Issues, Trends, and Health Policy Part III

Question 1

“Healthy People 2020”

1. Access to health care and ____ health are both major issues for health policy.

Answer 1

improved

Question 2

“Healthy People 2020”

2. ________ of Healthy People 2000; published in 1990 by the United States Department of Health and Human Services

Answer 2

Continuance

Question 3

“Healthy People 2020”

3. Goals (2):
   a. Increase the ________ and years of healthy life
   b. Eliminate health disparities among Americans

Answer 3

quality

Question 4

“Healthy People 2020”

4. Document contains ____ of health objectives based on numerous focus areas

Answer 4

hundreds

Question 5

“Healthy People 2020”

5. Objectives relate to _____ access, availability, cost, quality of care, etc.

Answer 5

equal

Question 6

“Healthy People 2020”

6. Used to understand health status of the nation and plan _____ programs

Answer 6

prevention

Question 7

“Healthy People 2020”

7. Individuals, communities, and organizations are responsible for determining how to meet the ____ of Healthy People 2020.

Answer 7

goals

Question 8

“Healthy People 2020”

“_______” Statutes: Require practitioners to report specific health-related information; vary from state to state but commonly involve:

Answer 8

Reporting

Question 9

“Healthy People 2020”

Reporting Statutes:
1. ___ ___ and injury from a dangerous weapon (police)

Answer 9

Criminal acts

Question 10

Reporting Statutes:

2. In most states, the NP must notify-the Department of Health of the following diagnoses:
   a. Gonorrhea
   b. Chlamydia
   c. ______
   d. HIV
   e. TB

Answer 10

Syphilis

Question 11

Reporting Statutes:

3. _____ bites (animal control; subsidiary of the DHHS)

Answer 11

Animal

Question 12

Reporting Statutes:

4. Suspected or actual child or ____ abuse (police via social services)

Answer 12

elder

Question 13

Reporting Statutes:

5. Domestic violence: NPs are ___ legally required to report in most states

Answer 13

not

Question 14

Collaborative Practice

1. Exists to enhance the ___ of care and improve patient outcomes

Answer 14

quality

Question 15

Collaborative Practice
2. ANA’s Nursing: A Social Policy Statement (1995) describes collaboration as a “___ ____” in which all players have and desire power, share common goals, and recognize/accept separate areas of responsibility and activity

Answer 15

true partnership

Question 16

Navigating the Health Care System for Patients

1. Social services
2. Psychiatric services
3. ______
4. Security officers
5. Physical therapy
6. Occupational therapy

Answer 16

Police

Question 17

Issues Regarding Access to Care:

1. ___ ____
2. Hospice
3. Skilled Nursing Faciltiy
4. Private duty nursing

Answer 17

Home health

Question 18

Health Care Financing

1. Coding: Evaluation and Management (E&M) codes identify the level of care provided
   a. Codes match the level of service provided to the complexity of the presenting patient problem
2. Billing
3. _________
4. Third party payers

Answer 18

Reimbursement

Question 19

1. ______: Evaluation and Management (E&M) codes identify the level of care provided
   a. Codes match the level of service provided to the complexity of the presenting patient problem

Answer 19

Coding

Question 20

Categories of Third-Party Payers
1. Medicare
2. ______
3. Commercial indemnity insurers
4. Commercial management organizations [e.g. health
maintenance organizations (HMOs)]
5. Businesses or schools wanting health services for
employees or students

Answer 20

Medicaid

Question 21

Categories of Third-Party Payers
________: Sets the standard for reimbursement and
cutting costs

Answer 21

Medicare

Question 22

Medicare Rules for NPs
1. To qualify to be a Medicare provider, an NP must:
a. Hold a state license as an NP
b. Be certified as an NP by a recognized ___ ____
____
c. Hold at least an MSN degree

Answer 22

national certifying body

Question 23

Medicare Rules for NPs

2. The NP meets Medicare qualification ________

Answer 23

requirements

Question 24

Medicare Rules for NPs
3. The practice/facility accepts Medicare payment (i.e., _____% of physician schedule rate for bills submitted under the NP’s provider number)

Answer 24

85

Question 25

Medicare Rules for NPs

4. ____ facility or other provider charges or is paid with respect to the furnishing of services

Answer 25

No

Question 26

Medicare Rules for NPs
5. The services are:
a. “___ _____”: Those for which a physician can
bill Medicare

Answer 26

Physician services

Question 27

Medicare Rules for NPs

5. The services are:
   b. Performed in ______ with a physician

Answer 27

collaboration

Question 28

Medicare Rules for NPs

5. The services are:
   c. Within the NP’s scope of practice as defined by ____ law

Answer 28

state

Question 29

Medicare Payments

1. Medicare reimburses NPs __% of the physician fee delineated in Medicare’s Physician Fee Schedule.

Answer 29

85

Question 30

Medicare Payments

2. For a procedure, Medicare pays NPs ___% of the 85% of the Physician Fee Schedule rate.

Answer 30

80

Question 31

Medicare Payments
3. Practices must bill under the provider of the clinician who performs a given service. The exception is “____ ____” billing. When billing “incident to” a physician’s service, a practice may be reimbursed 100% of the Physician Fee Schedule rate.

