question

What does "PPS" stand for?

answer

Prospective payment system

question

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

answer

-Managed care -New technology -Patient preference (all of the above)

question

Hospice services are primarily for people with:

answer

terminal illness

question

Palliation

answer

Pain and symptom management

question

two reasons for growth of outpatient services:

answer

technology and managed care

question

EMTALA

answer

The law that requires ER departments to treat patients regardless of their ability to pay

question

two outpatient primary care service sites:

answer

-Physician offices -Hospital emergency services

question

Inpatient care:

answer

Healthcare delivered in conjunction with an overnight stay in a facility

question

To be called a hospital, a facility must have at least __ beds.

answer

6

question

The biggest share of national health spending is used by

answer

hospitals

question

What is the meaning of "excess capacity" in the healthcare inpatient sector?

answer

empty beds

question

What has been the effect of intense consolidation in certain hospital markets?

answer

dilution of competition

question

The Hill Burton act was passed to

answer

relieve shortage of hospitals

question

What did the swing bed program allow rural hospitals to do?

answer

use the same beds for acute or long term care

question

How did the PPS based on DRGs lead to hospital downsizing in the United States?

answer

It created financial incentives to minimize the patients length of stay

question

Which of these hospitals it not likely to serve the general public?

answer

federal hospitals

question

Which ownership type constitutes the largest group of hospitals and hospital beds in the United States?

answer

private nonprofit

question

For whose financial benefit are proprietary (for profit) hospitals operated?

answer

stockholders

question

Which hospitals provide services to children in the communities that do not have specialty children's hospitals?

answer

general hospitals

question

To be classified as a critical access hospital, the number of acute care beds should not exceed:

answer

25

question

According to US law, nonprofit organizations are

answer

tax exempt

question

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

answer

the board of trustees

question

Which entity oversees the licensure of healthcare facilities?

answer

state government

question

3 hospital types by ownership:

answer

-public -private for profit -private for nonprofit

question

3 functions of a teaching hospital:

answer

-research -education to residents -provide care to poorer population

question

The HMO act of 1973 required

answer

Employers to offer an HMO alternative to conventional health insurance

question

32. Under the fee-for-service system, providers had the incentive to

answer

Deliver more services than what would be medically necessary because a greater volume would increase their incomes

question

Gatekeeping heavily depends on the services of a

answer

Primary care physician

question

Closely associated with the function of UR is the function of

answer

discharge planning

question

Review of patterns of practice is undertaken as part of

answer

Retrospective utilization review

question

When an MCO adopts capitation as the primary method of payment, which service is likely to be carved out?

answer

mental health

question

Which HMO model is likely to provide the greatest control over the practice patterns of physicians?

answer

staff model

question

Physicians are employees of the HMO

answer

staff model

question

A network model HMO

answer

Contracts with more than one group practices

question

Which type of MCO has achieved the greatest success in member enrollment?

answer

PPO's

question

Which of the following is NOT an example of consolidation?

answer

building of new facilities

question

An organization ceases to exist as a separate entity and is absorbed into the purchasing corporation.

answer

Acquisition

question

Two organizations cease to exist and a new corporation is formed

answer

Merger

question

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

answer

Horizontal integration

question

Which type of long term care service is predominantly used in the US?

answer

Informal care

question

Which part of medicare covers SNF services?

answer

Inpatient

question

Tertiary care is

answer

highly specialized

question

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

answer

Most of these procedures were shifted to outpatient settings

question

Cost-effective management of care for patients who have complex medical conditions

answer

case management

question

Antitrust legislation is intended to provide checks against

answer

payments for patient referrals

question

Development of the hospital and _____ happened almost hand in hand in a symbiotic relationship between the two.

answer

Professionalization of medical practice

question

E-health has resulted in

answer

Patient empowerment and a dilution of their dependent role

question

Physicians and hospitals in the U.S. began consolidating and integrating mainly in response to

answer

- Pressure to contain costs -The growth of managed care (b and c)

question

Historically, inpatient care developed ___________ outpatient care.

answer

After

question

Emergency departments, in most cases, are equipped to provide:

answer

-secondary services -tertiary services (both b and c)

question

Which of the following is an example of a secondary care service?

