HSCI 523 Flashcards
(146 cards)
1
Q
Describe Jeffersonianism.
A
Emphasized states’ rights.
Against a powerful national government.
Weak national government.
Majority of authority should be in the legislature.
Welfare & healthcare are not part of the government’s role/responsibility.
2
Q
After the revolution and emancipation from Great Britain, what has the most significant political debate been about?
A
How much responsibility the federal government should have regarding healthcare & welfare.
Very differing political ideologies control healthcare.
3
Q
Jeffersonianism refers to…?
A
Democratic-Republicans/Our current Republicans
4
Q
Which historical view describes a weak national government?
A
Jeffersonianism
5
Q
Which historical view places an emphasis on states’ rights?
A
Jeffersonianism
6
Q
Which historical view believes healthcare is not part of the federal government’s role?
A
Jeffersonianism
7
Q
Which historical view takes more of a farming approach?
A
Jeffersonianism
8
Q
Which historical view believes in a weak executive branch?
A
Jeffersonianism
9
Q
Hamiltonianism refers to…?
A
Federalists.
Democrats of today.
10
Q
Describe Hamiltonianism.
A
Hamilton believed that the U.S. had the resources to become a superpower & the only way to achieve that was to make one powerful national government with one president.
Federal government should take care of everything for citizens (including welfare & healthcare)
11
Q
Which historical view believes in a national/federal/central government?
A
Hamiltonianism
12
Q
Which historical view believes in one powerful president?
A
Hamiltonianism
13
Q
Which historical view believes that the government is responsible for healthcare?
A
Hamiltonianism
14
Q
Describe James Madison’s view.
A
Divided power of checks and balances.
Was for a big national government as long as it was checked by the other branches.
15
Q
Which historical view wanted checks and balances?
A
Madison’s view.
16
Q
Which historical view wanted a big national government as long as it was checked by other branches?
A
Madison’s view.
17
Q
What year was the Flexner Report?
A
1910.
18
Q
What did Flexner’s Report result in?
A
Modern Medical School Education
19
Q
What did Flexner’s Report lead to?
A
Blue Cross and then Blue Shield
20
Q
Describe Blue Cross’s origins.
A
First health insurance in the U.S.
Justin Kimball created a pre-paid hospital plan with Baylor University & DUSD.
50 cent premium & up to 21 days of hospitalization free.
21
Q
Describe Blue Shield’s origins.
A
After provider request, copied BX’s model for professional physician services.
Separate until the 70s when they merged as Blue Cross Blue Shield.
22
Q
What year was Blue Cross created?
A
1929
23
Q
What year was Blue Shield created?
A
1939
24
Q
What was the Social Security Act passed?
A
1935
25
What did the Roosevelt Revolution Era comprise of?
Stock market and economic depression that led to SSA '35 & New Deal
26
What was enacted during the Roosevelt Era?
Congress enacted the SSA with its "New Deal Social Welfare System
27
What is SSA the foundation of?
Of all health & welfare policies.
| Medicare & Medicaid are amendments to SSA.
28
Why did FDR establish the Office of Economic Stabilization?
FDR established The Office of Economic Stabilization as a way to control inflation by freezing wages.
29
What year was the IRS Rule in?
1943
30
What did the IRS Rule of 43 cause?
Employer contributions to group health plans (ESHI) became exempt from taxation due to the IRS ruling.
Foundation of the U.S. healthcare system
31
What year did the Hill-Burton Act pass?
1946
32
What was the purpose of the Hill-Burton Act?
To rebuild hospital stock to help the underserved community after the Great Depression.
Supported for hospitals to expand their facilities through federal funding.
Caused a hospital boom.
33
In exchange for federal funding, what did the Hill-Burton act require?
Charity care (to provide free services to the poor and indigenous)
34
What caused a hospital boom in the 50s?
Hill-Burton Act
35
Briefly describe Medicare during the first era.
'65-'94
Bipartisan popular program.
Earned right.
Generated a $100 billion surplus in Part A's trust fund
36
Briefly describe Medicare during the second era.
