Focus Questions Flashcards
Healthcare reform that deals with placing capitations on pain and suffering and limits attorney fees is called: A. Malpractice litigation reform B. Provider reform C. Scope of practice reform D. Health service planning reform
A. Malpractice litigation reform
Rationale: malpractice litigation reform deals with limits on attorney fees and limits on liability and capitation set for pain and suffering.
In recognition of World Patient Safety day- Practice Question #50:
According to the Agency for Healthcare Research and Quality (AHRQ) a culture of safety includes all of the following except:
A. Acknowledgement of high-risk activities
B. Provider and staff engagement
C. Blame-free environments
D. Organization commitment to safe operations
B. Provider and staff engagement
Rationale: The Agency for Healthcare Research and Quality (AHRQ) defines a “culture of safety” as encompassing acknowledgment of the high-risk nature of activities and the determination to achieve safe operations, blame-free environments, encouragement of collaboration across ranks and disciplines, and organizational resource commitment to address safety concerns. Engagement of providers and staff is related, but is not part of the definition.
Robert and Susan are discussing discrimination. Susan does not believe Robert when he says discrimination is still a problem. Robert uses this scenario to illustrate his point: “Last night at the local emergency room, four people arrived at the same time. All four are the same age, have similar symptoms and vital signs. One person was white, one was Asian, one was African-American, and one was Hispanic. Based on statistics, of the four people who arrived, which one will wait the longest to be seen?” A. African-American B. Asian C. White D. Hispanic
A. African-American
Rationale: African-Americans are more likely to visit but leave the emergency department without being seen, compared to whites, and African-Americans wait longer to be seen then other groups. African Americans were 30% more likely than whites to die prematurely from heart disease in 2010 and African-American men are twice as likely as whites to die prematurely from stroke. African Americans, Asians, American Indians/Alaska natives, and Hispanics continue to lag behind whites in the percentage of the population over 50 who received colon cancer screening, and this gap has widened in recent years.
Betty is transferring to a skilled nursing facility. Which rule for extended Medicare benefit applies to clients transferring to a skilled nursing facility? A. Observation rule B. The three midnight rule C. Transition rule D. Stop loss rule
B. The three midnight rule
Rationale: skilled nursing facility SNF is covered if it follows within 30 days of a hospital stay in which the person was inpatient for three days or more and is deemed medically necessary.
What type of hospice program has no facility except an office? A. Inpatient-based program B. Inpatient-based hospice team program C. Community-based program D. Freestanding Hospice
C. Community-based program
Rationale: a community-based hospice has no facility, just an office, and care is the focus.
Robert’s client has recently had knee replacement surgery. While in the rehabilitation facility, the client and Robert are increasingly concerned about the care he is receiving. The client has been left in his wheelchair and has only been up to walk once in the last two days. Physical therapy has not been completed as ordered. Robert attempted to speak to the nursing staff and administration, but was told he needed to take it up with the doctors. Robert is meeting with a group of physicians regarding his clients care. Which of the following strategies will serve Robert best in this meeting?
A. Cite the guidelines for rehabilitation after near replacement surgery
B. Threaten legal action of care does not improve
C. Using peer pressure to imply that care is substandard
D. Suggest remedies without being overly directive
D. Suggest remedies without being overly directive
Rationale: with an audience of experts such as physicians, the advocate should be careful not to be excessively directive and suggesting solutions for the client. The tone of communication is essential in medical settings were power disparities exist. Citing guidelines can certainly be a part of this, but it needs to be done in a collaborative matter.
Mrs. Brown was just diagnosed with diabetes. Robert is looking for a health coach for her. He knows that a health coach can:
A. Teach Mrs. Brown about diabetes
B. Teach Mrs. Brown how to prevent complications
C. Help Mrs. Brown achieve her goals
D. Help Mrs. Brown understand their insurance plans
C. Help Mrs. Brown achieve her goals
Rationale: the purpose of health coaching or wellness coaching is to help clients achieve their goals
Palliative care focuses on: A. Pain management B. Symptom management C. Family D. All of these
C. Symptom management
Rationale: palliative care is intended for clients who need to improve their quality of life by managing symptoms, including pain management. Palliative care can begin at any time during an illness and is unrelated to the diagnosis or life expectancy. Clients can continue to receive curative treatment. Clients with life-threatening diseases can begin with palliative care to control pain and other symptoms and then made progress to hospice care as the disease progresses.
