- Description
HCS 235T Wk 5 – Health Care Costs, Insurance, and Trends Test
- Question 1
6/6
Which 4 factors contribute to quality of care?
Highly reliable organizations
Process improvement
Fee for service
Outcomes linked to payment (
Patient-centered care
Preauthorization
- Question 2
5/5
Which 3 statements are characteristics of patient-centered care?
1.Patient-centered care happens if the care provider does all the treatment, tests, and prescriptions the patient wants done.
Evidence-based medicine shows that an outcome is patient-centered is if care is meaningful and valuable to the patient.
Making the health care facility look like an upscale hotel or spa makes it patient-centric under the Patient-Centered Medical Home (PCMH) standards.
Access and continuity, care management, and coordination are key functions of patient-centered medical homes.
Patient-centered care is a key element of high-quality care.
- Question 3
5/5
Which 3 are accurate statements about health care ethics?
If something is illegal, it is prima facie ethical.
Rationing of health care resources is avoidable.
Ethical decision-making is based on the right thing to do.
Ethical standards are right and wrong choices as determined by society and individuals.
Ethical issues can arise when there are 2 sets of values or obligations or courses of action in conflict and a decision must be made between them.
- Question 4
5/5
Choose the correct descriptions for the following abbreviations: HIX and HIE.
1.HIX: The technical process of how information will be exchanged between stakeholders to ensure that all information is exchanged for privacy and security in accordance with standards by the Department of Health and Human Services (HHS)
HIE: The technical process of how information is exchanged between stakeholders to ensure that all information is exchanged for privacy and security in accordance with standards by the Department of Health and Human Services (HHS)
HIE: Entities established under the Affordable Care Act (ACA) that offer patients the ability to choose a health plan based on price
HIX: Entities established under the Affordable Care Act (ACA) that offer patients the ability to choose a health plan based on price
- Question 5
5/5
Which 2 statements are accurate about eligibility for Medicare coverage?
People with disabilities are eligible without an age requirement or ESRD.
Anyone 65 years of age or older is eligible.
To be eligible for premium-free Part A, an individual must be entitled to receive Medicare based solely on their own earnings.
A patient can receive all 4 Parts (A, B, C, and D) at the same time.
- Question 6
6/6
Which 3 statements accurately describe the Patient Protection and Affordable Care Act of 2010 (PPACA)?
It allowed states to choose to expand Medicaid with federal funding assistance.
It is also known to the public as Obamacare.
It offers bronze, silver, gold, platinum, and catastrophic plans.
It covers all those who do not have health insurance coverage.
- Question 7
5/5
Which 2 are accurate when planning for future health care in the U.S.?
Supply chains for PPE are now all manufactured in the U.S. to ensure they are available when and where needed for the care of patients.
FEMA operates before, during, and after natural disasters, such as floods, forest fires, and
hurricanes.
All states now require certificate of need approval for new hospitals and expensive equipment, such as new PET scanners and robotics.
Analysis of big data is useful to both government for health care planning and individual hospitals as part of current operations and identifying future trends and solutions.
- Question 8
5/5
Which 2 types of insurance plans are known for being gatekeeper models?
Preferred provider organization (PPO)
High deductible health plan (HDHP)
Health maintenance organization (HMO)
Provider-sponsored organization (PSO)
- Question 9
5/5
Which 3 health care services are funded by the government?
Veterans Health Administration
Indian Health Services (IHS)
Military Health System (MHS)
Workers’ Compensation Programs
Medicare Supplemental Insurance
- Question 10
6/6
Which 3 populations do not have health care coverage, even after the implementation of the Affordable Care Act (ACA)?
Tribal citizens
People who do not file income taxes and do not qualify for Medicaid
Undocumented immigrants
Younger, healthier individuals who do not have disabilities and choose not to purchase coverage
Non-exempt individuals under the ACA
- Question 11
10/10
Match each model of physician/patient interaction to its description.
Answers
- Paternalistic
The physician decides on the best treatment and talks to patient to obtain consent only.
- Informative
The physician provides information about treatment options and patient decides on their own treatment.
- Interpretive
The physician assists patient in determining which treatment is most in line with the patient’s values.
- Deliberative
The physician dialogs with patient to help choose the best health-related values and achieve the best outcome for the patient’s specific situation.
- Question 12
5/5
Which 2 are terms used when referring to functions only related to electronic health records (EHRs)?