'94-'97
Debate over how to save Part A's trust fund from bankruptcy (considered raising taxes, cutting reimbursement, emphasizing managed care)
BBA '97
37
What health plans came as a result of BBA '97?
Medicare Advantage & SCHIP
38
What is BBA '97?
Bipartisan agreement that Medicare was the spending criminal and main source of deficit.
Medicare Managed care (part C) was created and let private HMO’s run their own programs.
39
What is SCHIP?
Provided health insurance coverage to low-income children who do not qualify for Medicaid.
40
Briefly describe Medicare during the third era.
'98-'06
Part A's surplus grew.
2003, Congress enacted Part D.
MMA brought about MA.
41
Briefly describe Medicare during the fourth era.
'07- present
As baby boomers began to join, enrollment grew rapidly and surplus shrank again.
57 million enrolled today.
42
Briefly describe Medicaid during the first era.
'65-'86
| Welfare based program for low-income individuals on the discretion of states.
43
Briefly describe Medicaid during the second era.
'86-'92
Federal mandates to expand eligibility, benefits packages, and reimbursement.
Rising enrollment and costs.
Growing tension between states and federal government
(State efforts to leverage federal dollars)
44
Briefly describe Medicaid during the third era.
'93-'99
'97 CHIP block grant
For low-income children who do not qualify for Medicaid.
% of uninsured Americans declines.
45
Briefly describe Medicaid during the fourth era.
'00-'08
| During recession, Bush focuses on constraining the cost of Medicaid.
46
Briefly describe Medicaid during the fifth era.
'09- present
Obama signs MACRA '15.
75 million enrolled today.
47
What is MACRA '15?
Medicare Access & CHIP Reauthorization Act.
Medicaid funding for states.
Includes Medicaid Expansion as part of ACA
(Supreme court then made the expansion mandate into an option)
48
What are the main components of the HMO Act of '73?
Kaiser
Managed Care 1.0
Managed Care 2.0
Managed Care 3.0
49
Why did Nixon want to copy Kaiser's model?
To fix skyrocketing healthcare expenditures due to Medicare/Medicare.
50
Briefly describe the history of Kaiser.
Henry Kaiser created on-site clinics.
Dr. Garfield approached Kaiser with an offer to put a clinic on urban construction sites & wanted BX style payments.
The clinic later became Kaiser hospital and then Kaiser health plan.
Garfield then hired doctors and formed a medical group.
51
What does Managed Care 1.0 include?
Capitation PMPM
Practice Guideline
Gatekeeper
52
What is Practice Guideline?
To standardize treatment to streamline practice and cost.
To try to solve the problem of small area variation.
(Remember from cost conundrum, hospitals only a few miles apart had a large difference in expenditures)
53
What is Gatekeeper?
Have to always go through a PCP
| Tried to transform our unmanaged care to managed care.
54
What does Managed Care 2.0 include?
Rigid Utilization
DRG
Backlash
55
Why did Reagan get rid of the HMO Act in '81?
Didn't like 2.0 because it encouraged the establishment of more not for profit HMO’s.
Not for profits didn’t need to pay property tax or federal income taxes, so there were huge incentives for not for profit HMO’s to remain not for profit HMO’s.
Reagan got rid of the HMO Act in 1981 and made not for profit HMO’s into for profits.
Caused their primary interest to be profit driven to make money and to use rigid utilization to cut costs.
56
What is Rigid Utilization?
Drive-through delivery
Pre-certification
Pre-authorization
Refusal to cover certain procedures/name brand drugs
Must call before you prescribe a service to get approval/micromanaging
57
What is DRG '83?
Before DRG, hospitals would hold patients for as long as possible to provide a lot of procedures to generate revenue, but then DRG caused this to go away (changed to only getting a fixed dollar amount for a diagnosis).
During change from retrospective (FFS) to prospective (DRG), small hospitals couldn't survive so either closed or merger/consolidations took place.
58
What is the backlash in Managed Care 2.0?
Because of everything involved in 2.0, backlash took place with PPO's gaining market share/popularity.
