Chapter 2 The Health Care Delivery System-Fundamentals of Nursing

Chapter 02: Health Care Delivery System
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MULTIPLE CHOICE ra



1. The nursing attendant is caring for a hospital client whose insurance coverage is Medic
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are. The nursing attendant should consider which information when planning care for th
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is hospital client ?
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a. Capitation provides the hospital with a means of recovering variable charges. ra ra ra ra ra ra ra ra ra ra




b. The hospital will be paid for the full cost of the hospital client ’s hospitalization.
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c. Diagnosis-related groups (DRGs) provide a fixed reimbursement of cost. ra ra ra ra ra ra ra ra




d. Medicare will pay the national average for the hospital client ’s condition. ra ra ra ra ra ra ra ra ra ra ra




ACCURATE ANSWER:-C ra



In 1983, Congress established the prospective payment system (PPS), which grouped inhospi
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tal client hospital services for Medicare hospital client s into diagnosisrelated groups (DRGs), ea
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ch of which provides a fixed reimbursement amount based on assig
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ned DRG, regardless of a hospital client ’s length of stay or use of services. Capitation means t
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hat providers receive a fixed amount per hospital client or enrollee of a health care plan. DRG
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reimbursement is based on case severity, rural/urban/regional costs, and teaching costs, not n
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ational averages. ra




DIF:Understand (comprehension) ra



OBJ:Explain the concept of ―pay for value,‖ used to reward hospitals financially. T
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OPIC:-Planning MSC: Management of Care ra ra ra




2.
A nursing attendant is teaching the staff about integrated health care systems. Which model
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o f care should the nursing attendant include in the teaching about seam-less care delivery?
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a. Affordable Care Act ra ra




b. Hospital Value–Based Purchasing ra ra




c. Bundled Payments for Care Improvements ra ra ra ra




d. The hospital client -centered medical home modelra ra ra ra ra ra




ACCURATE ANSWER:-D ra



Basically, two types of integrated health care systems are found: an organizational structure t
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hat follows economic imperatives (such as combining financing with all providers, from hosp
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itals, clinics, and physicians to home care and long-
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term care facilities) and a structure that supports an organized care delivery approach (coord
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inating care activities and services into seamless functioning). The hospital client centered medic
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al home model is an example of an integrated health care system that strength ens the physician-
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hospital client relationship with coordinated, goaloriented, individualized care. All the other opt
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ions are more related to the financial accessibilit y of health care.
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DIF:Understand (comprehension) ra



OBJ:Explain the concept of ―pay for value,‖ used to reward hospitals financially. T
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OPIC:-Teaching/Learning MSC: Management of Care ra ra ra




3. A nursing attendant is teaching a family about health care plans. Which information
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from the nursing attendant indicates a correct understanding of the Affordable Car
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e Act? ar




a. A family can choose whether to have health insurance with no consequences.
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, b. Primary care physician payments from Medicaid services can equal Medicare.
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c. Adult children up to age 26 are allowed coverage on the parent’s plan.
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d. Quality hospital outcome scores are tied directly to hospital client satisfaction.
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ACCURATE ANSWER:-C ra



The Affordable Care Act ties payment to organizations offering Medicare Advantage plans to
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the quality ratings of the coverage they offer. If hospitals perform poorly in quality scores, the
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y receive lower payments for services. Quality outcome measures include hospital client satis
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faction, more effective management of care by reducing complications and readmissions and i
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mproving care coordination. All individuals are required to have some form of health insuranc
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e by 2014 or pay a penalty through the tax code. Primary care physician payments for Medicaid
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services increased to equal Medicare payments. Implementation of insurance regulations pre
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vents private insurance companies from denying insurance coverage for any reason and from
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charging higher premiums based on health status and gender.
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DIF:Remember (knowledge) ra



OBJ:Explain the concept of ―pay for value,‖ used to reward hospitals financially. T
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OPIC:-Teaching/Learning MSC: Management of Care ra ra ra




4. A nursing attendant is caring for a hospital client in the hospital. When should th
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ear nursing attendant begin discharge planning? a. ra ra ra ra



