HOM 5307 Exam 1 |98 Complete
Questions and Answers
T/F
An IPA is an HMO that contracts directly with physicians and hospitals. - -
False
An IPA is an HMO that contracts with physicians, then health plan. An HMO
contracts directly with hospital
(A direct contract Open Panel HMO contracts directly with physicians and
hospitals)
- T/F
The defining feature of a direct contract model is the HMO contracting
directly with a hospital to provide acute services to its members - -false
the defining feature of a direct contract model is between the HMO and
physicians. Almost all models of HMOs contract directly with hospitals
- T/F
HMOs are licensed as health insurance companies - -false
HMOs are licensed by states under certificate of authority (COA) rather than
under an insurance license
- T/F
A PHO is usually a separate business entity requiring the participation of a
hospital and at least some of the hospital's admitting physicians - -true
PHO = physician hospital organization
- T/F
hospitals purchased physician practices and employed physicians in the
1990s but will no longer do so - -false
- T/F
an IDS can be described as a legal entity consisting of more than one type of
provider to manage a populations' healthcare and/or contract with a payer
organization - -true
IDS = integrated delivery system
(Not all types of providers will be found in all IDS - it is highly variable)
- T/F
the GPWW requires the participation of a hospital and the formation of a
group practice - -false
GPWW requires the practice of physicians that are actual
members/employees of a medical group
, GPWW = group practice without walls
- EPOs share similarities with:
A- PPOs
B- HMOs
C - Point of Service
D - A & B - -D - PPOs and HMOs
EPO = exclusive physician organization
- commonly recognized HMOs include:
A- IPAs
B- Network
C - Staff and group
D- All the above - -D- All of the above
- T/F
PSOs, created by the BBA of 1997, proved to be very popular and successful
- -false
they failed spectacularly
PSO = physician service organization
BBA = balanced budget act
- key common characteristics of PPOs include:
A- Selected provider panels
B- Negotiated payment rates
C- Consumer choice & Utilization management
D- All the above - -D- all of the above
- advantages of an IPA include:
A- Broader physician choice for members
B- More convenient geographic access
C- Requires less start-up capital
D- All the above - -D- all of the above
(HMOs are extremely costly)
- capitation is usually described as:
A- Fee-for-service including withhold provisions
Questions and Answers
T/F
An IPA is an HMO that contracts directly with physicians and hospitals. - -
False
An IPA is an HMO that contracts with physicians, then health plan. An HMO
contracts directly with hospital
(A direct contract Open Panel HMO contracts directly with physicians and
hospitals)
- T/F
The defining feature of a direct contract model is the HMO contracting
directly with a hospital to provide acute services to its members - -false
the defining feature of a direct contract model is between the HMO and
physicians. Almost all models of HMOs contract directly with hospitals
- T/F
HMOs are licensed as health insurance companies - -false
HMOs are licensed by states under certificate of authority (COA) rather than
under an insurance license
- T/F
A PHO is usually a separate business entity requiring the participation of a
hospital and at least some of the hospital's admitting physicians - -true
PHO = physician hospital organization
- T/F
hospitals purchased physician practices and employed physicians in the
1990s but will no longer do so - -false
- T/F
an IDS can be described as a legal entity consisting of more than one type of
provider to manage a populations' healthcare and/or contract with a payer
organization - -true
IDS = integrated delivery system
(Not all types of providers will be found in all IDS - it is highly variable)
- T/F
the GPWW requires the participation of a hospital and the formation of a
group practice - -false
GPWW requires the practice of physicians that are actual
members/employees of a medical group
, GPWW = group practice without walls
- EPOs share similarities with:
A- PPOs
B- HMOs
C - Point of Service
D - A & B - -D - PPOs and HMOs
EPO = exclusive physician organization
- commonly recognized HMOs include:
A- IPAs
B- Network
C - Staff and group
D- All the above - -D- All of the above
- T/F
PSOs, created by the BBA of 1997, proved to be very popular and successful
- -false
they failed spectacularly
PSO = physician service organization
BBA = balanced budget act
- key common characteristics of PPOs include:
A- Selected provider panels
B- Negotiated payment rates
C- Consumer choice & Utilization management
D- All the above - -D- all of the above
- advantages of an IPA include:
A- Broader physician choice for members
B- More convenient geographic access
C- Requires less start-up capital
D- All the above - -D- all of the above
(HMOs are extremely costly)
- capitation is usually described as:
A- Fee-for-service including withhold provisions