59
What does Managed Care 3.0 include?
EHR
Profiling (HIPAA)
HITECH
60
What is EHR in relation to 3.0?
No need for HMO to apply rigid utilization management.
| Data analytics allowed the adoption of EHR & no longer a need for micromanagement
61
What is profiling?
The only strategy before was to harass physicians and hospitals.
EHR caused managed care organizations to use data to categorize or classify providers (through data can identify bad apples that prescribe or refer a lot through investigations)
EDI & HIPAA aided in profiling
62
What is the HITECH Act of '09?
Health Information Technology & Economic Clinical Health.
Required hospitals to install EHR records and promote the adoption of meaningful use of EHR/HIT.
Without meaningful use, our healthcare system/CMS would not be able to implement VBP because VBP is based on scoring (ranking, benchmark, improvement).
63
What is HIPAA & how did it aid in profiling for 3.0?
Health Insurance Portability & Accountability Act '97.
| Requires for physicians and hospitals to submit their reimbursement rates electronically instead of paper.
64
What is Quicker Sicker?
DRG caused hospitals to kick patients out sooner in order to not lose money but discharged prematurely leaving them sicker.
65
What is COBRA?
Consolidated Omnibus Budget Reconciliation Act.
| Congress must enact either COBRA or OBRA each year or else we will not have a budget.
66
What is COBRA '86?
25 provisions.
| 1 provision allows, in the case of a layoff, for employees health insurance to maintain health insurance coverage
67
Which Act does EMTALA fall under?
COBRA '86?
68
What is the number of uninsured that have coverage now thanks to the ACA?
18-20 Million
69
What are the 5 overreaching strategies of the ACA '10?
```
Medicaid Expansion
Insurance Exchanges
New federal regulations on the insurance industry
Employer mandate
Individual mandate
```
70
What is Medicaid Expansion as it relates to ACA?
Converted to an option by the Supreme Court, so not all states expanded
71
What are federal regulations as they relate to ACA?
Minimum benefits
No limits on annual dollar (or lifetime dollar)
MLR, etc.
72
What is the individual mandate as it relates to ACA?
Required to have insurance or a penalty will be enforced
73
What are four issues of the ACA?
Risk Corridor program
Risk Adjustment Program
Weak Individual Mandate
Minimum benefits & grandfathered plans
74
What is a risk corridor?
If the insurance company lost an excessive amount of money, the federal government made up the loss in the first 3 years.
If the insurance company made an excessive profit compared to previous years, would have to give the money back to the federal government.
Risk corridors didn't work
75
What was the end result of the individual mandate?
Starting from 2019, the penalty for the individual mandate is out
76
How did the ACA improve access to care?
Individual mandate
Employer mandate
Medicaid Expansion
HIE
No longer can deny due to pre-existing condition
Up to 26 can stay under parents' health plan
77
What is the individual mandate in regards to access?
Made enrollment in health insurance a mandatory requirement with a consequence of a penalty.
Has since been overturned by the Trump administration through the abolishment of the penalty.
78
What is the employer mandate in regards to access?
Employers with more than 50 employees must provide health insurance
79
What is Medicaid Expansion in regards to access?
Expanded program to allow more individuals to become eligible by increasing the FPL to 138%
80
What is the pre-existing condition provision in regards to access?
Allows more individuals to seek coverage knowing they will not be turned away
81
What is the HIE in regards to access?
Government regulated marketplace that allows individuals and small businesses to purchase health insurance.
Ex: Covered California
Equivalent of online shopping for health insurance with a comparison of benefits with each plan available.
Easily accessible tool because it’s web-based.
82
How did ACA try to slow healthcare costs?
MLR
Sunshine Act
Bundled Payments
HRRP
83
What is HRRP in regards to cutting costs?
30-day readmission penalty implemented to shift focus on quality and in turn decrease expenditures caused by readmissions
Not completely successful because it puts rural and hospitals serving low-income areas at an unfair disadvantage
84
What are 3 cost containment strategies of the ACA?
Regulate price and volume (as is done in many peer nations).
