Exam 1: Chapter 10 Flashcards
To prepare for the orientation of newly hired nurses, the nurse manager plans a presentation outlining the concept of healthcare networks. Healthcare networks are:
a. units that provide only primary care services.
b. owned by the institutions.
c. a feature of all public institutions.
d. units that serve large populations.
ANS: D
Healthcare networks are interconnected units. Their aim is serving large regional populations.
A local hospital has formed a corporate partnership with a reputable HMO (health maintenance organization). The nurse manager has had to educate staff and personnel about the financial implications of this partnership. An HMO:
a. provides more expensive care than other types of insurance plans.
b. has a centralized administration that directs and compensates physician services.
c. pays physicians on a fee-for-service basis.
d. does not pay as much for acute care as other practice plans.
ANS: B
The HMO is a configuration of healthcare agencies that provide basic and supplemental health maintenance and treatment services to voluntary enrollees who prepay a fixed periodic fee without regard to the amount of services used. HMOs have a centralized administration that directs and pays salaries for physician practice (e.g., HMOs).
With the help of a federal grant, the local school nurse has established a spreadsheet that contains relevant nursing data so that she can analyze children’s health. School health programs are:
a. increasingly seen as primary care sites for children.
b. providing only health education programs for children and their parents.
c. capable only of providing referrals for health problems to primary care providers.
d. funded exclusively by local authorities.
ANS: A
Traditionally, school health programs were organized to control infectious disease outbreaks, treat and control on-site injuries, and educate parents and children about basic health. Increasingly, schools are being seen as primary healthcare sites for children.
The local health department nurse manager has developed and implemented a disaster readiness plan as part of a community service. Community services:
a. care for the specific needs of individual families in the community.
b. focus on the treatment of community-wide problems rather than on individual health problems.
c. do not include services provided by public health departments.
d. provide personal health follow-up for all acute care hospitalizations.
ANS: B
Community services, including public health departments, are focused on the treatment of the community rather than that of the individual. These funds provide personal health services, care for communicable diseases, services for children with birth defects, mental health care, investigation of epidemiology, and treatment of bioterrorism threats and attacks. Monies are allocated also for
environmental services and for health resources.
A nursing informatics specialist hired by Blue Cross/Blue Shield Insurance System (a form of third-party payers benefit package for a prepaid fee that uses specific standards to approve a period of time for the use of inpatient and community health services) is participating in:
a. critical pathways.
b. healthcare networks.
c. health maintenance organizations.
d. managed care.
ANS: D
Managed care strives to contain costs (e.g., through limitation of time in care) while maintaining quality. Managed care combines care delivery with financing and provides comprehensive services for a fixed prepaid fee. Group practice plans take various forms. One form has a centralized administration that directs and pays salaries for physician practice (e.g., HMOs).
A merger has occurred between a hospital and a local home health agency, creating new roles for the nursing staff in both agencies. The nurse managers of both systems begin to evaluate and revise patient care processes and systems. With the merger, the healthcare organization’s changes are:
a. creating more jobs in the community for registered nurses.
b. resulting in an overall loss of jobs for registered nurses.
c. controlled by the federal and state governments.
d. controlled by the insurance agency.
ANS: A
Home care agencies staffed appropriately with adequate numbers of professional nurses have the potential to keep older adults, those with disabilities, and persons with chronic illnesses comfortable and safe at home. Home care is the fastest growing segment in health care and the volume of home health care may have a subsequent impact on the numbers of nurses required.
You are a nurse manager in a facility that is part of a national system of specialized hospitals that provide services to children and that is funded and managed through a religious charity organization. This system emphasizes compassionate, faith-based care.
What level of consolidated system is represented in this example?
a. First level
b. Second level
c. Fourth level
d. Fifth level
ANS: D
Consolidated systems tend to be organized into five levels. The fifth level involves special interest groups that own and operate units along religious lines, teaching interests, or related special interests that drive their activities. In this example, the facilities are funded and managed by a religious organization that provides care that is congruent with its particular faith-based values.