Beginning in 2020, once a Medicare part D beneficiary has reached $\_\_\_\_\_\_, (includes what the patient and the plan of paid) in drug costs, they are responsible for 25% of the cost of their drugs. A. 4020 B. 6350 C. 5340 D. 2480
A. 4020
Rationale: in 2020, once a patient has reached $4020 (includes what the patient and the plan have paid) in drug costs, they are responsible for 25% of the cost of their drugs. For example, if a drug cost $100 and the patient previously paid a co-pay of $20 during the initial coverage, (up to $4020), the patient will now pay $25, 25% of $100, during the coverage gap after ($4020 has been reached).
People with low annual incomes:
A. Are 10 times more likely to have an adverse chemotherapy event.
B. Rarely experience 80 final difference in cancer survivorship or treatment outcomes based solely on their economic status
C. Are twice as likely to experience recurrence, treatment failure, or death as those with higher annual incomes
D. Or 3 to 7 times more likely to die of cancer than those with high annual incomes
D. Are 3 to 7 times more likely to die of cancer than those with high annual incomes.
Rationale: people with low incomes or 3 to 7 times more likely to die of cancer than those with high annual incomes
Mr. Green is on Medicare and has abdominal pain, he sees his PCP on Tuesday at 9 AM, who sent him to urgent care. Urgent care sent him to the emergency room. The emergency room since I’m up to the med/surge floor at noon where he is giving a room and treated just like any other patient on the floor. Mr. Green receives an MRI and has several tests to isolate the cause of his abdominal pain. He has also given IV antibiotics and anti-nausea medication. The next morning, Mr. Green is giving a MOON form. Which of the following is true?
A. The MOON form is a Medicare notice letting Mr. Green know that he has officially been admitted to the hospital
B. Mr. Green will need to pay the 20% copayment for all the tests and medications he received in the hospital and there’s no limit to the out-of-pocket expenses he may have to pay
C. Mr. Green will not have to pay a copayment if he is transferred to an SNF
D. Medicare pays for all of us to Green’s treatment since he has a room on the med/surge floor
B. Mr. Green will need to pay the 20% copayment for all the tests and medications he received in the hospital and there is no limit to the out-of-pocket expenses he may have to pay
Rationale: the MOON form is a standardized a notice to inform beneficiaries that they are an outpatient receiving observation services that are not an inpatient of the hospital. What that means is that Medicare treats Mr. Green as if you were still at the clinic, even though he spent the night. That means that Mr. Green needs to pay the 20% copayment for all the tests and medications he received in the hospital and there is no limit to the out-of-pocket expenses he may have to pay.
What does the suffix -desis mean? A. Hardening B. Binding, fusion C. A breaking down D. Surgical fixation
B. Binding, fusion
Rationale: -desis means binding or fusion, and example is arthrodesis. A surgical fixation is pixie as in urethropexy.
Most medical insurance will not cover: A. Intermediate care B. Skilled nursing facilities C. Hospice D. ambulatory care
A. Intermediate care
Rationale: well most patients use Medicare or Medicaid for hospice services, some patients he’s private health insurance plans to cover hospice care. Most private insurance plans cover hospice care and other end of life services. These insurance plans typically cover the full cost of hospice services. Most policies pay for care received in home or at an accredited medical facility. Intermediate care is a level of care for patients who require more assistance than custodial care, and may require nursing supervision, but do not have a true skilled need. Most insurance companies do not cover intermediate care.
Susan has been asked to locate an alternative care setting for Mrs. LIS. Along with quantity and quality of care, another important factor for Susan to consider is:
A. Distance to the nearest acute care hospital
B. Cost and Mrs. Lee’s financial resources
B. Policies relating to a multidisciplinary team approach
D. Professionals
B. Cost and Mrs. Lee’s financial resources
Rationale: evaluation and assessment of alternative care arrangements requires attention to the needs and goals of Mrs. Lee. In addition to the quantity and quality of the care, two important considerations are cost and Mrs. Lee’s resources, including insurance coverage and benefits.