Use financial incentives to encourage consumers to be more cost and quality conscious through cost-sharing methods.
Use financial incentives to encourage health care providers to be more cost and quality conscious through VBP/P4P.
85
What is MLR in regards to cutting costs?
Pre-ACA, insurance companies would set their own guidelines.
Post-ACA, MA plans must spend 85% of profits on care and only 15% on administrative costs (ie marketing, overhead).
(For smaller plans, 80/20)
86
What is the Sunshine Act in regards to cutting costs?
Designed to increase transparency in healthcare.
Requires Medicare, Medicaid, & SCHIP to collect and track financial relationships with providers and pharmaceutical companies to report to CMS to identify potential conflicts of interest.
87
What are the 3 programs in VBP/P4P?
Ranking
Benchmark
Improvement
88
What is HRRP in regards to cutting costs?
30-day readmission penalty implemented to shift focus on quality and in turn decrease expenditures caused by readmissions.
Not completely successful because it puts rural and hospitals serving low-income areas at an unfair disadvantage.
89
What are the disadvantages of bundled payments?
Premature discharges to collect $$$ and then can get hit with the 30-day readmission if proper care isn’t shown in the first place.
Patient Dumping
90
What is patient dumping?
Inappropriately/prematurely releasing or not accepting patients
91
What programs were born out of CMMI?
ACO (vivity) & Bundled Payment
92
What is an ACO in regards to quality?
Team of providers (physicians, medical groups, & healthcare organizations), that collectively provide coordinated quality care to Medicare beneficiaries.
Main objective is to promote coordinated care that will ensure quality care, while also minimizing excessive/wasteful services.
The more an ACO can reduce costs, while still maintaining a high level of quality care, the more of a financial bonus is available.
Very successful!
Vivity.
93
What are bundled payments in regards to quality?
Before ACA, each provider would get a separate check but rather than sending a separate check to multiple providers, they send one check to one person making that one person more motivated to coordinate care.
Force providers to coordinate by changing reimbursement to ensure quality.
94
What is HVBP in regards to quality?
ACA changed the way HCO’s get paid for Medicare patients changed
FFS→ quality metrics
The reimbursement program, VBP, was introduced by CMS.
Provides incentive payments for providing higher quality services.
ACA requires the program to be budget neutral so hospital DRG payments are reduced and given to organizations with high quality (CMS pays bonuses using the withholdings)
95
What is CMMI?
Created by ACA and managed by CMS to test innovative payment & delivery models to maintain quality of care
96
What are the 5 goals of VBP?
```
Improve clinical quality
Ensure appropriate use of services
Encourage patient-centered care
Reduce adverse events
Improve patient safety
```
97
Which of the 3 aims of the ACA (cost, quality, access) do you believe has most successfully been achieved and how?
Access!
More so than the other two because quality and cost containment would not have been possible or applicable if health care coverage was not made more easily accessible.
98
How has the ACA served as the catalyst for the movement away from FFS & towards population health?
Moved from FFS ---> HVBP ---> Population health
By shifting the focus away from provider induced demand, overutilization, fragmented services, waste & fraud to quality-based purchasing ultimately leading to population health through preventative measures.
99
What is the future direction of the ACA?
```
Wellness
Prevention*
Value-driven
Quality focused
Coordinated
Integrated health delivery system
```
100
How has the ACA shifted our focus to population health?
Focuses on disparities between different socioeconomic backgrounds and their access to health care services.
ACA supports opportunities to improve public health concerns by increasing access to preventative services.
CHNA.
101
What is CHNA?
Community health needs assessment.
Hospitals must take part in CHNA every three years to identify the community the hospital serves, in order to properly provide care.
ACA provision of national prevention, health promotion, and public health council aims to build healthier and safer communities by expanding clinical and community preventive services to empower health choices, and therefore eliminate health care disparities.
102
What are two current issues you believe still need to be addressed?
Interoperability & Population health
103
Why do you believe the issue of interoperability still needs to be addressed?
Ability of healthcare software systems to connect/exchange information/data to benefit patients.
