HS Cost and Quality Flashcards

1
Q

Sets fee based on diagnosis, forces hospitals to develop standards of care and limits ordering of procedures

A

Diagnosis Related Group

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2
Q

Prior authorizations, benefit denials. Capitation and PMPMs, resulted in consolidation of providers and rise of physician groups

A

Managed Care/HMOs

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3
Q

Incites providers to order and use more services. Typically rewards newer technologies and procedures with higher reimbursement

A

Fee for Service

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4
Q

What are the 3 components of Meaningful Use?

A

Use of certified EHR in meaningful manner
Use of EHR for electronic exchange of health information
Use of EHR to submit quality measures and other measures

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5
Q

Based on cost of care for attributed patients, quality and meaningful use reporting

A

Value Based Modifier

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6
Q

ACO goals

A

High quality
Low cost
Positive patient experience

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7
Q

ACO outcomes

A
Big data
Building large network of primary care
Created narrow networks
Providers owning the insurance
Rise of population health management
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8
Q

Program for those not participating in Medicare APM

A

MIPS

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9
Q

What is the Triple Aim?

A

Population health
Experience of Care
Per Capita Cost

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