2|Page
CHAPTER 1
Introduction
Primedocs
, 3|Page
ANSWERS TO KNOWLEDGE-BASED QUESTIONS
1. What are some of the changes that have affected hospitals
during the twentieth and twenty-first centuries?
Answer:
The student may list any of the following changes:
• increases in hospital costs
• Medicare, Medicaid, and CHIP
• the emergence of health maintenance organizations
• shifts from independent to network health care providers
• technological advances in both health care and information
management
• development of a Nationwide Health Information Network
(NHIN)
• average age of the U.S. population is increasing, hence more
associated chronic illness
• shifts from inpatient to other care settings
Primedocs
, 4|Page
• prospective payment systems for most settings
• legislative changes
• increased focus on quality of care and pay-for-performance
or value-based purchasing initiatives
• increased focus on Medicare and Medicaid fraud, abuse and
waste
• ICD-10-CM and ICD-10-PCS adoption
• Patient Protection and Affordable Care Act (Affordable Care
Act)
Students may also mention that voluntary accreditation began
during the twentieth century. They may also note changing
patterns in inpatient admissions, such as increasing inpatient
admissions during the first part of the twentieth century
followed by a reduction in inpatient admissions as care shifted
from the inpatient to the outpatient setting.
Primedocs
, 5|Page
2. How have payment issues affected health care delivery?
Answer:
The implementation of Medicare and Medicaid in 1966
combined with ever-increasing hospital costs helped spark a
shift from the standard fee-for-service payment plan to the
Medicare prospective payment system, enacted in 1982. Also,
Medicare payments to hospitals switched from a per diem basis
to a per case basis. With the emergence of HMOs, other
payment models, such as capitation, became a larger factor in
health care financing.
Both prospective payment and capitation discourage
lengthy hospital stays and excessive services, because the number
of services or days of care rendered increases costs without
increasing reimbursement. These payment changes have been a
factor in decreasing inpatient lengths of stay and in the shift from
inpatient to other care settings.
Between 1998 and 2002, prospective payment system
Primedocs
CHAPTER 1
Introduction
Primedocs
, 3|Page
ANSWERS TO KNOWLEDGE-BASED QUESTIONS
1. What are some of the changes that have affected hospitals
during the twentieth and twenty-first centuries?
Answer:
The student may list any of the following changes:
• increases in hospital costs
• Medicare, Medicaid, and CHIP
• the emergence of health maintenance organizations
• shifts from independent to network health care providers
• technological advances in both health care and information
management
• development of a Nationwide Health Information Network
(NHIN)
• average age of the U.S. population is increasing, hence more
associated chronic illness
• shifts from inpatient to other care settings
Primedocs
, 4|Page
• prospective payment systems for most settings
• legislative changes
• increased focus on quality of care and pay-for-performance
or value-based purchasing initiatives
• increased focus on Medicare and Medicaid fraud, abuse and
waste
• ICD-10-CM and ICD-10-PCS adoption
• Patient Protection and Affordable Care Act (Affordable Care
Act)
Students may also mention that voluntary accreditation began
during the twentieth century. They may also note changing
patterns in inpatient admissions, such as increasing inpatient
admissions during the first part of the twentieth century
followed by a reduction in inpatient admissions as care shifted
from the inpatient to the outpatient setting.
Primedocs
, 5|Page
2. How have payment issues affected health care delivery?
Answer:
The implementation of Medicare and Medicaid in 1966
combined with ever-increasing hospital costs helped spark a
shift from the standard fee-for-service payment plan to the
Medicare prospective payment system, enacted in 1982. Also,
Medicare payments to hospitals switched from a per diem basis
to a per case basis. With the emergence of HMOs, other
payment models, such as capitation, became a larger factor in
health care financing.
Both prospective payment and capitation discourage
lengthy hospital stays and excessive services, because the number
of services or days of care rendered increases costs without
increasing reimbursement. These payment changes have been a
factor in decreasing inpatient lengths of stay and in the shift from
inpatient to other care settings.
Between 1998 and 2002, prospective payment system
Primedocs