Most systems today are not interoperable!
(Example: Patient who normally goes to Providence is rushed to a Dignity Health for emergency treatment
Both facilities used different EHR’s and cannot exchange the same data of the patient)
104
What are the benefits of interoperability?
Easier access to patients’ EHR is available and will boost efficiency.
Data from a patient who had a blood test last week at his doctor’s office can be used today during a trip to the emergency room, saving the time and cost of doing more (and unneeded tests) at the hospital.
105
How do you believe interoperability should be addressed?
Although not easy to achieve, a nationwide interoperable healthcare software system is needed to be implemented to ensure complete quality of care, efficiency, & avoidance of unnecessary/excessive services
106
Why do you believe population health is still an issue that needs to be addressed?
More of an emphasis needs to be placed on preventative care.
Easier and less expensive to take part in preventative screenings rather than to miankamits tackle a complex health issue.
Managed Care 1.0’s gatekeeper aspect is crucial to ensuring preventative measures are taken to enhance the health status of patients.
107
How do you believe the issue of population health should be addressed?
Can be addressed through more education toward the public about the benefits of preventative care to spread awareness of benefits and risks of avoiding
108
What are the positives/benefits of having a provider-sponsored health plan (eg Kaiser model)?
Provider-sponsored health plans are everything! (ACO [Began by copying the Kaisers model], HMO, Medical, Groups, Hospitals, Health Plans)
Positives of Coordinated care, Integrated services, Practice Guideline, improving care quality, lowering costs, managing population health, expanding geographic reach, and diversifying the organization's revenue stream
Seen major success since ‘33 (Kaiser’s establishment)!
109
Where does the U.S. rank in healthcare costs vs. healthcare quality?
The US spends far more on medical care than other high-income nations do.
The price of nearly all medical services is higher in the US.
Volume of high-tech services (such as MRIs) also is unusually high.
The US ranks as the lowest of industrialized countries and highest in cost due to inflation.
110
Why can Medicaid be described as a boost to the economy?
Medicaid expansion
(Grants more access to those who cannot afford private health insurance, Drops uninsured rates, Able to reimburse providers instead of providing free services (ED), Reduce cost shifting: Normally the costs of services for those without insurance are placed upon insured individuals through higher service rates), Affordability)
111
Why can Medicaid be described as straining on the economy through government spending?
Jeffersonianism & Currently Republicans believe that too many funds are spent on Medicaid and could be redirected to other sectors that are directly related to boosting the economy.
3.3 trillion in expenditure!
112
What is the problem with high deductibles & copayments?
Those who enroll in HD & Co-pay plans are relatively young & healthy and don’t need continuous care.
If/when there is a need to go to the hospital for an emergency, they may avoid it or put it off due to not being able to afford a high expensive deductible/co-pay.
Leads to hospitals providing uncompensated care that negatively impacts their finances.
Hospitals have to cost- shift to recover from the loss, leading to expensive treatments and services that other insurance companies then have to pay for.
Ultimately leads to an increase in health insurance premiums!
113
What were the 2 Republicans Healthcare legislation?
HEART & AHA 2017
114
What are today's Republican ideologies regarding healthcare?
Jeffersonianism based!
Emphasize states’ rights.
Not the responsibility of the federal government to provide healthcare for everyone.
Object Medicaid Expansion, especially California’s effort of extending Medi-Cal coverage to undocumented immigrants.
115
What was HEART '93?
Health Equity and Access Reform Today Act
Republican predecessor for ACA.
Individual mandate (same as ACA).
Didn't require employer contribution to employee’s health insurance cost.
Did not expand Medicaid.
Included Medical malpractice tort reform (unlike ACA)
Ultimately didn’t pass due to lack of Republican support
116
What was AHA '17?
American Healthcare Act of 2017
Would have left millions uninsured.
To Repeal individual (successful with BBA 2018) and employer mandate.
Would have cut of Medicaid spending and eligibility.
Would have altered pre-existing condition provision.
Would have altered minimum essential benefits provision.
117
What are cost-sharing subsidies & why do they matter?
