Key Facts Flashcards
1
Q
How does medicare bill for an amputation?
A
DRG
2
Q
what is the difference between vertical and virtual organizations?
A
..
3
Q
Example of Vertical model
A
Kaiser Permanente
4
Q
Example of Virtual Model
A
..
5
Q
Why did Independent Practice Associations come about?
A
Came about in response to Kaiser
6
Q
1973 HMO Act by NIxon
A
employer mandate that required that any employer who provided insurance MUST also offer an HMO; it could either be an HIM or IPA
7
Q
Benefits of IPA style
A
- easier to set up; however if physician doesn’t have enough patients, they can contract with other IPAs - problem with this is more paperwork because each has their own payment system
- different formularies
8
Q
Integrated Medical Groups
A
- another form or virtual integration
- one step beyond the IPA
- capitated and pay salaries
9
Q
Major distinction between IPA and IMG
A
IPA has private practice physicians; other has hired physicians
10
Q
painful measure
A
increases cost without increasing benefit to patient
11
Q
painless measure
A
increases benefit without increasing cost