answer

-Rehabilitation -Surgery -Consultation (all of the above)

question

Which country's health care system is founded on the principles of gatekeeping?

answer

UK

question

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

answer

Higher satisfaction with health services among their populations

question

Which primary factor was the trigger that made hospitals limit care to the more acute periods of illness rather than the full course of the disease?

answer

Pressure to contain costs

question

Who pioneered the transformation of nursing into a recognized profession?

answer

Florence Nightingale

question

Which factor was the most instrumental in the growth of nonprofit community hospitals in the United States?

answer

Hill Burton Act

question

Why are discharge statistics more accurate than admission statistics as a count of inpatients served by a hospital?

answer

Deaths are counted as discharges

question

ALOS is an indicator of

answer

severity of illness

question

How is average length of stay calculated?

answer

days of care/discharges

question

Average daily census is a measure of a hospitals

answer

days of care

question

What financial benefit does a small rural hospital reap by qualifying for the designation Critical Access Hospital?

answer

It can receive cost-plus reimbursement under Medicare Part A

question

Nonphysician practitioners (NPPs) include

answer

Physicians Assistants

question

Capitation is best described as

answer

per member per month payment

question

Under which payment method is a fee schedule used?

answer

discounted fees

question

In the beginning, why did HMOs only had limited appeal?

answer

The insured wanted to maintain the choice of providers

question

Who is likely to bear the most financial risk under the IPA model?

answer

The providers

question

Among HMOs, which model is predominant in the marketplace?

answer

IPA model

question

PPOs were created by _____ in response to HMOs growing market share.

answer

insurance companies

question

Public health is the science of

answer

-Preventing disease -Prolonging life -Promoting health (all of the above)

question

HIM professionals participate in a variety of public health roles by acting as

answer

-Data collectors -Data analysis -Data reporters (All of the above)

question

The top section of the Public Health Pyramid, direct health care services, provides direct health services, such as medical care, psychological counseling, and hospital care to

answer

Individuals

question

The enabling services level of the Public Health Pyramid provides health and social services that support of supplement the health of

answer

Aggregates

question

At which level of the Public Health Pyramid are services delivered to an entire population?

answer

population-based services

question

Outpatient care accounts for what percent of gross patient revenue for all US hospitals?

answer

40%

question

Approximately how many emergency departments exist in the US?

answer

4000

question

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

answer

COPC adds a population-based approach to identifying and addressingcommunity health problems

question

Which of the following factors helps determine the proportion of primary care personnel to specialists needed for the adequate provision of primary care?

answer

how rigidly the health care delivery system employs gatekeeping and the population's rates of utilization of primary care services

question

The managed care phenomenon was welcomed mostly by

answer

employers

question

With the growth of managed care, the balance of power in the medical marketplace swung toward

answer

the demand side

question

A managed care organization functions like

answer

an insurer

question

What is the purpose of risk sharing with providers?

answer

It makes providers cost concious

question

In the term, managed care, 'manage' refers to

answer

management of utilization

question

Closed-panel plan:

answer

the enrollee is restricted to the providers on the panel

question

Under _____ a primary care physician becomes the portal of entry to the health care delivery system.

answer

gatekeeping

question

Precertification is the responsibility of

answer

the health plan

question

Concurrent UR in a hospital will be primarily concerned with the

answer

length of stay

question

A primary care physician decides whether or not to refer a patient to a specialist.

answer

prospective utilization review

question

Which legislation created the State Children's Health Insurance Plan (SCHIP)?

answer

Balanced Budget Act of 1997

question

Community health centers serve primarily:

answer

populations which are medically underserved

question

Which of the following factors was particularly important in promoting the growth of office-based medical practice in the postindustrial period?

answer

urbanization

question

Which type of health care facility employs the most people in the U.S.?

answer

hospitals

question

The basic source of the physician distribution problem in the U.S. is:

answer

lack of health coverage for all

question

Primary care is:

answer

-Longitudinal -The portal to the healthcare system -Holistic (all of the above)

question

Which of the following is a major criticism of managed care?

answer

quality of care may be sacrificed

question

In a hospital classified as short stay, the ALOS is less than

answer

25 days

question

The first hospitals in the United States served mainly

answer

the poor

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