Designed to reduce a portion of the claim that the insured would have to pay.
Cost-sharing subsidies are offered to lower income individuals who purchase plans through HIE for premiums.
Normally most cannot afford to purchase insurance so subsidies are made available.
HIE now in trouble because subsidies are being cut due to Trump Administration.
Important in order to maintain a reasonably sized risk pool to encourage low-income individuals to participate
(In other words, for costs to go down)
118
Why is the individual mandate important to the healthcare system?
Increased access!
Will allow for access to cheaper preventative services, instead of costly treatments when health issues arise.
To increase the risk pool and spread the healthcare expenditures throughout a large pool rather than a small one.
Without a mandate, only sick people will purchase insurance and healthy people just forego leading to a death spiral (Rapidly increasing premiums)
119
Why is the employer mandate important to the healthcare system?
To Prevent “crowd- out”
If employers are aware that employees are eligible for federal subsidies to purchase health insurance from the market, they may drop them from the insurance to avoid paying for health insurance.
If all employers do this, there will be too many people receiving federal subsidies and this will increase the cost of ACA.
To prevent this, Obama came up with the employer mandate!
120
What are block grants?
Federal funding given to state and local governments for any purpose decided upon by the state
121
What are categorical grants?
Federal funding given to state and local governments for a specific purpose
122
Why are block grants important?
Reagan started/merged/converted MLR from a categorical to a block grant because it is the fastest way to cut funding.
Trump is currently proposing to convert Medicaid into a block grant to cap payments and stop keeping up with the pace of rising healthcare expenditures.
123
What is Capitation?
Per member per month.
Takes us back to Blue Cross & Justin Kimball.
Minimizes provider induced demand and promotes prudence.
Physician gets the same dollar amount regardless of how many times the patient is seen.
It's the solution for FFS reimbursement.
124
Is Capitation a type or Prospective or Retrospective System?
Neither!
Capitation payment occurs before services have been rendered.
Prospective/Retrospective occur after services have been rendered.
Prospective is DRG (Fixed price per diagnosis)
Retrospective is FFS
125
Why are Medicare & Medicaid so important to the nation's healthcare system?
Serves a combined 135 million Americans.
First major government-funded health insurance plans that set a precedent for other plans to follow.
CMS through Medicare & Medicaid set the tone for the healthcare industry today through.
Adjusted payment rates
Adding new services
Adopting VBP
Private sector has adopted and mimicked efforts spearheaded by Medicare/Medicaid.
126
What are the main characteristics of FFS?
Charges set by providers.
Hospitals can bill CMS separately for every service rendered.
Incentivizes providers to administer unnecessary procedures to increase profits.
The cost of healthcare has increased.
Unnecessary/overutilization of procedures wasteful and harmful to patients.
Can force them to stay in hospitals longer also contributing to healthcare costs.
ACA ended fee for service plan programs with Medicare especially.
Transitioned to a set amount per member per month (capitation), regardless of the services rendered.
127
How has FFS contributed to the country's current healthcare crisis?
FFS based on the retrospective payment system.
Hospitals can bill CMS separately for every service rendered.
Incentivizes providers to administer unnecessary procedures to increase profits.
The cost of healthcare has increased.
Unnecessary/overutilization of procedures wasteful and harmful to patients.
Can force them to stay in hospitals longer also contributing to healthcare costs.
Unbundled/fragmented!
128
How is ACO different from HMO?
The system takes care of patients with member providers so those referrals are very different than that of HMO
129
What is the Delegated Model?
Because managed care wanted to compete with Kaiser, DM became entrenched in California.
Health plans supported the model because they perceived physician organizations would be able to manage care more efficiently than they can.
HMO’s through the delegated model were able to offer lowers plans, leading to higher enrollment numbers for California.
DM has comparisons to ACO’s and set the trend in the state.
130
Why did California's DM decline?
California DM declining due to the shift HMO to PPO.
| Lost momentum and interest in DM after Blue Cross’ move and Pacificare was bought by United Health
131
Why did physicians support DM?
