Chapter 5: Ambulatory Care Questions and Answers Updated 2026

Chapter 5: Ambulatory Care
Questions and Answers Updated
2026
MAnswerMhealthcareMservicesMthatMdoMnotMrequireMovernightMhospitalization



examplesMofMambulatoryMcareM-
MAnswerMroutineMmedicalMprocedures,MoutpatientMvisits,MvisitsMtoMprivateMphysiciansMof
fices,Mscreening,MdiagnosticMprocedures,Mdialysis,Mwomen'sMhealth,MPT,MpainMmgt,Mcardia
c



whatMisMtheMDRGMpaymentMsystem?M-
MAnswerMplacedMfinancialMincentivesMonMaMprospectiveMpaymentMsystemMwhereMaMhos
pitalMgetsMaMcertainMamountMofMmoneyMandMifMtheyMdontMuseMitMallMtheyMgetMtoM
keepMtheMrest.M



ambulatoryMcareMdecreasedMtheMnumberMofMvisitsMandMLOS,MsoMitMsavedMhospitalsMm
oney



whenMdidMambulatoryMcareMstartMgrowing?M-MAnswerM1995M-M2010



WhatMisMtheMpredominantMmodeMofMambulatoryMcareMinMtheMU.S.?M-
MAnswerMprivateMphysicianMoffice



whatMfactorsMinfluencedMaMshiftMfromMtheMsoloMmodeMofMprivateMpracticeMtoMgroupM
practice?M-MAnswerM1.MsocialMmovementsMinMtheM60's

2.MmedicalMspecialization

3.MintroductionMofMmedicareMinMtheM65's

4.MneedMtoMshareMcomplexMadminMsupport/expensiveMtechnology



whatMareMtheM2MformsMofMgroupMpractice?M-
MAnswerMoneMisMjustMoneMspecialtyMandMtheMotherMisMmultidisciplinary



howMdidMtraditionalMambulatoryMcareMmodelsMreimburseMprovidersMforMservices?M-
MAnswerMonMaMfee-for-serviceMbasis

, whatMareMPCMH'sMandMACO'sMfromMtheMAffordableMcareMact?M-
MAnswerMnewMcareMdeliveryMmodels



patient-centeredMmedicalMhomes

accountableMcareMorganizations



theseMemphasizeMpopulationMhealthMandMtheMintegrationMofMrolesMofMbothMprimaryMan
dMspecialtyMcare



whatMisMaMpatient-centeredMmedicalMhomeM(PCMH)?M-MAnswerMaMteam-
basedMmodelMofMcare

-
MledMbyMprimaryMphysicianMwhoMcoordinatesMallMspecialtiesMofMcareMthroughoutMtheMl
ifeMofMtheMpatient

-



whatMisMtheMInstituteMforMHealthcareMImprovementM"TripleMAim"?M-MAnswerM-
MimprovedMpopulationMhealth

-MimprovedMpatientMexperienceMofMcare

-MreductionsMinMper-capitaMcosts



principlesMofMpatient-centeredMmedicalMhomesM-MAnswerM-
MincorporatesMtheMpatient,Mfamily,MandMcaregiversMintoMtheMdevelopmentMofMplans

-Mcomprehensive,MholisticMcare

-McoordinatedMcare,M"medicalMneighborhood"

-MaccessibleM

-McommitmentMtoMqualityMandMsafety



whatMareMtheM5MmainMwaysMthatMtheMACAMsupportsMPCMH's?M-
MAnswerM1.MexpandedMmedicaidMcoverageMeligibility

2.MnewMmedicaidMandMmedicareMpaymentMenhancements

3.MprimaryMcareMpayment

4.MincreasedMalternativeMpaymentMmodelsM(APMs)MthatMincreasedMcoverageMandMquality