HCM Exam2.,WELL DESCRIBE WITH VERIFIED ANSWERS.

A significant advance in the provision of hospital emergency department services occurred with the introduction of: board-certified emergency medicine physicians .. In addition to providing primary and preventive care, federally supported community health centers also: help patients link with other supportive programs and services such as welfare, Medicaid, the Women, Infants and Children supplemental nutrition program (WIC) and the Child Health Insurance Program. .. In today's hospitals, outpatient clinics frequently provide: all of the above .. The primary organizational mode of medical care in the United States, in terms of volume of services delivered, is: private practice physicians' offices .. The predominant services of local public health departments today are: child and adult immunizations .. The number of surgeries performed as ambulatory procedures significantly decreased the need for hospital admissions. The proportion of all surgical procedures performed in ambulatory facilities now exceeds: 65% .. Ambulatory care comprises health care services that require hospitalization (inpatient care). False .. Non-for-profit agencies provide many ambulatory care services within our current system. True In the United States, there has been a steady increase in the number of large medical group practices as opposed to solo (one physician) practices. True Reasons for the increase in ambulatory care include all of the following except . Some illnesses can only be treated in out-patient settings. Most consumers would prefer to be treated as an out-patient instead of being hospitalized.True Before 1950, most physicians practiced in group practices.False Factors that have caused a shift to more medical group practices (rather than solo practice) include which of the following? All of the above The two major types of medical group practices are single-specialty and multi-specialty. True Acute care hospitals did not become involved in ambulatory care until the late 1990's.False Hospital outpatient services can facilitate a steady stream of referrals for inpatient care. True Hospital emergency departments only serve those with life-threatening emergencies.False Which of the following is not true regarding hospital emergency services. Hospital emergency departments provide more cost-effective care than treatment in doctors offices or urgent care centers. There were no medical schools in colonial America, true Academic Health Centers may be best described as: complexes of medical schools and other health professional schools -- such as nursing, pharmacy, dentistry, and allied health -- affiliated with each other and with teaching hospitals and other research and clinical facilities At the time of the Flexner Report, a standard for speciality training had been well established. false Health care reforms will change the emphasis in medical practice from treating illness in individual patients to maintaining wellness in community populations. This shift poses major challenges to the medical education process because: all of the above Health information technology has become an essential part of the patient care process. True In 1965, the federal government recognized the contributions of medical- school/teaching-hospital research and training activities in advancing the sophistication and effectiveness of medical care with the passage of: Regional Medical Program legislation in colonial America, the primary mode of medical education was: A. and C. In order to provide direct patient care, physicians are required to: complete a 3-7 year accredited residency program and pass a medical board exam of the state in which they will practice Large academic medical centers often train not only physicians, but also allied health professionals as well as nurses, pharmacists and dentists. true Medical societies were first established for the primary purpose of: true Physician employment by hospitals continues on a pathway of steady growth. One reason why physicians are leaving private practice for hospital employment is: increasingly complex health insurance and information technology demands of private practice Physician report cards encourage providers to improve their The U.S. imbalance between specialty physicians and primary care physicians has its origins in many factors. Which of the following does not contribute to physicians' attraction to specialty medicine over primary care? Higher government tuition subsidies for specialty training The concept of the patient-centered medical home is dependent upon having an adequate supply of primary care The rising costs of malpractice insurance has had no impact on the way medicine is practiced. false US physicians and medical education have a history of excellence in health promotion and disease prevention. False An aim of managed care is to transfer some measure of financial risk to providers and, to a lesser extent, to patients. Transferring financial risk to patients is accomplished by: requiring co-pays for specified services By focusing on insured populations rather than individuals, managed care organizations can project health service use by: demographic factors such as age, gender, and other factors Cost-control initiatives undertaken by managed care organizations to improve communications with chronic disease patients in the hope of avoiding unnecessary, costly care are known by the term: disease management Despite U.S. health care spending exceeding by far, expenditures of 28 other developed nations, U.S. health outcomes lag far behind. Extensive research has concluded that reasons for high U.S. high expenditures are: higher U.S. per capita income and much higher U.S. prices for medical care Enacted in 1965 as Title XIX of the Social Security Act, Medicaid is: a joint federal-state program supporting basic health services for low income individuals and in which federal and state support is shared based on a state's per capita income. Enacted in 1983, the Diagnosis-related Group payment methodology shifted hospital reimbursement from the retrospective to prospective basis. The