HCMG Exam 3 Questions & Answers
100% Correct!!
Who grants MD admitting privileges? - ANSWERSHospital
Who refers/admits some or all patients? - ANSWERSMD
What are some examples of inpatient services? - ANSWERS-Labor & delivery
-Intensive care units
-Inpatient surgery
What are some examples of outpatient services? - ANSWERS-Emergency room
-Outpatient surgery
-Diagnostic testing
What are some examples of clinical support services? - ANSWERS-Pharmacy
-Laboratory
-Radiology
-Physical therapy
What are some examples of non-clinical support services? - ANSWERS-Admitting dept.
-Medical records
-Social services
-Purchasing
What are the background trends of the U.S. hospital sector? - ANSWERS-Beds per
1,000 pop. downward
-Inpatient admin. per 1,000 pop. downward
-Avg. length of stay downward
-Outpatient rev./total patient rev. upward
-Inpatient surgeries downward
-Outpatient surgeries upward
What percentage of hospitals are not-for-profit? Government? For-profit? - ANSWERS-
Not-for-profit 58%
-Government 21%
-For-profit 20%
What percentage of hospitals are in a system? - ANSWERS63%
What percentage of national health expenditure shares does hospitalization account
for? Physician services? Prescription drugs? - ANSWERS-Hospitalization 34%
-Physician services 21%
, -Prescription drugs 10%
How many FTE employees are employed by hospitals? - ANSWERS4.8 million
How has the number of U.S. hospitals changed over time? - ANSWERSOn the rise until
1970 then gradually declined until 2000 and has remained steady at around 5,000 since
then
What has shifted the locus of care (e.g., cataract surgery)? - ANSWERSImprovements
in technology and financial incentives
What are the current hospital trends? - ANSWERS-Hospitals joining systems
-Physician employment increasing
-Government's role as a payer is increasing
What is the prospective payment for Medicare? - ANSWERS-Diagnostic-related groups
(DRGs)
-Incentive for hospitals to be more efficient but MDs are still paid fee-for-service
(contrasting incentives)
What are the implications of DRGs? - ANSWERS-Reduction in growth rate of Medicare
inpatient expenditures
-Intended hospital responses = reduction of inpatient admissions and LOS
-Other responses = gaming of DRGs to higher codes (DRG creep) and admitting less
sick patients
How was Medicare pricing determined (pre-2007)? - ANSWERS-Operating base
payment rate
-Adjust for geographic factors (regional variation in labor costs and other hospital inputs)
-Adjust for DRG weight
-Payment (plus 'outlier' payments for exceptionally complex cases)
What is an example of Medicare DRG payment variation according to HOW a patient is
treated? - ANSWERSMedicare patients with heart attacks:
-Coronary bypass with catheterization $36,243
-PTCA (angioplasty) with AMI $14,795
-Medical treatment of circulatory disorders with AMI, discharged alive $8,313
What are severity-adjusted DRG payments? - ANSWERS-538 DRGs replaced with 745
Medicare-severity DRGs
-Co-morbidities or complications (without, with, major)
What are potential challenges of prospective payment system? - ANSWERS-
Technically complex
-Hard to adjust for severity
-Hard to deal with extreme cases - outlier payments (but not too generous)
100% Correct!!
Who grants MD admitting privileges? - ANSWERSHospital
Who refers/admits some or all patients? - ANSWERSMD
What are some examples of inpatient services? - ANSWERS-Labor & delivery
-Intensive care units
-Inpatient surgery
What are some examples of outpatient services? - ANSWERS-Emergency room
-Outpatient surgery
-Diagnostic testing
What are some examples of clinical support services? - ANSWERS-Pharmacy
-Laboratory
-Radiology
-Physical therapy
What are some examples of non-clinical support services? - ANSWERS-Admitting dept.
-Medical records
-Social services
-Purchasing
What are the background trends of the U.S. hospital sector? - ANSWERS-Beds per
1,000 pop. downward
-Inpatient admin. per 1,000 pop. downward
-Avg. length of stay downward
-Outpatient rev./total patient rev. upward
-Inpatient surgeries downward
-Outpatient surgeries upward
What percentage of hospitals are not-for-profit? Government? For-profit? - ANSWERS-
Not-for-profit 58%
-Government 21%
-For-profit 20%
What percentage of hospitals are in a system? - ANSWERS63%
What percentage of national health expenditure shares does hospitalization account
for? Physician services? Prescription drugs? - ANSWERS-Hospitalization 34%
-Physician services 21%
, -Prescription drugs 10%
How many FTE employees are employed by hospitals? - ANSWERS4.8 million
How has the number of U.S. hospitals changed over time? - ANSWERSOn the rise until
1970 then gradually declined until 2000 and has remained steady at around 5,000 since
then
What has shifted the locus of care (e.g., cataract surgery)? - ANSWERSImprovements
in technology and financial incentives
What are the current hospital trends? - ANSWERS-Hospitals joining systems
-Physician employment increasing
-Government's role as a payer is increasing
What is the prospective payment for Medicare? - ANSWERS-Diagnostic-related groups
(DRGs)
-Incentive for hospitals to be more efficient but MDs are still paid fee-for-service
(contrasting incentives)
What are the implications of DRGs? - ANSWERS-Reduction in growth rate of Medicare
inpatient expenditures
-Intended hospital responses = reduction of inpatient admissions and LOS
-Other responses = gaming of DRGs to higher codes (DRG creep) and admitting less
sick patients
How was Medicare pricing determined (pre-2007)? - ANSWERS-Operating base
payment rate
-Adjust for geographic factors (regional variation in labor costs and other hospital inputs)
-Adjust for DRG weight
-Payment (plus 'outlier' payments for exceptionally complex cases)
What is an example of Medicare DRG payment variation according to HOW a patient is
treated? - ANSWERSMedicare patients with heart attacks:
-Coronary bypass with catheterization $36,243
-PTCA (angioplasty) with AMI $14,795
-Medical treatment of circulatory disorders with AMI, discharged alive $8,313
What are severity-adjusted DRG payments? - ANSWERS-538 DRGs replaced with 745
Medicare-severity DRGs
-Co-morbidities or complications (without, with, major)
What are potential challenges of prospective payment system? - ANSWERS-
Technically complex
-Hard to adjust for severity
-Hard to deal with extreme cases - outlier payments (but not too generous)