Answer 31

incident-to

Question 32

Incident-to Billing: Services billed under the physician’s provider number to get the full physician fee (100%) given the following rules:
1. The services are:
a. An integral, although incidental, ____ of the
physician’s professional service

Answer 32

part

Question 33

Incident-to Billing: Services billed under the physician’s provider number to get the full physician fee (100%) given the following rules:
1. The services are:
b. Commonly rendered ____ charge or included in
the physician’s bill

Answer 33

without

Question 34

Incident-to Billing: Services billed under the physician’s provider number to get the full physician fee (100%) given the following rules:
1. The services are:
c. Of a type commonly _____ in physician’s offices
or clinics

Answer 34

furnished

Question 35

Incident-to Billing: Services billed under the physician’s provider number to get the full physician fee (100%) given the following rules:
1. The services are:
d. Furnished under the physician’s direct personal
_______ and are furnished by the physician or
by an individual who is an employee or
independent contractor of the physician. Direct
supervision does not require the physician’s
presence in the same room but the physician
must be present in the same office suite and
immediately available.

Answer 35

supervision

Question 36

Incident-to Billing: Services billed under the physician’s provider number to get the full physician fee (100%) given the following rules:
2. The physician must perform “the initial service and
subsequent services of a frequency which reflect his
or her active _________ in the management of the
course of treatment.”

Answer 36

participation

Question 37

Incident-to Billing: Services billed under the physician’s provider number to get the full physician fee (100%) given the following rules:
3. The physician/other provider under whose name and
number the bill is submitted must be the individual
present in the ___ ____ when the service is
provided.

Answer 37

office suite

Question 38

Incident-to Billing: Services billed under the physician’s provider number to get the full physician fee (100%) given the following rules:
4. *Incident-to billing is not allowed in the _____ setting;
an NP must bill under his/her provider number.

Answer 38

hospital

Question 39

Incident-to Billing: Services billed under the physician’s provider number to get the full physician fee (100%) given the following rules:
5. An NP may bill for an assistant’s work (e.g., performing
an EKG) under the NP’s provider number as long as
the _____ for incident-to billing are followed.

Answer 39

roles

Question 40

Other Rules for Billing
1. Physicians and NPs may see a patient on the same day
for their services; however, the two must _________
billing to avoid duplicate payments.

Answer 40

coordinate

Question 41

Other Rules for Billing
2. For inpatients, physicians and NPs must decide for
which party (i.e., the NP or the physician) should bill,
given the amount of ________ rendered by each on
given day.

Answer 41

services

Question 42

Other Rules for Billing
3. For home NP visits billable for Medicare A services,
NPs do not need a physician’s order to bill under the
NP’s provider number, unless the NP is providing
______ ______ exclusively.

Answer 42

moving services

Question 43

______: Federally supported, state administered

program for low-income families and individuals

Answer 43

Medicaid

Question 44

Medicaid:

1. Benefits vary from state to _______.

Answer 44

state

Question 45

Medicaid:
2. Medicaid payments are made after other insurance or
_____ party payments have been made.

Answer 45

third

Question 46

Case Management
1. Involves a comprehensive and systematic approach to
provide _____ care

Answer 46

quality

Question 47

Case Management
2. _______: Mobilize, monitor and control resources that
a patient uses during a course of an illness while
balancing quality and cost

Answer 47

Purpose

Question 48

________, __________, ________
1. A management process of monitoring, evaluating,
continuous review, and improving the quality in
providing health care

Answer 48

Quality Assurance (QA)/Quality Improvement 
       (QI)/Continuous Process Improvement (CPI)

Question 49

2. ___ _____: A process for evaluating the care
   of patients using established standards of care to
   ensure quality

Answer 49

Quality Assurance

Question 50

3. Based on the methodology developed by Deming and
   tested in ________ industry that quality can be
   improved by continually monitoring structure, process
   and outcome standards (CQI)

Answer 50

Japanese

Question 51

a. _______: Inputs into care such as resources,

equipment, or numbers and qualifications of staff

Answer 51

Structures

Question 52

b. ___ ___ ____: Include assessments, planning,
performing treatments and managing
complications.