Mr. White is 74 years old and has fractured his knee. Immediately, following surgery to repair his knee, he had a heart attack. Susan, his patient advocate, knows that a denial or non-certification of services may result if:
A. Mr. White dies
B. The hospitalization is extended because PT is not available on the weekends
C. The hospitalization is extended due to the heart attack
D. There’s a change in policy after the services are rendered
B. The hospitalization is extended because PT is not available on the weekends
Rationale: Denial or noncertification may result from an extended hospital position if PT or other services are not available on the weekend. If there is a cost, such as the heart attack, a concurrent authorization may be required to notify the payer of the change in condition. A change in policy after services are rendered would not affect this, as the policy that is in place when services were rendered at the time of the authorization is the policy that informs this. The death of Mr. White would terminate benefits rather than a denial.
Susan is the advocate for Mrs. Lee, and Asian woman. Mrs. Lee has just received a diagnosis of breast cancer. She appears distressed and withdrawn. The most appropriate action for Susan is to:
A. Touch her hand and ask if she needs to talk about the situation
B. Ask her if she would like to discuss any of her concerns or fears
C. Sit and provide a silent presence to show support
D. Sit next to Mrs. Lee, take her hand, and provide silent presence to show support
C. Sit and provide a silent presence to show support
Rationale: the Asian culture generally prefers personal space not to be invaded, touched to be reused rarely, and silence as a method of communication.
Dr. Black is a primary care provider. He carries a typical patient load. He strives to adhere to current guidelines. According to Duke University, how many hours a day with Dr. Black need to work? A. 18.9 B. 10.8 C. 13.2 D. 22.6
D. 22.6
Rationale: Duke university researchers estimate, they given the typical patient load and the current guidelines for care, a PCP should be spending 7.4 hours per day on preventive care, 10.6 hours on managing chronic diseases, and 4.6 hours on handling acute illness, totaling 22.6 hours a day. When your clients wonder why appointments are short or there’s a long wait time, this is part of the reason why this is also another contributor to the primary care physician shortage.
What is the third largest health problem in the world and consumes 80% of primary care visits? A. Heart disease B. Chronic pain C. Diabetes D. Depression
B. Chronic pain
Rationale: chronic pain is the third largest health problem in the world and affects 116 million Americans. Pain related problems account for 80% of primary care office visits.
The type of managed care plan that combines features of HMOs and PPOs and allows a person to see Physicians and care providers within a network and seek outside treatment in some situations is:
A. Exclusive provider organization (EPO)
B. Integrated care organization (ICO)
C. Point of service plan (POS)
D. Preferred provider organization (PPO)
C. Point of service plan (POS)
Rationale: the POS is a hybrid the combines features of HMOs and PPOs. This hybrid allows the client to choose a physician that is either in network or out of network. The clients PCP oversees referrals to out of network providers. In contrast to a PPO, when the services are obtained out of network, the beneficiary has a higher deductible, higher coinsurance, and higher copayments to make. To receive services, the beneficiary must first pay the deductible and the co-pay.
Susan’s client has a regular healthcare provider but has recently broken her foot and is unable to drive. She also has congestive heart failure. She recently experienced a 5 pound weight gain in the last three days. Which of the following demonstrates Susan promoting equitable access to appropriate and safe healthcare and treatment?
A. Arranging for transportation to her regular healthcare provider for an appointment today
B. Do nothing, it is reasonable to have a 5 pound weight gain in three days
C. Calling an ambulance to take her to the nearest emergency room
D. Taking her to the nearest urgent care center
A. Arranging for transportation to her regular healthcare provider for an appointment today
Rationale: this is the most appropriate action for the given situation in the scenario
Mr. Peters has become incompetent. He has no surviving relatives, no close friends, and no legal surrogate. Which of the following should serve as a surrogate to make medical decisions? A. The medical ethics committee B. Robert C. A hospital social worker D. Two Physicians
D. Two Physicians
Rationale: in this case in which there is no legal surrogate, family, close friends, or significant other, two physicians can serve as surrogates.
