Midterm Questions Flashcards
The acronym that refers to the graphical point where risk is managed to be as low as we can practically make it.
ALARP
As Low as Reasonably Practicable
What percent of its GDP does the United States currently spend on healthcare?
17.6
The concept of having enough healthy individuals paying into the system to pay the cost for the sick individuals in the system is known as
Risk Pooling
As discussed in the film, “America’s Health Insurance Crisis”, what was the key finding of Dr. Fisher’s research concerning the utilization of care?
- Areas with lower utilization of care by Medicare recipients had higher mortality rates.
- More care clearly produces better outcomes.
- More hospitalizations had no impact on outcomes.
- More care does not necessarily result in better outcomes.
More care does not necessarily result in better outcomes.
Choose the answer that accurately conveys what happened historically. The HMO Act
* began with a plan offered by Kaiser in California public works projects.
* Came about it the 1970s when there were few checks on healthcare utilization and employers and the government were confronted with rising healthcare cost
* was intentionally promoted by the government in the 1930’s after President Roosevelt opted not to include national health insurance in his social security legislation
* was passed in the early 1980’s and signed into law by Ronald Reagan.
Came about it the 1970s when there were few checks on healthcare utilization and employers and the government were confronted with rising healthcare cost
How are healthcare cost a “Hidden Tax” on all Americans?
The cost of heathcare is built into the price of everything we purchase.
Which U S government program most resembles the healthcare system in the UK ?
Veterans Administration
Historically, where do the majority of Americans get health insurance coverage?
Private - Employers
Which is the major difference between a “traditional” indemnity health insurance policy and a managed care health insurance policy?
* Those with a traditional indemnity health insurance policy can go to any provider, while those that are covered by managed care plans generally are limited to a prescribed network of providers.
* Indemnity health insurance cost less than managed care health insurance plans like PPOs and HMOs.
* Indemnity health insurance policies only cover catastrophic illnesses like cancer, while managed care plans cover everything.
* Indemnity care plans limit access to specific providers.
Those with a traditional indemnity health insurance policy can go to any provider, while those that are covered by managed care plans generally are limited to a prescribed network of providers.
What is Moral Hazard?
An increase in an insurers risk arising from the insured’s indifference to loss because of the existence of insurance.
The diagnostic related group is associated with
The prospective payment system
diagnostic related group = DRG’s
Copays and deductibles
- Are not a part of HMOs
- Shift financial risk to patients
- Help to reduce cost by discouraging unnecessary tests by providers
- Are only found in indemnity plans
Shift financial risk to patients
The name of the third party administrators contracted by the government to run the Medicare program.
Fiscal Intermediaries
A Prospective Payment System helps to control cost by
setting the rate for reimbursement prior to the delivery of services
Coinsurance differs from a co-payment in that
* coinsurance is the same as a deductible.
* coinsurances are billed to the patient after the insurer pays its portion. Copays must be paid at the time services are delivered.
* coinsurance is a percentage of the allowed reimbursement and copays are set amounts.
* coinsurance is always less than what a copay would be.
coinsurance is a percentage of the allowed reimbursement and copays are set amounts.
The Affordable Care Act
* Addresses the issue of Moral Hazard by giving financial support directly to health insurers
* Addresses both the cost and quality of healthcare by mandating prices and defining what outcomes are expected
* Addresses financial access by providing tax credits and also prohibits the exclusion of individuals with pre-existing health conditions
* Addresses the high cost of premiums by directly limiting what providers are able to charge for services through annually published price caps
Addresses financial access by providing tax credits and also prohibits the exclusion of individuals with pre-existing health conditions
Based on the material presented in class which of the following is true of the US healthcare system?
* It offers equal access to care to all citizens
* It performs well in delivery of care to every segment of the population
* The federal government is the only financial risk bearer in American system
* It is one of the most expensive and decentralized system in the world.
It is one of the most expensive and decentralized system in the world.