Answer 52

Processes of care

Question 53

c. ____: Include complications, adverse events,
short term results of treatment and long term
results of patient health and functioning.

Answer 53

Outcomes

Question 54

Quality Assurance (QA)/Quality Improvement
(QI)/Continuous Process Improvement (CPI)
4. Used to assess, ______, and improve care provided to patients

Answer 54

monitor

Question 55

Quality Assurance (QA)/Quality Improvement
(QI)/Continuous Process Improvement (CPI)
5. Components include monitoring of care ____, care appropriateness, effectiveness of care, cost of care, self-regulation and peer review to ensure compliance to care standards

Answer 55

quality

Question 56

6.Steps of CQI/QA (outlined by the Joint Commission)
a. ____ _____ (i.e., developing a quality
management plan which assigns responsibility for
degree of involvement)

Answer 56

Quality planning

Question 57

6.Steps of CQI/QA (outlined by the Joint Commission)
b. Delineate scope of care Identify important aspects of
care
• i) Identify ____ aspects of care
ii) Identify related to aspects of care

Answer 57

i) important

ii) indicators

Question 58

6.Steps of CQI/QA (outlined by the Joint Commission)
c. Establish ______ for evaluation related to the
indicators

Answer 58

thresholds

Question 59

6. Steps of CQI/QA (outlined by the Joint Commission)

d. _______ and organize data

Answer 59

Collect

Question 60

6. Steps of CQI/QA (outlined by the Joint Commission)

e. Evaluate care when ______ are reached

Answer 60

thresholds

Question 61

6. Steps of CQI/QA (outlined by the Joint Commission)

f. Take action to ____ care

Answer 61

improve

Question 62

6.Steps of CQI/QA (outlined by the Joint Commission)
g. Assess the ________ of the action and document
improvement

Answer 62

effectiveness

Question 63

6. Steps of CQI/QA (outlined by the Joint Commission)

h. Communicate ______ information

Answer 63

relevant

Question 64

7. ____ ____: Contains key patient care activities and time frames for those activities which are needed for a specific case type or diagnosis-related group (DRG) 8.

Answer 64

Critical Path

Question 65

8. ___ ____: A newer version of the critical path and is a blueprint for planning and managing care delivered by all disciplines

Answer 65

Care Map

Question 66

a. The Care Map contains a critical path section plus a
section that identifies common problems
encountered by patients of a specific case type, the
day-to-day goals that the patient must achieve, and
the final desired clinical ______.

Answer 66

outcomes

Question 67

8. Care Map:
   b. Monitoring of ________ of care is a very important
   goal

Answer 67

outcomes

Question 68

___ ____ ___: A tool for identifying prevention strategies to ensure safety

Answer 68

Root Cause Analysis

Question 69

Root Cause Analysis:
1. A process that is part of the effort to build a culture of
_____ and move beyond the culture of blame

Answer 69

safety

Question 70

Root Cause Analysis:

2. Involves and incorporates:
   a. ____-_____ experts from the frontline services

Answer 70

Inter-disciplinary

Question 71

Root Cause Analysis:

2. Involves and incorporates:
   b. Those who are the most ____ with a situation

Answer 71

familiar

Question 72

Root Cause Analysis:
2. Involves and incorporates:
c. Continually digging _____ by asking why, why,
why at each level of cause and effect

Answer 72

deeper

Question 73

2. Involves and incorporates:

e. A process that is as _______ as possible

Answer 73

impartial

Question 74

2. Involves and incorporates:

d. Identifying changes that need to be made to ______

Answer 74

system

Question 75

Sentinel Events

1. Unexpected occurrences involving _____ or serious physical or psychological injury, or the risk thereof

Answer 75

death

Question 76

Sentinel Events

2. Serious injury specifically includes loss of _____ or function.

Answer 76

limb

Question 77

Sentinel Events
3. The phrase, “or the _____ _____” includes any process variation for which a recurrence would carry a significant chance of a serious adverse outcome.

Answer 77

risk thereof

Question 78

Sentinel Events

4. Such events are called “‘_____” because these signal the need for immediate investigation and response.

Answer 78

sentinel

Question 79

Sentinel Events
5. The terms “‘sentinel event” and “____ ____” are not synonymous; not all sentinel events occur because of an error and not all errors result in sentinel events.

Answer 79

medical error

Question 80

Sentinel Events
6. In response to a sentinel event (e.g., _____ in nursing homes or a colleague’s behavior that undermines a culture of safety), clinicians and institutions are expected to conduct a root cause analysis.

Answer 80

falls