You’ve just been called by your client, Mary, who was in tears. Mary has worked as a clerk at a local department store for 12 years. She has just been laid off by her employer because the other states the cost of healthcare for all 11 employees is too expensive. Mary has metastatic cancer and his fridge cannot afford her own insurance. Your recommendation to her is based on which of the following?
A. Mary qualifies for protection from the American with disabilities act, ADA, and the family medical leave act, FMLA, and should apply for assistance.
B. Mary should sue her employer for discrimination
C. The ADA and FMLA only apply to employers with more than 15 and 50 employees, respectively
D. Mary should apply for long-term disability and Medicaid
C. The ADA and FMLA only apply to employers with more than 15 and 50 employees, respectively.
Rationale: because Mary works for a small business owner with you were than 15 employees, she is not protected at the workplace by ADA and the FMLA. The Americans with disabilities act applies to employers with 15 or more workers. The family and medical leave act applies to our government employers (local, state, and federal) and a private businesses with 50 or more workers within 75 miles with some exceptions. She would not wear a suit against her employer given these conditions. She would not qualify for long-term disability since she is no longer employed. She should apply for Medicaid, for which she qualifies.
You are Mr. Green’s advocate. Today marks the third day he has been listed as observation status. Following rounds this morning, the discharge coordinator is now talking about discharging him to an SNF tomorrow. Mr. Green lives alone and has nearest relative is 500 miles away. What is your best course of action?
A. Advocate for admission status right away
B. Explore alternatives such as if home health or home infusion can provide the same services as the SNF safely
C. Have Mr. Green apply for financial assistance with the hospital
D. Do nothing. Since he has met the three midnight rule, Medicare will pay for the SNF
B. Explore alternatives such as if home health or home infusion can provide the same services as the SNF safely
Rationale: the hospital is ready to discharge Mr. Green and is unlikely to agree to admission in order to meet the requirements. If Mr. Green had just been placed in the hospital there are some options for advocates.
- Seek the doctors help to admit the patient as an inpatient
- Remind the hospital of Medicare’s to midnight rule. If the doctor expects the patient to require hospital care for at least you’ve been nice to the hospital should be able to admit the patient as an inpatient
- Consider other post hospital sources of care inpatient rehabilitation hospital (also known as inpatient rehabilitation facility), home health, outpatient therapy - that do not require a three day inpatient stay
Roberts client, Mr. Green, has just been diagnosed with adenocarcinoma. He has selected an oncologist that Robert knows has a reputation of having a poor track record with this type of cancer and has had multiple malpractice lawsuits. Which ethical standards would best guide Roberts choice of action?
A. Avoidance of discriminatory practices, avoidance of impropriety and conflict of interest, and transparency and honest disclosure
B. Advocate role, fostering autonomy, protecting confidentiality and privacy, and continuing education and professional development
C. Continuing education and professional development, advocate role, avoidance of impropriety and conflict of interest, and provision of competent services
D. Advocate role, transparency and honest disclosure, provision of competent services, and fostering autonomy
D. Advocate role, transparency and honest disclosure, provision of competent services, and fostering autonomy
Rationale: the advocate role speaks to Robert’s role as a facilitator and guide which provides clients with information to make informed choices. Transparency and honesty disclosure speaks to the mandate for Robert to maintain integrity in the conduct of his practice. Provision of competent Services requires that Robert refrain from offering opinions about the skills or aptitude of other healthcare professionals. Fostering autonomy requires that Robert respect Mr. Green’s ability to choose, provided that Mr. Green has complete and accurate information.
As part of patients rights, basic rules of conduct between patients and medical caregivers includes: A. Quality and safety B. Caring practice C. Privacy and confidentiality D. The code of ethics
C. Privacy and confidentiality
Rationale: patient rights are those basic rules of conduct between patients and medical caregivers as well as the institutions and people that support them which are the following: informed consent, right to treatment, privacy and confidentiality, medical experimentation, advanced directives, and right to die.