A nurse manager at a home healthcare service has resigned to take a position at a local ambulatory care center. She has been hired because of her expertise in TJC accreditation. To initiate the changes, the nurse manager has to be knowledgeable about the differences between a home healthcare institution and an ambulatory care center, which is a primary care institution. Primary care institutions are facilities that provide:
a. rehabilitative or long-term care.
b. disease-restorative care.
c. first access to care.
d. only outpatient services.
ANS: C
The spectrum of care services provided are typically described as primary care (first-access care), secondary care (disease-restorative care), and tertiary care (rehabilitative or long-term care). Ambulatory care centers are an example of primary care.
A nurse manager working for a not-for-profit organization should be familiar with the regulations that impact the organization. Not-for-profit organizations:
a. pay dividends to stockholders.
b. can refuse clients who are unable to pay.
c. have no paid employees.
d. pay no taxes.
ANS: D
Not-for-profit organizations, often referred to as voluntary organizations, are controlled by voluntary boards and provide services to both paying and charity clients. Funds are redirected toward maintenance and growth as opposed to profit shares for stockholders. Historically, non-profit organizations have been exempt from paying taxes as they commit to providing an important community
service.
In reviewing the current delivery model, the nurse manager is aware that a demographic change that will have a significant effect on healthcare delivery systems of the future is:
a. changes in staffing patterns.
b. increasing reports of violence in the workplace.
c. the increasing percentage of the population that will be over age 65.
d. escalations in the cost of health care.
ANS: C
A demographic change that will significantly impact the healthcare system of the future is the increasing proportion of individuals 65 years and older. By 2025, more than 18% of the population is expected to be 65 years and older, which means that new healthcare organizations will evolve as the system attempts to maintain older adults in the community for as long as possible.
A facility that provides care for patients whose average length of stay is less than 30 days and to patients whose average length of stay is longer than 30 days, and who require inpatient and ambulatory care for addictions, through a spectrum of wellness and illness services and providers, would be considered:
a. a healthcare network.
b. a tertiary care institution.
c. rehabilitative.
d. long-term care.
ANS: A
Healthcare networks embrace and provide wellness and illness services, including primary, secondary, and tertiary care, through a network of providers.
Healthcare organization XYZ provides women’s health services on an inpatient basis (average stay of less than 30 days). This facility would likely be considered:
a. primary care, specialized.
b. tertiary care, long-term.
c. acute care, specialized.
d. public care, specialized.
ANS: C
The AHA defines an acute care hospital as a facility in which the average length of stay is less than 30 days. Because of the focus on women’s health services, it would also be considered specialized.
You are the nurse manager for a not-for-profit health service for the homeless and for drug users in an impoverished neighborhood. As the manager, your concern about sustainability is related to:
a. the possibility of violence.
b. an increase in prescription drugs available for abuse.
c. decisions of the public board.
d. an increase in uncompensated care events.
ANS: D
Public and nonprofit hospitals are tax exempt and have a concomitant responsibility to provide mandated community service such as delivering care to the poor and indigent. To keep a nonprofit status, facilities must make a good-faith effort to provide community service and charity care. Nonprofit organizations located in impoverished urban and rural areas are often economically
disadvantaged by the amount of uncompensated care that they provide.
A nurse manager in a for-profit environment finds it difficult to recruit staff. This difficulty may be most related to aggressive profit goals and:
a. lower salary compensation for staff.
b. rising expectations of impoverished and indigent individuals for services.
c. poor orientation and retention practices for staff.
d. an overwhelming emphasis on accepting learners from health disciplines.
ANS: A
For-profit hospitals tend to have lower wage and salary costs that are most likely connected to aggressive goals for profit.
What is an example of an HMO?
a. Nurse practitioners are paid promptly at discounted fees for each service rendered at a women’s health clinic.
b. Physicians in a large urban center are reimbursed for visits made to their clients.
c. Physicians are paid for each service delivered to enrolled patients through a prepaid plan.
d. Patients pay fixed annual fees for ambulatory care services, regardless of actual utilization of health services.
ANS: D
Fee-for-service systems provide compensation to healthcare providers in group practices based on fee-for-service, which in PPQs means that fees are paid promptly but at a discounted rate. HMOs are configurations of healthcare agencies that provide health maintenance and services for enrolled patients for a fee that is preestablished regardless of utilization of service.
