NURS 486 FINAL QUESTIONS ANSWERS WITH SOLUTIONS 2024

NURS 486 FINAL QUESTIONS
ANSWERS WITH SOLUTIONS 2024
WhyTwereTthereTnoTincentivesTforTphysiciansTtoTcontrolTcostsTinThealthcare?T-
TANSWERTtheyTwereTtheTprimaryTdecisionTmakers



didTasTmanyTtestsTasTpossibleTifTthereTwasTanyTmarginalTbenefit



inTtheTfeeTforTserviceTpayment,TtheTmoreTtesysTorTproceduresTperformed,TtheTwhatT-
TANSWERTgreaterTtheTphysician'sTearningsTbecauseTearningTtiedTtoTprocedures




inTfeeTforTservice,TpatientsTwereTinsulatedTfromTtheTcostsThowT-TANSWERTinsuranceTwasTpayingTitTall



lackTofTwhatTcontributedTtoTincreasedTcosts?T-TANSWERTcostTconsciousness

ptsTnotTawareTofTcosts

providersThadTnoTincentiveTtoTbeTconcerned



inT1983TtheTmovementTofTMedicareTshiftedTtoTwhatTpaymentTsystem?T-
TANSWERTprospectiveTpaymentTsystemT(predeterminedTpayment)




basedTonTDRGs,TwhichTwasTaTcommonTmethodTofTreimbursementTbasedTonTwhatT-
TANSWERTpredeterminedTfixedTprice-per-caseTdiagnosis




underTDRGs,TtheThospitalTwon'tTgetTreimbursedTforTwhatT-TANSWERTgoingToverTpre-establishedTprices



theTDRGsTcreatedTaTneedTforTwhat?T-TANSWERTnursingTmanagers



BroughtTphysicianTreimbursementTmoreTinTlineTwithTskillsTrequiredT&TactualTtimeTspentTonTprocedures



Ex:TwhenTcataractTsurgeryTwasTnew,TitTtookTlongerTandTwasTmoreTexpensiveT-TANSWERTRBRVs

nowTthatTitsTmoreTroutineTandTmainstream,TRBRVsTbroughtTpaymentTdown

,•TIndividualTorTemployerTpaysTforTpremium

•TCopaymentTwhenTpatientTseesTphysician

•TMustTselectTprimaryTcareTproviderT(inTnetworkTphysician)T=TGATETKEEPER

•TCan'tTgoTtoTanyTotherTphysician/specialistTw/oTreferral

•TInsuranceTwon'tTgiveTcoverageTifTyouTdoT-TANSWERTHMO



•TMemberTpaysTpremiumTforTfixedTpercentage

•TThereTisTaTdeductibleTandTcopayment

•TCanTchooseTphysicianTinTnetworkT-TDON'TTHAVETTOTHAVETATGATETKEEPER

oTCanTchooseTanyoneTinTtheirTlistTw/oTaTreferral

•TMightTbeTableTtoTgetTreimbursedToutTofTnetwork,TbutTlowerTrate

•TMayTorTmayTnotTpayTforTpreventativeTcareT-TANSWERTPPO



•TAllowsTuseTofTprovidersToutsideTtheTplan'sTpreferredTlistTorTnetwork,TbutTrequiresThigherTpremiumsTandT
copaymentsTforTservicesT-TANSWERTPOS



oTExpandsThealthTinsuranceTcoverageTtoTuninsuredTAmericansTwhileTcontrollingTcostsTandTimprovingTtheTq
ualityTofThealthTcareT-TANSWERTpatientTprotectionTandTaffordableTcareTact



encompassesTskillsTandTriskTtakingTthatTbusinesspersonsTbringTtoThealthTcareTorganizationsT-
TANSWERTentrepreneurship




includingTallTmedicalTfacilitiesTandTequipmentTavailableT-TANSWERTcapital



whatTpartTofTmedicareTisTfree?T-TANSWERTtheTbasicTpart



largestTHealthTinsuraneTinTtheTUST-TANSWERTmedicare



EntitlementTprogramTbasedTonTageT(65)TorTdisabilityT(kidneyTfailure,TterminalTcancer)TcriteriaTratherTthanT
onTneedT-TANSWERTmedicare

, coversTinpatientThospitalTservices,TskilledTnursingTfacilitiesT(SNFs),TandThomeThealthTbenefitsT-
TANSWERTmedicareTpartTA




coversTphysicianTservicesT-TANSWERTmedicareTpartTB



whatTcoversTimpoverishedTfamiliesT-TANSWERTmedicaid



medicaidTcoversTwho?T-TANSWERTdisabled

lowTincomeTwithTchildren

nursingThomeTlowTincome



methodTofTreimbursingTprovidersTbasedTonTtheTqualityTofTcareTprovidedTwithTanTemphasisTonTdiseaseTprev
entionTandTreductionTofTcomplicationsT-TANSWERTpayTforTperformance



whatTareTneverTevents?T-
TANSWERTwhereTmedicareTnoTlongerTpaysThospitalsTforTtheTextraTcostTofTtreatingTpreventableTerrorsT




HAI

injuriesTfromTfalls

wrongTsiteTsurgery

mismatchedTbloodTtransfusions



decreaseTduplicationTofTservicesTandTreduceTwastedThealthTcareTresourcesT-TANSWERTcareTcoordination



ensureTthatTpatientsTgetTeffectiveTtreatmentTatTtheTappropriateTlevelTofTcareT

•TMakesTsureTpatientTisn'tTkeptTinThospitalTlongerTthanTshouldTbeTorTdischargedTbeforeTtheyTshouldTbeTdisc
hargedT-TANSWERTcaseTmanagement