major purpose of this new payment system was to: provide financial incentives for hospitals to spend no more than needed to produce optimal outcomes for hospitalized patients Medicaid and CHIP quality initiatives are carried out through partnerships with the respective states' programs using five quality criteria that include which of the following? prevention and health promotion, management of acute conditions, management of chronic conditions, family experience of care, availability of services The 1973 HMO legislation responded to which of the following national concerns: rapidly increasing Medicare expenditures and concerns about the quality of care The Centers for Medicare & Medicaid Services “Hospital Compare” web- based program the primary purpose of: providing consumers with objective criteria that allow comparisons of hospitals' use of evidence-based practices and patient satisfaction ratings The Medicare program enacted in 1965 as Title XVIII of the 1935 Social Security Act is characterized as the most sweeping social legislation ever enacted by the federal government because it: was only the second mandated U.S. health insurance program after worker's compensation and signaled the federal government's entry into the personal healthcare financing arena The current highest personal care expenditure in the U.S. is for: hospital care The intent of the Medicaid Child Health Insurance Program (CHIP) was to: enroll 10 million uninsured children in Medicaid whose family incomes were too high to qualify for Medicaid but too low to purchase private health insurance The “Managed care backlash” beginning in the 1990s, refers to: health care providers and consumers protesting managed care's restrictive policies on provider choice, referrals to specialty care and other practices Although the ACA will enact sweeping U.S. healthcare system reforms, one fundamental element of the system that will remain unchanged is: financing of healthcare through a combination of public and private sources is a provider of care that addresses care of the feet,and ankles, primarily. Podiatrist Major drivers of U.S. health expenditures include: medical technology, growth in the older population, specialty medicine, labor intensity, and volume-based reimbursement incentives. The Department of Labor estimates that 10% of the US workforce is employed in the healthcare industry. True Which of the following is not a level of credentialing mentioned by your text, in relation to healthcare providers? University certificate The leaset restrictive regulating process for healthcare occupations is . Registration Nurse Practitioners (NP) and Physician Assistants (PA) are licensed to work indpendently withour supervision of physicians. False All of the following are considered to be allied health professionals except . LPN's The United States does not have enough faculty to support training of healthcare professionals. True The United States healthcare system does not have strong representation of minorites and women in healthcare administration. True are considered to be alternative therapies. all of the above Americans are said to have "the richest urine in the world" becuase of the excessive use of unecessary nutritional supplementation. True Dental care of underserved populations has received high priority in the US healthcare system. False A physical therapist assists patients in recovering from accidents, injuries or diseases to improve their ability to perform tasks in daily living, with emphasis on their work environment. False Technology does not particularly affect demand for health personnel. False Long-term care and nursing-home reform legislation of the 1970s occurred as a response to which of the following: A and C Long-term care is best described as: services provided in both home and institutional settings for persons of all ages with varying levels of medical, social, and personal care needs The US history of institutional long-term care began with: communal care settings operated by charitable community members and government supported almshouses The development of formal home care services, such as those provided by the Visiting Nurses Association originated as: a social response to improve unhealthy living conditions of immigrants residing in crowded urban tenements and prevent the spread of infectious diseases The enactment of Medicare and Medicaid in 1965 affected the long-term care industry in many ways. Which of the following was not an effect of the Medicare and Medicaid enactment on the long-term care industry? Prohibition of for-profit providers' participation in Medicare and Medicaid long-term care reimbursement The hospice movement is concerned with care for terminally ill patients. Which of the following is not a major goal of hospice care? decreasing costs of care for the terminally ill by avoiding use of expensive technology The major distinction between skilled-nursing and residential care facilities is that skilled nursing facilities: provide care primarily for people requiring intensive nursing, rehabilitation, or related services Which of the following best describes the informal long-term care system? care and assistance provided in the home by family members and friends Which of the following societal factors increases the need for formal long- term care services? all of the above Which of the following was not a driver of expanded home care services during the 1980s through the 1990s? audits documenting significant fraud and abuse of Medicare billing The so-called "sandwich generation" must balances the needs of their own family nad children while caring for elderly parents/aging family members. True Respite care is long term care for those who are bedridden. False Continuing care retirement and life care communities may be an option for who have the financial resources to pay for them, but a less likely option for those who only have government assistance for long-term care. true Care-giver support is one of the components of the national long term care strategy mentioned in your text. true Aging in place helps delay or avoid the move to a nursing