HCMG EXAM QUESTIONS AND ANSWERS LATEST
EDITION ALREADY GRADED A+
voluntary physician payment reform
NJ hospitals allow doctors to keep Medicare FFS payments and get bonus if reduce patient costs
-bonus did not decrease costs or quantity of services
-doctors pick cheaper patients (decrease in costs)
FFS
not much savings when switched to APM (still so many doctors on FFS)
-so many other factors like complexity and selection in voluntary programs which don't reduce cost
physicians in US are paid more than other countries
hospitals
WHO: at least one physician, can offer inpatient accommodation, and can provide active medical and
nursing care
AHA: licensed institutions with at least 6 beds whose primary function is to provide diagnostic and
therapeutic patient services for medical conditions
CMS: institution primarily engaged in providing, by or under the supervision of physicians, inpatient
diagnostic and therapeutic services or rehabilitation services
types of hospitals
general medical/surgical (74%)
psychiatric (9%)
acute long-term care (6%): stable but need complex, intensive care; continuation of hospital-level care in
longer-term setting
rehabilitation (5%): restore physical independence, intensive therapeutic and rehabilitative care to
regain functions after severe injury or illness
other: pediatrics, cancer
organizational structure
-non profit (51%)
-for-profit (26%)
-public/government (23%)
non profit hospitals
, tax exemptions bc of community benefit
cannot distribute profit (no shareholders)
receive lots of donations
for-profit hospitals
no limitation in ability to enjoy surplus
no favorable tax status
can take profit for themselves
hospital spending is largest
33%
6.5 million people employed
hospital payment brekdown
facility related: room, food, nursing, medical supplies and services, tests
professional fees: reading tests
payment systems
fee for service: fixed amount for each service
diagnosis-related groups (DRG): hospital paid on diagnosis
per diem: based on number of days in hospital
per diem payments
daily fee that includes everything other than professional fees
- all procedures have same base rate multiplied by total number of days
insurers determine medical necessity of additional days in hospital (people don't overstay)
hospital at risk for number services provide: spend too much money --> loss
insurer at risk for length of stay
payment per episode (DRG)
medicare at risk for number of admissions
medicare at risk for number of admissions: can admit a lot of people but reduce spending on them
EDITION ALREADY GRADED A+
voluntary physician payment reform
NJ hospitals allow doctors to keep Medicare FFS payments and get bonus if reduce patient costs
-bonus did not decrease costs or quantity of services
-doctors pick cheaper patients (decrease in costs)
FFS
not much savings when switched to APM (still so many doctors on FFS)
-so many other factors like complexity and selection in voluntary programs which don't reduce cost
physicians in US are paid more than other countries
hospitals
WHO: at least one physician, can offer inpatient accommodation, and can provide active medical and
nursing care
AHA: licensed institutions with at least 6 beds whose primary function is to provide diagnostic and
therapeutic patient services for medical conditions
CMS: institution primarily engaged in providing, by or under the supervision of physicians, inpatient
diagnostic and therapeutic services or rehabilitation services
types of hospitals
general medical/surgical (74%)
psychiatric (9%)
acute long-term care (6%): stable but need complex, intensive care; continuation of hospital-level care in
longer-term setting
rehabilitation (5%): restore physical independence, intensive therapeutic and rehabilitative care to
regain functions after severe injury or illness
other: pediatrics, cancer
organizational structure
-non profit (51%)
-for-profit (26%)
-public/government (23%)
non profit hospitals
, tax exemptions bc of community benefit
cannot distribute profit (no shareholders)
receive lots of donations
for-profit hospitals
no limitation in ability to enjoy surplus
no favorable tax status
can take profit for themselves
hospital spending is largest
33%
6.5 million people employed
hospital payment brekdown
facility related: room, food, nursing, medical supplies and services, tests
professional fees: reading tests
payment systems
fee for service: fixed amount for each service
diagnosis-related groups (DRG): hospital paid on diagnosis
per diem: based on number of days in hospital
per diem payments
daily fee that includes everything other than professional fees
- all procedures have same base rate multiplied by total number of days
insurers determine medical necessity of additional days in hospital (people don't overstay)
hospital at risk for number services provide: spend too much money --> loss
insurer at risk for length of stay
payment per episode (DRG)
medicare at risk for number of admissions
medicare at risk for number of admissions: can admit a lot of people but reduce spending on them
