CPMSM Study Guide questions n answers graded A+

CPMSM Study Guide Non-profit under religious/community control. - correct answer Voluntary/Charitable Hospital Non-profit under city, state, county. - correct answer Govt (non-federal) hospital Owned/operated by fed gov't, supported by fed funds, e.g., VA. Under direct supervision of Surgeon General. - correct answer Govt (federal) hospital Owned by corporation, partnership. - correct answer Proprietary for-profit hospital Provides services typical of a doctor's office our outpatient clinic. - correct answer First Level Hospital The average hospital. Provides short term/general acute care. - correct answer Secondary Care Hospital Large urban teaching hospital with more complex care/specialized services. - correct answer Tertiary Care Hospital Specializing in long term care, psychiatric care, cancer, pediatric, geriatric care etc. - correct answer Specialty Hospitals Managed Care Organization - correct answer MCO Influenced by accreditation standards, fed/state regulations, policies/procedures, standard of care, HEDIS/CAHPS. - correct answer MCO Characteristics Healthcare Effectiveness Data and Information Set - correct answer HEDIS Consumer Assessment of Healthcare Providers and Systems - correct answer CAHPS Health Maintenance Organization, provides healthcare to group of members who pre-pay dues. - correct answer HMO 1 Organized system for providing healthcare. 2 Agreed upon set of basic and supplemental health and treatment services. 3 A voluntarily enrolled group of people. - correct answer HMO Three Characteristics Staff model, group model, network model, independent practice association (IPA), direct contract model. - correct answer HMO Models Physicians work directly for and are paid by organization. - correct answer HMO Staff Model Physicians are a separate corporation that contracts with plan to provide services exclusively to members. - correct answer HMO Group Model Physicians are separate corporation that contracts with plan to provide services. Plan contracts with several physician groups (vs just one in a group model). - correct answer HMO Network Model IPA, plan contracts with individual physicians in a per person agreement. These physicians have their own practices and also see patients outside of the plan. IPAs contract with Hospital MSO to provide services. HMSO charges a fee. The Plan frequently drives reimbursement cost down for IPA. - correct answer HMO Independent Practice Association HMO contracts directly with individual physicians to provide physician services to members. - correct answer HMO Direct Contract Model PHO/HMSO joins forces as a negotiating team, at the Managed Care Plan's bargaining table. PHO provides outpatient care and services for plan's members, and hospital becomes the "preferred" hospital. PHO/hospital accepts full risk capitation. - correct answer Physician Hospital organization/Hospital Medical Staff Organization