A capitated plan
Pays providers a set amount per person they serve per period of time
What area of the healthcare system accounts for approximately 1/3 of healthcare spending?
Hospitals
How would utilization costs likely be impacted in an area with higher numbers of specialists and/or hospital beds compared to areas with lower numbers of specialists and/or hospital beds.
Utilization costs would likely be higher in the area with more specialists and/or more hospital beds.
More bed = high cost = more untilization
Does the change in healthcare cost between 1960 and 2008 help to explain the increasing number of uninsured during the same period?
Yes. The cost of healthcare grew faster then growth of GDP during the same period of time.
Which of the following is an accurate list of the categories of sources that pay for healthcare.
* Taxes credits, employer coverage, individual coverage and military coverage
* Tax credit reimbursement and individual payments
* Self-insured and employer coverage
* Out-of-pocket payments, private health insurance and public health insurance
Out-of-pocket payments, private health insurance and public health insurance
Concerning the continuum of managed care, which of the following statements is true
As you move across the continuum, insurers’ level of control over costs and control over quality changes
The key ideas underlying the concept of insurance
Risk transfer and risk pooling
Which statement best reflects how retrospective fee-for-service works?
* Providers are paid for each test or procedure they do and are paid after they provide the services.
* Providers receive a fixed amount, based on the patient’s diagnosis, regardless of how much care they provide the patient.
* Providers are paid based on the outcomes they produce.
* Providers receive compensation based on the number of patients they are charged with caring for and receive a set amount per patient per year.
Providers are paid for each test or procedure they do and are paid after they provide the services.
Displayed on a graph the relationship between cost and quality shows that
* the line ascends to a point and turns down indicating that quality begins to decline with greater spending
* At a point, the line levels out showing that quality is no longer improving
* The line is erratic and rises and falls depending on the spending amount.
* quality continues to improve as you spend more
At a point, the line levels out showing that quality is no longer improving
Which of the following statements is true concerning the labels attached to health plans (PPO, HMO…)
* The level of control over cost and quality that an insurer has can always be reliably determined by the label applied to the insurance plan
* The label given to a plan can be relied upon to indicate where a plan falls on the continuum of managed care
* Because the actual features of the plan are unknown until confirmed, it is impossible to know where a plan lies on the continuum of managed care based on its label
* Plans labeled PPO are always on the center of the continuum of managed care
Because the actual features of the plan are unknown until confirmed, it is impossible to know where a plan lies on the continuum of managed care based on its label
Which of the following managed care mechanisms transfers risk to the insured
* Capitated payment
* DRG
* Deductible
* Prospective payment
Deductible
Which of the following managed care mechanisms transfers risk to the healthcare provider
* Risk pooling
* Co-pay
* Capitation
* Deductible
Capitation
How does ongoing training and continuing education support patient care risk management?
It supports the maintenance of current knowledge
What ideas in the responses below represent major influences on the development of insurance during the 20th century?
* Advances in computer technology, benefit tax law and social unrest
* The rise of organized labor and government moderated labor negotiations
* WWI and WWII
* The cost of healthcare began to rise and group insurance began to be offered as an employee benefit.
The cost of healthcare began to rise and group insurance began to be offered as an employee benefit.
The objective of a cost effective risk management program should be to
* Eliminate all risk
* Reduce all risk that clearly exist today
* Address those risks that it makes economic sense to attempt to reduce
* Spend whatever amount is required to reduce the likelihood of preventable and unpreventable risk exposures
Address those risks that it makes economic sense to attempt to reduce
Which of the following best represents an example of structural improvement in a hospital?
* Increasing the use of hand hygiene practices
* Developing a patient education program
* Upgrading the hospital’s intensive care unit with advanced technology
* Measuring patient readmission rates
Upgrading the hospital’s intensive care unit with advanced technology
What did the IOM report “To Err is Human” reveal about the US healthcare system?
