HS Cost and Quality

Question 1

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

Answer 1

Diagnosis Related Group

Question 2

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

Answer 2

Managed Care/HMOs

Question 3

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

Answer 3

Fee for Service

Question 4

What are the 3 components of Meaningful Use?

Answer 4

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

Question 5

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

Answer 5

Value Based Modifier

Question 6

ACO goals

Answer 6

High quality
Low cost
Positive patient experience

Question 7

ACO outcomes

Answer 7

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

Question 8

Program for those not participating in Medicare APM

Answer 8

MIPS

Question 9

What is the Triple Aim?

Answer 9

Population health
Experience of Care
Per Capita Cost