-term care options in one location.

	True (pg. 425)
	False

Question 57

True or False? A facility that is certified as NF can admit only Medicaid patients.

	True
	False

Question 58

True or False? Facility licensing regulations are consistent nationwide.

	True
	False

Question 59

True or False? Medicare does not pay for regular adult day care services.

	True
	False

Question 60

True or False? Therapeutic services in long-term care are prescribed by a physician.

	True (pg. 408, ebook)
	False

Question 61

Which of the following demonstrates the movement in nursing homes, referred to as "culture change"?

	The environment promotes physical and psychological well-being.
	Older adults from all different backgrounds are being accepted as residents.

	Nurses have different attitudes towards the residents to help them feel accepted.
	Residents treat other residents like family members so the environment feels more like a home.