Nursing 1130 Final Concepts Test
Questions With 100% Correct Answers
Graded A+
growth in outpatient settings - Answer 1. changes in reimbursement
2. development of technology
3. utilization controls (managed care)
4. social factors
changes in reimbursement: growth in outpatient settings - Answer few payment restrictions
in outpatient services (surgeries, chemotherapy, dialysis, paid as fee-for-service
1. Medicare: PPS reimbursement based on DRGs
2. managed care: capitation
development of new technology: growth in outpatient settings - Answer less invasive
procedures enable quicker recuperation from surgery. patients often do not need to be
hospitalized for routine surgery
managed care: growth in outpatient settings - Answer restrictions on utilization, quicker
discharge, prior authorization, utilization review
social factors: growth in outpatient settings - Answer preference for obtaining services at
home or in community-based settings; especially true for long-term care
hospital outpatient departments - Answer 1. financial ability to adopt new technology
2. physical ability to provide appropriate facilities
3. best quipped to provide ER care
4. excess capacity
advantages of hospital outpatient departments - Answer significant contribution to profits,
continuum of services, cross-referrals within a hospital's own network
private practice - Answer shift from independent solo practice to group practice, institutional
employment
,advantages to physicians (outpatient) - Answer lower operating costs (startup, sharing of
overhead, equipment, diagnostics), greater opportunities to contract with managed care
advantages to patients (outpatient) - Answer most routine services available at one place,
cross-referrals, hospital-based
five main types of hospital outpatient services - Answer clinical, surgical, emergency, home
health care, women's health centers
emergent - Answer require immediate attention
urgent - Answer attention within a few hours
nonurgent, nonemergency - Answer misuse of emergency departments, but used mainly by
the uninsured as a substitute for primary care
women's health centers - Answer women are the major users of health care; walk-in, urgi-
centers, surgi-centers
examples of mobile medical services - Answer ambulance, EMT, paramedics
adult day care - Answer complements informal care provided at home by family members
with professional services available in adult day care centers during the day
alternative medicine - Answer refers to nontraditional approaches and includes the broad
domain of all health care resources
ambulatory care - Answer outpatient services: includes 1. care rendered to patients who
come to physicians offices, 2. services intended to serve the surrounding community, 3. certain
services that are transported to the patient
case management - Answer provides coordination and referral among a variety of healthcare
services
categorical programs - Answer public health programs specifically designed to address
certain categories of disease or serve specific categories of persons
CHC (community health center) - Answer local, non-profit, community owned health care
providers serving low income and medically underserved communities
, COPC (community-oriented primary care) - Answer incorporates the elements of good
primary care delivery and adds to this a population-based approach to identifying and
addressing community health problems
CAM (complementary and alternative medicine) - Answer broad domain of all health care
resources other than those intrinsic to biomedicine
Describe how some of the changes in the health services delivery system have led to a decline
in hospital inpatient days and a growth in ambulatory services. - Answer Medicare
reimbursement and cost-saving efforts of managed care are the two main factors that have led
to a decline in hospital inpatient days and a growth in ambulatory services. Medicare instituted
the prospective payment system (PPS) for reimbursing hospitals in the mid-1980s. PPS
reimbursement based on DRGs provides fixed case-based payment to hospitals. Hospitals,
therefore, have a strong incentive to minimize the inpatient length of stay and continue
treatment in an outpatient setting. The outpatient sector has fewer payment restrictions. Cost-
containment strategies adopted by managed care also stress lower inpatient utilization, with a
corresponding emphasis on outpatient services. These financial factors, for instance, have
provided a major impetus for the unprecedented growth of home health care. Such changes,
coupled with the availability of new technology, have also shifted a number of inpatient surgical
procedures to the outpatient setting.
What implications has the decline in hospital occupancy rates had for hospital management? -
Answer Due to declining occupancy rates, hospital executives have been forced to view
ambulatory care as an essential portion of their overall healthcare business rather than a
supplemental product line of an inpatient facility. Seeing their inpatient business erode, hospital
administrators have realized that establishing a firm position in the ambulatory care market is
critical to the continued survival of their organizations. To meet the growing demand for
outpatient services, hospitals have expanded into services that previously were not considered
a part of their core business. The growth of nonhospital-based ambulatory services has
intensified competition for outpatient medical services between hospitals and community-
based providers. Examples of such competition include home health care and ambulatory clinics
for routine and urgent care.
All primary care is ambulatory, but not all ambulatory services represent primary care. Discuss. -
Answer Accessibility is an essential feature of primary care. One of the goals of primary care
is to bring health care as close as possible to where people live and work. Hence, all primary
care services are ambulatory in nature. In other words, true primary care is community based. It
represents convenience and easy accessibility. The term "ambulatory care" is used
interchangeably with
© 2007 Jones and Bartlett Publishers, Inc.