home or dependent care setting. true Adult day care provides a supervised setting for solicialization and custodial care through skilled nursing or specialized services for the elderly. true About 25% of the US population currently has long-term care insurance policies. False A skilled nursing facilty is a coordinated program of care for those that are terminally ill. False Open Response Compare and contrast Patient-Centered Medical Homes and Accountable Care Organizations (Describe and tell how they they are similar and how are they different) Patient ceneterd medical homes are the main policy vehicle to reinvigorate U.S primary care and is a team-based model of care led by a personal physician who provides continuous and coordinated care throughout a patients lifetime to maximize health outcomes. While ACA is a group of providers and suppliers involved in patient care that work together to coordinate care for the patients they serve under the traditional Medicare fee for service program. PCMH provide care throughout a patients lifetime while ACA makes sure patients receive care in a timely manner. They both make sure patients are taken care of but just in different ways. What challenges are faced by emergency departments in our current healthcare system? Challenges faced by emergency departments I. our current healthcare systems are people who have no insurance for non- emergent conditions, because they know they cannot be refused care. List and describe the six non-hospital-based facilities that are detailed in your text. 1.) Urgent care centers - healthcare provided on a walk in, no appointment basis for acute illnesses or injury that is not life threating or limb threating, and is either beyond the scope or availability of the typical primary care practice or retail clinic 2.)Retail clinics - a clinic that represents an entrepreneurial response to patient demand for fast affordable treatment of easy to diagnose conditions 3.)Ambulatory Surgery Centers- surgical and nonsurgical procedures performed on an outpatient basis in a hospital or freestanding centers generally operating rooms, dedicated ambulatory surgery rooms, and other specialized rooms such as endoscopy units and cardiac catheterization labs. 4.)Federally qualified health centers - focus on the needs of underserved, comprehensive primary care, professional staffing, community involvement, and partnerships between the public and private sectors. 5.) Public Health Ambulatory Services - provide for less fortunate 6.) Not for profit agency ambulatory services - addresses needs of population groups afflicted by specific diseases or types of conditions What four modalities are common to telehealth?Live video, Store forward, Remote patient monitoring, Mobile Health List at least 3 trends in private physician office practice that have driven the growth of group medical practice (rather than solo practice).Specialization, Changing economics, Desire for more control over their lifestyles Describe the evolution of medical training in the US At first there were no medical schools in colonial America. Women treated people who were sick at home with the help of medicinal herbs, the advice of friends, and self-help publications of questionable credibility. European physicians trained other physicians in an apprentice relationship. The College of Philadelphia was the first medical school established in 1756 then Kings College was founded in 1768. A small number of students graduated from the colleges each year. Training under one physician was common until the mid 1700s. Philadelphia hospital started charging a fee to students who were not apprenticed of physicians of the staff. Later hospitals felt it was necessary to regulate the training system and initiated a program whereby an aspiring physician would pay a fee and be apprenticed to the hospital for 5 year and then would receive a certificate of completion of their apprenticeship. In 1892 Harvard was the first medical school to require 4 years of training. Johns Hopkins in 1893 initiated a 4-year curriculum as part of a pioneering effort to improve medical training. Explain the importance of evidence based clinical practice guidelines. Clinical practice guidelines are systematically developed protocols used to assist practitioner and patient decisions about appropriate healthcare by defining the roles of specific diagnostic and treatment modalities in patient diagnosis and management. The protocols contain recommendations that are based on scientific evidence gathered. From a rigorous systematic review and synthesis of the published medical literature and are therefore described as evidence-based. Where would a physician find clinical practice guidelines? AHRQs National Guideline Clearinghouse Discuss the main trends in the practice of medicine in the US. The main trends in the practice of medicine in the U.S were rising public awareness, media pressure, and enlightened leadership. Physicians participated in public health measures to prevent vaccine-preventable childhood diseases, STIs, and HIV infections that depend on physician case reporting, immunization, and education. They also continued to collaborate in community prevention campaigns for problems like childhood obesity, diabetes, and smoking cessation. How has the government attempted to improve quality and reduce costs in Medicare? Medicaid? Medicare Access and CHIP Reauthorization Act of 2015,Readmission reduction program,Hospital-based purchasing program,accountable care organizations,comprehensive primary care initiatives What are the benefits of expanding Medicaid under the ACA? Having a usual source of care and being better able to obtain care when needed,Receiving recommended preventive care including disease screenings,Relief from the financial burden of medical costs and fewer catastrophic out-of-pocket expenses,experiencing the improved mental health Discuss the continuing challenges and innovations in healthcare financing. The transformation of the U.S healthcare financing system through payment reform coupled with a population health focus will continue daunting array of