Computerized provider order entry (CPOE)
Meaningful use
Photocopy
Microfilm
- Question 13
5/5
Select 3 ways health care costs are paid for in the United States:
Publicly funded insurance coverage
Individuals
Universal health care coverage
Privately funded insurance coverage
- Question 14
5/5
Which 3 statements are current developments in health care that will continue to be future challenges?
Blockchain is a trend in protecting unauthorized access to patient electronic health records (EHRs).
The 21st Century Cures Act will require providers to have interoperability.
Identifying and matching the correct patient with the correct medical record will continue to have unacceptably high error rates.
Information blocking will be required under the 21st Century Cures Act.
- Question 15
5/5
Which statement is correct for source of payment?
Medicare and Medicaid costs are jointly paid for by the federal government and the states.
Medicare and Medicaid costs are paid for only by the federal government.
The state governments are the only payer for Medicaid costs.
The state governments are the only payer for Medicare costs.
- Question 16
10/10
Match each health care technology term to its correct description.
5 of 5 pairs matched correctly
Prompts
Answers
- Health Information Technology for Economic and Clinical Health (HITECH) Act
Part of the 2009 American Recovery and Reinvestment Act to stimulate the adoption of health information technology (HIT)
- Meaningful use
Standards to encourage the adoption of an electronic health record (EHR) to increase patient quality and safety
- Population health
Health outcomes of a group of individuals, including the distribution of such outcomes within the group which includes health outcomes, patterns of health determinants, and policies and interventions that link them.
- Big data
Characterized by the Four Vs, which are volume, variety, velocity, and veracity.
- Health information system (HIS)
Data generation, compilation, analysis and synthesis, and communication
- Question 17
5/5
Which 3 statements about future health care trends in the U.S. are true?
Inflation in wages and supplies will not be a factor in planning for costs.
Universal coverage and single payer coverage are the same.
Private health care insurance is now and for the next 5–10 years the largest source of health care coverage in the U.S.
National debt, gross domestic product (GDP), and economic indicators, such as interest rates and taxation, will impact health care planning and operations.
Prescriptions as a percent of health care expenditure in the U.S. will be greater than expenditures for physician and clinical services based on current trends.
Outpatient care will continue to be on average at least 50% or more of hospital revenue.
- Question 18
10/10
Match how the provider of care is financially impacted by each insurance plan type/model.
5 of 5 pairs matched correctly
Prompts
Answers
- Health maintenance organization (HMO)
If the provider can take care of the patient for less than the fixed payment, the provider makes money; if it costs the provider more than the fixed payment, the provider loses money.
- Preferred provider organization (PPO)
If the provider can make more money from the additional patient volume to exceed the cost of the discount on the provider’s fees, then the provider makes money; if the provider cannot do so, the provider loses money.
- Point of service (POS)
This hybrid model can have a combination of benefits and challenges of the 2 models it combines, depending on the contract structure between the provider and the payer/plan.
- Provider-sponsored organization (PSO)
Provider assumes all risk and can lose money if costs exceed revenue.
- High deductible health plan (HDHP)/health savings account (HAS)
Provider typically gets paid full fees at the time of service, unless the patient exceeds the available funds in their account. In that case, the provider must collect payment directly from the policyholder and the provider often has volume/usage by patients that reduces revenue to the provider compared to other plans.
- Question 19
5/5
Which 2 statements apply to infectious disease in the U.S.?
Travel guidelines and recommendations from the Centers for Disease Control and Prevention (CDC), the Department of Homeland Security (DHHS), and World Health Organization (WHO) should be monitored by health care providers to screen patients who have traveled to countries affected by infectious diseases that are transmissible.
Heightened infection surveillance and prevention must be a permanent part of planning and operations and a significant consideration in any setting, even if not directly related to health care.
The Joint Commission requires a 90% or better compliance with flu vaccines for staff in hospitals that it accredits.
Once the current COVID-19 pandemic has run its course, all health care organizations can resume their previous processes for infection surveillance, prevention, and control because it will be at least a century before another pandemic will happen.
- Question 20
10/10
Match each Medicare part with its correct description.
4 of 4 pairs matched correctly
Prompts
Answers
- Part A
Covers hospital care, skilled nursing facility care, hospice, and home health services
- Part B
Covers physician services, clinical research, ambulance services, durable medical equipment, mental health, inpatient, outpatient, and partial hospitalization
- Part C
An alternative coverage which is a managed care model known as Medicare Advantage Plans
- Part D
Prescription drug benefit created by the Medicare Prescription Drug, Improvement, and Modernization Act of 2003
- Question 21
10/10
Match the name of each health care law to its correct description.