Physicians supported the delegated model because it offered them more freedom.
132
What are a few differences between HMO & ACO?
HMO is not a dominant player anymore (PPO is).
Accountability of HMO is not comparable to ACO because ACO is VBP/P4P.
ACO looks at the outcome compared to HMO where they rarely look at the outcome.
133
What is upstream?
By spending money on social services, there will be an increase in health benefits.
Will lead to a decrease in healthcare costs.
Best way to improve health might often be to shift money away from health care.
134
What is an example of upstream?
The costs of social spending start piling up immediately, while most of the health benefits pay off years and even decades in the future.
Ex: Subsidized Housing
How social services investment shows a quick payoff:
In Oregon, they put 7,000 people in housing and in a couple of years healthcare cost dropped by 55%.
135
How are social services intertwined with healthcare?
Prior to our healthcare system, we had so many different social structures (education, environment, economic) that affected the well being of our society and population.
While we pay more for health care than any other country in the world, when it comes to spending on social services—education, subsidized housing, food assistance and more—we rank in the bottom 10 among developed countries.
We spend so much to make up for our lack of investment in education, housing, etc.
136
What are the 5 strategies of LTC?
```
Maintain your health
Become a millionaire
Public-private partnership
Spend down
Establish an irrevocable trust fund
```
137
What is a public-private partnership?
Purchase LTC insurance
If you show verification of eligibility for the state government to keep your assets and still check into a nursing home.
Small market (7%).
Very expensive because nursing home care is very expensive.
138
What is spend down?
Most people use this strategy
An applicant can have no more than $2,000 in assets.
Spend down refers to the spending or giving away of assets in order to meet Medicaid’s financial requirements.
139
What is RBRVS?
Used to reimburse physicians & slow the growth of physician payments.
AMA supported RBRVS due to Congress at the time having a different budget-neutral solution and wanted to fend off their threatening payments system.
140
What does RBRVS stand for?
Resource-Based Relative Value Scale
141
What are the relative value units of each service component?
Physician work
Practice Expense
Malpractice insurance
142
What is practice expense?
RVS Committee/Association of 21 members hears from specialty societies asking to update (usually increase) RVU’s that they believe to be undervalued.
CMS usually agrees 90% of the time.
MedPac (Medicare Payment Advisory Committee) criticizes this practice.
More objective/neutral and consists of real members representing a sector of the industry.
143
Who developed CPT codes?
AMA & placed loyalties on them.
144
What has Newson proposed since he came into office?
Purchasing power of prescription drugs
Negotiate as California so the savings they receive can trickle down to consumers.
Moving towards single payer and universal health
Urging Congress to give the power to create a state-level individual mandate
Expand the Medicaid expansion to undocumented young adults up to age 26, to provide for 138,000 young undocumented adults.
Health for All Adults Act
Create a State Surgeon General to focus on the public health issue and educate the public
Expand the ACA financial assistance to middle-income individuals and families to afford premiums
Increase subsidies for income between 250% and 400% and expand subsidies for 400% and 600% FPL
Will help promote health care affordability, coverage, and use of preventative care
145
List the 12 Most Important Health Policies that have transformed healthcare since 1900.
```
Jeffersonianism
Hamiltonianism
Madison’s View
Flexner Report (BX & BS)
SSA ‘35
IRS Rule ‘43
Hill-Burton Act ‘46
Medicare/Medicaid ‘65
HMO Act ‘73 (Managed Cares, Kaiser, DRG, HIPAA, HITECH)
COBRA ‘86
ACA ‘10 (MACRA ‘15)
```
146
List the 12 Most Important Health Policies that have transformed healthcare since 1900.
```
Jeffersonianism
Hamiltonianism
Madison’s View
Flexner Report (BX & BS)
SSA ‘35
IRS Rule ‘43
Hill-Burton Act ‘46
Medicare/Medicaid ‘65
HMO Act ‘73 (Managed Cares, Kaiser, DRG, HIPAA, HITECH)
COBRA ‘86
ACA ‘10 (MACRA ‘15)
```