issues. Paying for changes is only one issue. Breaking loose from old philosophies, value systems, and the politics have brought the U.S healthcare enterprise to its paradoxical state of superior technology while it remains plagued by profit-driven waste will pose overarching challenges. Innovation is also occurring, ACA provisions are reaching millions with affordable health insurance and initiatives such as bundled payments and accountable care organizations linking with costs with quality. The MACRA legislation is also new and will take care of things like historic steps with more equitable provider reimbursement linked with quality of care. What is the current status of the ACA (Affordable Care Act?) The ACA insurance provisions are now woven in the federal insurance funding fabric, in 2015 the CBO and JCT noted that subsequent reports will no longer separately identify the ACA's insurance coverage provisions on the federal budget. Instead, these effects will be included as part of overall reporting. How are health care personnel credentialed and regulated? Government regulation of healthcare profession is considered the safeguard to protect the public from incompetent and unethical practitioners. Because each state assumes and exercises most of that responsibility, how healthcare occupations are regulated and the manner in which regulation is carried out varies from state to state. Regulatory restrictions limit healthcare service organizations, and agencies in how they may use personnel and limit their ability to implement innovative ways to provide patient care. Healthcare occupations are regulated through four mechanisms, State licensure, professional certification, maintenance of certification, and registration. Describe the five factors that influence the demand for health personnel? Changing Nature of Disease, Disability, and Treatment - The aging of the population and advances in treatment of acute and life-threating conditions have a result of more people surviving with chronic illnesses or disabilities. A growing number of people also have deteriorating mental capacities, cardiac conditions, cancer and more continuously go up and increase the demand of workers needed to take care of those patients. Physician Supply – Important decisions and acceptances are made by physicians and are important to realize that the anticipated changes in the number and types of physicians will have a direct impact on the demand for many other types of healthcare personnel. Technology – Technology that is medical and nonmedical is used in the provision of healthcare has important implications for the for the new number and skill requirements of the healthcare workforce. Expansion of Homecare - The home care component of healthcare industry continues to expand, delivery sites are shifting from acute hospitals toward ambulatory, home care, and long-term care settings. Corporatization of Healthcare- Solo practicing is becoming more popular for health professionals over the recent years. While group practices and hospital employment of physicians, the development of several forms of provider organizations, and new models for physician payment interests are plummeting downhill. How would a person become a long term care administrator?(change around answer) Similar to many other careers in health administration, today’s long-term care administrator jobs often require professionals with advanced degrees in health administration or similar fields. Although some entry-level jobs do not require education beyond a bachelor’s degree, the standard for long-term administration jobs has become the master’s degree in health administration or long-term care administration. Must be licensed to practice: Academic preparation as indicated by the State, AIT (administrator in training under a licensed long term adm. (length of training designated by law); licensure exam and any related application fees for licensing. List and describe the 6 modes of long-term care delivery in the US.Adult Day Care- May provide a supervised program of social activities and custodial care (social model), medical and rehabilitative care through skilled nursing, or specialized services for patients with Alzheimer's disease or other forms of dementia. Respite Care-Is a temporary surrogate care given to a patient when that patient's primary caregivers must be absent. Hospice Care- A philosophy supporting a coordinated program of care for the terminally ill. Home care - Is a community-based care provided to individuals in their own residences. Assisted Living Facilities- Long-term care for individuals who do not require skilled nursing services and whose needs lie more in the custodial and supportive realm. Skilled Nursing Care-Medicare and Medicaid certified is defined as a facility, or distinct part of one, primarily engaged in providing skilled nursing care and related services for people requiring medical or nursing care, or rehabilitation services. Describe the four innovations in long-term care that were detailed in your text.Aging in place-Allows older adults to maintain their health while living as independently as possible in their own homes, without a costly, and in many cases traumatic, move to an institutional setting. Continuing Care Retirement and Life Care Communities-Communities that are available for those Americans who do not wish to stay in their own homes as they get older yet are essentially well enough to avoid institutionalization.Naturally Occurring Retirement Communities - Term coined by Professor Michael Hunt that describes apartment buildings where most residents were 60 years or older. Mainly used to describe apartment complexes, neighborhoods, or sections of communities where residents have opted to remain in their homes. High Technology Care: Hospitals Without Walls- Traditionally home health care focused on providing supportive care to persons with long-term disability and chronic disease, but now the more rapid discharge of all patients from hospitals after episodes of hospitalization for an acute illness, exacerbation of the chronic disease, progressions of disability, or surgery.