4 of 4 pairs matched correctly
Prompts
Answers
- False Claims Act (FCA)
Health care services that are not rendered, upcoded, and/or not supported by documentation in the medical record or part of a previously submitted claim
- Physician Self-Referral
Commonly referred to as the “Stark law”; prohibits certain physician relationships with other entities with whom the physician or a family member has a financial interest unless an exception applies
- Emergency Medical Treatment and Labor Act (EMTALA)
Federal law that requires anyone coming to an emergency department to be stabilized and treated, regardless of their insurance status or ability to pay
- Title VII
Prohibits discrimination based on race, sex, color, religion, and national origin
- Question 22
5/5
Which 2 of the following are barriers to electronic health records (EHRs)?
It’s important to secure patient information from unauthorized access.
Patient access to their own medical records kept in portals is not permitted by regulation.
It’s difficult to maintain privacy of patient information.
Patients requesting to change EHR information they believe to be in error is not permitted by law.
- Question 23
10/10
Match how the patient/policyholder can be impacted by each insurance plan type.
3 of 3 pairs matched correctly
Prompts
Answers
- Health maintenance organization (HMO)
Patient must get a referral from PCP to see a specialist.
- Preferred provider organization (PPO)
Patient can choose to go out of network to see providers of choice, but may have to pay more to do so.
- High deductible health plan (HDHP)
Patient is allowed to choose any provider. They may also have a high deductible to pay out of pocket, unless there is an HSA component to the plan.
- Question 24
5/5
Select 3 health care insurances that are publicly funded.
TRICARE
Medicaid
Blue Cross Blue Shield
Medicare Parts A, B, C, and D
- Question 25
6/6
Which 3 of the following are accurate statements about the Health Insurance Portability and Accountability Act?
It gives access to health information exchanges (HIEs).
It is abbreviated HIPPA.
It helps remove the barriers to employees who change employment without losing insurance coverage.
It enacted more health information privacy protections for patients.
- Question 26
5/5
Which 3 have been cited as long-term advantages of electronic health records (EHRs)?
Physicians/providers experience burnout due to more time spent on documentation.
Societal outcomes improve, such as improved ability to conduct research and improved population health.
Privacy and security issues do not occur in electronic records, but instead only in paper medical records. EHR involves low upfront cost of acquisition and implementation.
EHR involves low upfront cost of acquisition and implementation.
Patients experience improved quality of care.
Organizational outcomes include financial and operational benefits, such as workflow.
- Question 27
5/5
Which 2 types of insurance plans are most well known for being open access models?
Provider-sponsored organization (PSO)
High deductible health plan (HDHP)
Health maintenance organization (HMO)
Preferred provider organization (PPO)
- Question 28
10/10
Match each ethical decision-making principle in health care with its correct description.
4 of 4 pairs matched correctly
Prompts
Answers
- Autonomy
This refers to the right of patients to make decisions about their health care.
- Beneficence
The patient’s own interests must be considered foremost in any decisions that need to be made involving care and treatment or that affect the patient in some way.
- Non-malfeasance
This refers to the “First of all, do no harm” approach from the Hippocratic Oath.
- Justice
This refers to equity and fairness for patients, institutions, and society.
- Question 29
10/10
Match each term to its correct examples.
Prompts
Answers
- Provider
Physician, advanced practice nurse, psychologist, and physical therapist
- Payer
Medicare, Medicaid, Blue Cross Blue Shield®, United Healthcare, TRICARE, and Veterans Health Administration
- Plan type
Health maintenance organization (HMO), preferred provider organization (PPO), point of service (POS), provider-sponsored organization (PSO), and high deductible health plan (HDHP)/health savings plan (HSA)
- Place of service
Inpatient facility, outpatient clinic, assisted living, skilled nursing facility, tribal health, emergency department, and prison
- Question 30
6/6
Which 3 trends contribute to higher cost of health care in the U.S.?
Chronic conditions occurring at a younger age
Retail health
Administrative complexity
Implementation of the Affordable Care Act (ACA)
Pharmaceutical medication cost
- Question 31
5/5
Which 4 are current trends in health care?
1.Universal access to health care enacted as the result of the Affordable Care Act (ACA)
Technology cost and benefit for diagnosis, treatment, and information
Short-term impacts of the COVID-19 pandemic on patient access and willingness to seek health care without herd immunity
Challenges in access to health care for vulnerable populations, including people who are chronically ill, older adults, socially disparate people, rural health communities, mental health patients, and women
Ethical issues in patient treatment, informed decision-making, and technology
Replacing managed care for reimbursement with fee for service