* Errors occur because the system lacked sufficient safe guards and reliability
* Only spending more money could solve safety problems
* Errors in healthcare were only sporadic and not a major concern
* Poor healthcare worker performance was the source of problems in the system
Errors occur because the system lacked sufficient safe guards and reliability
Which strategy below aims to reduce healthcare costs by restricting access?
* Expanding health insurance coverage
* Offering free preventive care
* Increasing provider payment rates
* Implementing high deductible health plans
Implementing high deductible health plans
A key concept in continuous quality improvement is
* Organizational discipline
* delighting the customer
* timeliness
* controlling variation
controlling variation
Which of the following is NOT an element of Continuous Quality Improvement
* Assurance checks for product or service defects after the product or service are delivered
* Focus on the customer
* Using data to make all improvement decisions
* employee empowerment
Assurance checks for product or service defects after the product or service are delivered
Risk identification can be aided by
* The employee handbook
* Regular CPR training
* Insurance premiums rate changes
* Reports and surveys from accrediting bodies such as the Joint Commission and NCQA and professional ethics documents
Reports and surveys from accrediting bodies such as the Joint Commission and NCQA and professional ethics documents
Risk management methods consist of
* Handoff activities
* Risk control methods and risk financing methods
* Long and short term approaches
* Team empowerment and communication
Risk control methods and risk financing methods
Which of the following best describes a highly reliable healthcare system?
* Delivers care without patient feedback
* A system that requires that no unusual activity occurs to function
* The system is expected to perform effectively only 90% of the time
* Delivers the standard of care consistently despite complex environmental challenges
Delivers the standard of care consistently despite complex environmental challenges
The most common type of civil litigation that is brought against audiologists
Unintentional tort of negligence
n order for a cause of action of negligence to be pursued, four elements must be present:
* A legal duty must exist, a breach of legal duty must exist, a proximate cause (i.e., cause and effect relationship) must exist between the breach of duty and the injury, an actual loss or damage must result from the injury
* Proximate cause must be determined, injury must persist, prompt action, plaintiff must submit to questioning
* A legal duty must exist, proximate cause must be determined, both parties must have representation, arbitration must have failed
* Parties must both have represenation, a breach of legal duty must exist, the court must accept the claim, witnesses must be called
A legal duty must exist, a breach of legal duty must exist, a proximate cause (i.e., cause and effect relationship) must exist between the breach of duty and the injury, an actual loss or damage must result from the injury
In the Institute of Medicine’s definition of quality, the phrase desired health outcomes focuses on
the values that individuals place on various health outcomes and how these may differ among individuals
The two most important factors influencing a practitioner’s ability to reduce exposure to liability are
Awareness and Education
Which of the following is a model of oversight used in healthcare
* Listing
* Check up
* Accreditation
* Combing
Accreditation
models of oversight are
* Peer Review
* Accrediation
* Inspection
In terms of the types of problems that can occur in healthcare quality, medication errors are
misuse
What is the “Duty of Reasonable Care”?
* The patient’s obligation to accept or reject the care offered
* The provider’s responsibility to ensure patient safety in the facility
* The clinician’s responsibility to deliver the standard on care
* The clinician’s obligation to not exceed usual and customary fees
The clinician’s responsibility to deliver the standard on care
A Duty of Reasonable Care comes into existence when
* A clinician accepts someone as a patient
* A clinician responds to a question regarding an individuals health
* Payment is made for the care administered
* Anytime an interactions causes a clinician to use their clinical knowledge
A clinician accepts someone as a patient
Which part of Donabedian’s quality model does CQI focus on?
Process
Which of the following explains James Reason proposed the image of “Swiss cheese” to explain the occurrence of system failures, such as medical errors?
* Blame culture has limited impact on employee behavior
* In a complex system, hazards are prevented from causing harm by a series of barriers.
* He liked Swiss Cheese
* The holes represent gaps in knowledge
In a complex system, hazards are prevented from causing harm by a series of barriers.