24
"outpatient services." Primary care is delivered on an outpatient basis and is therefore
ambulatory. However, the scope of ambulatory services extends beyond primary care. For
example, hospital emergency departments and trauma centers provide secondary and tertiary
Questions With 100% Correct Answers
Graded A+
growth in outpatient settings - Answer 1. changes in reimbursement
2. development of technology
3. utilization controls (managed care)
4. social factors
changes in reimbursement: growth in outpatient settings - Answer few payment restrictions
in outpatient services (surgeries, chemotherapy, dialysis, paid as fee-for-service
1. Medicare: PPS reimbursement based on DRGs
2. managed care: capitation
development of new technology: growth in outpatient settings - Answer less invasive
procedures enable quicker recuperation from surgery. patients often do not need to be
hospitalized for routine surgery
managed care: growth in outpatient settings - Answer restrictions on utilization, quicker
discharge, prior authorization, utilization review
social factors: growth in outpatient settings - Answer preference for obtaining services at
home or in community-based settings; especially true for long-term care
hospital outpatient departments - Answer 1. financial ability to adopt new technology
2. physical ability to provide appropriate facilities
3. best quipped to provide ER care
4. excess capacity
advantages of hospital outpatient departments - Answer significant contribution to profits,
continuum of services, cross-referrals within a hospital's own network
private practice - Answer shift from independent solo practice to group practice, institutional
employment
,advantages to physicians (outpatient) - Answer lower operating costs (startup, sharing of
overhead, equipment, diagnostics), greater opportunities to contract with managed care
advantages to patients (outpatient) - Answer most routine services available at one place,
cross-referrals, hospital-based
five main types of hospital outpatient services - Answer clinical, surgical, emergency, home
health care, women's health centers
emergent - Answer require immediate attention
urgent - Answer attention within a few hours
nonurgent, nonemergency - Answer misuse of emergency departments, but used mainly by
the uninsured as a substitute for primary care
women's health centers - Answer women are the major users of health care; walk-in, urgi-
centers, surgi-centers
examples of mobile medical services - Answer ambulance, EMT, paramedics
adult day care - Answer complements informal care provided at home by family members
with professional services available in adult day care centers during the day
alternative medicine - Answer refers to nontraditional approaches and includes the broad
domain of all health care resources
ambulatory care - Answer outpatient services: includes 1. care rendered to patients who
come to physicians offices, 2. services intended to serve the surrounding community, 3. certain
services that are transported to the patient
case management - Answer provides coordination and referral among a variety of healthcare
services
categorical programs - Answer public health programs specifically designed to address
certain categories of disease or serve specific categories of persons
CHC (community health center) - Answer local, non-profit, community owned health care
providers serving low income and medically underserved communities
, COPC (community-oriented primary care) - Answer incorporates the elements of good
primary care delivery and adds to this a population-based approach to identifying and
addressing community health problems
CAM (complementary and alternative medicine) - Answer broad domain of all health care
resources other than those intrinsic to biomedicine
Describe how some of the changes in the health services delivery system have led to a decline
in hospital inpatient days and a growth in ambulatory services. - Answer Medicare
reimbursement and cost-saving efforts of managed care are the two main factors that have led
to a decline in hospital inpatient days and a growth in ambulatory services. Medicare instituted
the prospective payment system (PPS) for reimbursing hospitals in the mid-1980s. PPS
reimbursement based on DRGs provides fixed case-based payment to hospitals. Hospitals,
therefore, have a strong incentive to minimize the inpatient length of stay and continue
treatment in an outpatient setting. The outpatient sector has fewer payment restrictions. Cost-
containment strategies adopted by managed care also stress lower inpatient utilization, with a
corresponding emphasis on outpatient services. These financial factors, for instance, have
provided a major impetus for the unprecedented growth of home health care. Such changes,
coupled with the availability of new technology, have also shifted a number of inpatient surgical
procedures to the outpatient setting.
What implications has the decline in hospital occupancy rates had for hospital management? -
Answer Due to declining occupancy rates, hospital executives have been forced to view
ambulatory care as an essential portion of their overall healthcare business rather than a
supplemental product line of an inpatient facility. Seeing their inpatient business erode, hospital
administrators have realized that establishing a firm position in the ambulatory care market is
critical to the continued survival of their organizations. To meet the growing demand for
outpatient services, hospitals have expanded into services that previously were not considered
a part of their core business. The growth of nonhospital-based ambulatory services has
intensified competition for outpatient medical services between hospitals and community-
based providers. Examples of such competition include home health care and ambulatory clinics
for routine and urgent care.
All primary care is ambulatory, but not all ambulatory services represent primary care. Discuss. -
Answer Accessibility is an essential feature of primary care. One of the goals of primary care
is to bring health care as close as possible to where people live and work. Hence, all primary
care services are ambulatory in nature. In other words, true primary care is community based. It
represents convenience and easy accessibility. The term "ambulatory care" is used
interchangeably with
© 2007 Jones and Bartlett Publishers, Inc.
24
"outpatient services." Primary care is delivered on an outpatient basis and is therefore
ambulatory. However, the scope of ambulatory services extends beyond primary care. For
example, hospital emergency departments and trauma centers provide secondary and tertiary
