Healthcare Management Exam 2 2024/2025

3 types of practice arrangements - correct answer--1. Hospital provides exclusive contract to physical group practice (practice pays physicians a salary) ex. radiology, anesthesiology, pathology, emergency medicine) 2. hospital purchases MD's practice and pays the physician a salary (Health system collects MD's practice revenues, pays all practice expenses, and keeps any profit) 3. Health Maintenance Organization employs the physician (only treats HMO patients. HMO pays all practice expenses) Accountable Care Organization (ACO) Program - correct answer--created by the ACA Voluntary, 3-year program that began in 2012. A group of physicians and hospital(s) agree to be accountable for the quality and cost of care provided to a group of Medicare patients Medicare predicts those patients' costs for next year. Hospitals and physicians continue to be paid fee-for-service (MDs by the RBRVS system; hospitals by DRG system). If quality and cost targets are met, the ACO receives about 50% to 60% of the savings (and Medicare the rest). The ACO can eventually choose to be paid a fixed amount per patient per year (i.e., capitation, not fee-for-service). Early results show modest reductions in medical spending. ads before 1997 and after 1997 - correct answer--Before 1997: Either the condition OR the brand name could be mentioned on TV, but not both. Emphasized speaking with one's physician. After 1997: Ads can now mention both a drug's name and the condition that it treats. Ads must highlight the major benefits and risks. Patients are encouraged to speak with a physician, call an 800 #, or visit a web site for more info. Affordable Care Act (ACA) - correct answer--provides subsidies and tax credits to individuals, small businesses, and low income employees, and employers to provide health insurance benefits to their employees amount of physicians in US - correct answer--doubled since 1960 but still has less physicians then most high-income countries (2.5 per 1000 people) it also has a slow growth rate of practicing physicians (.8%) Artificially scarce good - correct answer--giving someone cable doesn't cost them extra money (excludable, non-rival) average amount of money needed to be spent on matt drugs to be assured that 1 will be FDA approved - correct answer--• 54→231→$802 million (in 2000) in 2015 it is greater then a billion bc it needs to beat what is already out Bundled payment - correct answer--The Affordable Care Act (ACA) is Encouraging Hospitals and Physicians to Accept Bundled Payments to Help Align Incentives Between the Two (With a Single Bundled Payment, Physicians should Work With Hospital to Reduce Costs) 5-year voluntary Medicare program that began in 2013 and focuses on about 50 health conditions, or DRGs. Instead of making separate payments to physicians and hospitals, Medicare will make a single bundled payment for an episode of care (not exceeding current $ amount). Money needs to be shared between the physician(s) and hospital. capitation - correct answer--rare : the practice receives a fixed amount of money per enrollee/patient per month, regardless of whether the MD sees the patient and regardless of what services the MD provides choosing wisely and rationing - correct answer--trying to convince MDs to reduce their use of common tests and procedures that have little/no value. save money and not expose people to potentially harmful/costly techniques common resource - correct answer--people tend to overuse bc not excludable (government kicks in and regulates) ex. highway ( non-excludable, rival) cost effectiveness analysis (CEA) - correct answer--establish the most it is willing to pay for a drug. (Used by United Kingdom) death payment - correct answer--- if a medical authorirty decides if a patient should be provided with a certain treatment • what is the value of life we will gain after providing this service