In 2020, once a Medicare part D beneficiary has reached $6350 in out-of-pocket drug expenses, they are moved in what kind of coverage? A. Pharmacy assistance program B. Donut hole coverage C. Extra help program D. Catastrophic coverage
D. Catastrophic coverage
Rationale: between $4020 and $6350, patients pay the 25% co-pay once a person reaches $6350 in out-of-pocket drug expenses, they are moved in a catastrophic coverage. Catastrophic coverage will lower co-pays and coinsurance for the remainder of the year. The person in catastrophic coverage will pay 5% of the cost of the drug or $3.60 for generics and $8.95 for brand-name drugs
The patient self-determination act (PSDA) of 1990 requires that all healthcare institutions which receive funding from Medicare or Medicaid to do which of the following?
A. Ensure healthcare to all patients regardless of ability to pay
B. Provide all patients with a written information about advance directives
C. Provide all patients with written information regarding financial obligations
D. Vital patients with written information regarding informed consent
B. Provide all patients with a written information about advance directives
Rationale: PSDA requires all healthcare institutions receiving Medicare or Medicaid reimbursement to ask patients that they admit if they have an advance directive. If the patient does not, the institution is required to provide written information about advance directives.
People with low annual incomes:
A. Are 10 times more likely to have an adverse chemo therapy event
B. Are twice as likely to experience recurrence, treatment failure, or death as those with higher annual incomes
C. Are 3 to 7 times more likely to die of cancer than those with high annual incomes
D. Rarely experience a definable difference in cancer survivorship or treatment outcomes based solely on their economic status
C. Are 3 to 7 times more likely to die of cancer than those with high annual incomes
Rationale: people with low incomes are 3 to 7 times more likely to die of cancer than those with high annual incomes
With Medicare, the benefit period ends:
A. 30 days after discharge from an inpatient facility
B. 60 days after discharge from an inpatient facility
C. At the time of discharge from an inpatient facility
D. 150 days after discharge from an inpatient facility
B. 60 days after discharge from an inpatient facility
Rationale: the benefit. Begins when the person is first admitted to the hospital and ends when the person has been out of the hospital or skilled nursing facility for 60 consecutive days.
What is the percentage of medication errors after leaving the hospital for patients over 65? A. 55% B. 70% C. 30% D. 40%
D. 40%
Rationale: studies have shown that as many as 40% of patients over 65 had medication errors after leaving the hospital, and 18% of Medicare patients discharged from the hospital or readmitted within 30 days.
Robert’s client, Mr. Fredericks, has an extremely rare disorder and is having a hard time finding a position familiar with the disorder. What would be the first step for Robert to take in helping Mr. Fredericks?
A. Determine what Mr. Fredericks insurance will pay for
B. Refer Mr. Fredericks to another advocate familiar with the disorder
C. Research local physicians to determine who is familiar with Mr. Fredericks disorder
D. Determine Mr. Fredericks preferences and goals in a patient/physician relationship
D. Determine Mr. Fredericks preferences and goals in a patient/physician relationship
Rationale: advocates honor their client’s personal values concerning care and the right to be involved in all decisions that affect their care. Advocates ensure that a client’s wishes, if known, are the guiding force behind decisions affecting medical care received or medical care that is withheld.
The primary purpose of pharmacy benefit management is to: A. Increase the use of generic drugs B. Reduce costs of drugs C. Provide a drug formulary for clients D. Promote drug safety
B. Reduce costs of drugs
Rationale: PBM’s and insurance plans try to keep their costs low by steering patient’s to generics and other cheaper drugs
Before receiving benefits, the person with a preferred provider organization, PPO, insurance plan may have to pay: A. The deductible and a copayment B. The deductible C. A copayment D. The premium only
A. The deductible and the copayment
Rationale: in a PPO, in order to receive services, the beneficiary must first pay the deductible and a co-pay.
A decision by a patient about a diagnostic or therapeutic procedure based on choice, which requires the decision to be voluntary by the person who has the capacity to understand information and make decisions on a set of values and goals is the definition of: A. Ethical standard B. Empowerment C. Informed consent D. Shared Decision support
D. Shared decision support
Rationale: informed decision making, also known as share decision support - a decision by a patient about a diagnostic or therapeutic procedure based on choice, which requires a decision to be voluntary by the person who has the capacity to understand information and make decisions on a set of values and goals.