When the hospital client is ready.ra ra ra ra ra




b. Close to the time of discharge. ra ra ra ra ra




c. Upon admission to the hospital. ra ra ra ra




d. After an order is written/prescribed. ra ra ra ra




ACCURATE ANSWER:-C ra



Discharge planning begins the moment a hospital client is admitted to a health care facility.
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When the hospital client is ready may be too late. Close to the time of discharge and after an or
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der is written/prescribed are too late to help the transition of hospital client care from the ho
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spital to home or other care facility.
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DIF:Remember (knowledge) ra



OBJ:Discuss the role of nursing attendant s in various health care settings.
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TOPIC:-
Planning MSC: Management of Care ra ra ra ra




5. The nursing attendant is applying for a position with a home care organization th
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at s ra



pecializes in spinal cord injury. In which type of health care facility does the nurs
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ing a ttendant want to work? a. Secondary acute
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b. Continuing
c. Restorative
d. Tertiary
ACCURATE ANSWER:-C ra



Hospital client s recovering from an acute or chronic illness or disability often require additi
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onal services (restorative care) to return to their previous level of function or reach a new lev
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el of function limited by their illness or disability. Restorative care includes cardiovascular a
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nd pulmonary rehabilitation, sports medicine, spinal cord injury programs, and home care.
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Secondary acute care involves emergency care, acute medicalsurgical care, and radiological proce
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dures. Continuing care involves assisted living, psychiat ric care, and older-
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adult day care. Tertiary care includes intensive care and subacute care.
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, DIF:Understand (comprehension) ra



OBJ:Discuss the role of nursing attendant s in various health care settings.
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TOPIC:-
Implementation MSC: Management of Care ra ra ra ra



6. A nursing attendant provides immunization to children and adults through the public hea
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lt h department. Which type of health care is the nursing attendant providing? a.
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Primary care ra




b. Preventive care ra




c. Restorative care ra




d. Continuing care ra




ACCURATE ANSWER:-B ra



Preventive care includes immunizations, screenings, counseling, crisis prevention, and com
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munity safety legislation. Primary care is health promotion that includes prenatal and wellbaby c
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are, nutrition counseling, family planning, and exercise classes. Restorative care inclu
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des rehabilitation, sports medicine, spinal cord injury programs, and home care.
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Continuing care is assisted living and psychiatric care and older-adult day care.
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DIF:Understand (comprehension) ra



OBJ:Summarize the six levels of health care. T ra ra ra ra ra ra ar



OPIC:-Implementation MSC: Health Promotion and Maintenancera ra ra ra




7. In order to receive payment for care provided, nursing centers must comply with requirem
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ents outlined in what federal legislation?
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a. Omnibus Budget Reconciliation Act ra ra ra




b. Medicare Act ra




c. Medicaid Act ra




d. Affordable Care Act ra ra




ACCURATE ANSWER:-A ra



Nursing centers must comply with the Omnibus Budget Reconciliation Act of 1987 and its mi
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nimum requirements for nursing facilities to receive payment from Medicare and Medicaid. The
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Affordable Care Act ties payment to organizations offering Medicare Advantage plans to the
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quality ratings of the coverage they offer.
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DIF:Understand (comprehension) ra



OBJ:Explain the concept of ―pay for value,‖ used to reward hospitals financially. T
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OPIC:-Implementation MSC: Management of Care ra ra ra




8. The nursing attendant is trying to determine risk factors unique to home care hospita
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l client s. What resource should the nursing attendant access? a.
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Pew Health Professions Commission
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b. The Outcome and Assessment Information Set (OASIS)
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c. American Nursing attendant s Credentialing Center (ANCC) Magnet Recognition Program
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d. Hospital Consumer of Assessment of Healthcare Providers and Systems ( ra ra ra ra ra ra ra ra ar



HCAHPS)
ACCURATE ANSWER:-B ra



OASIS (the Outcome and Assessment Information Set) includes a group of standardized core
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assessment items for an adult home care hospital client . OASIS forms the basis
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for measurin ra