HOM 5307 Test 1 Exam |73 Questions and
Answers
An IPA is an HMO that contracts directly with physicians and hospitals. - -
False
- The defining feature of a direct contract model is the HMO contracting
directly with a hospital to provide acute services to its members. - -False
- HMOs are licensed as health insurance companies. - -False
- A PHO is usually a separate business entity requiring the participation of a
hospital and at least some of the hospitals admitting physicians. - -True
- Hospitals purchased physician practices and employed physicians in the
1990s but will no longer do so. - -False
- An IDS can be described as a legal entity consisting of more than one type
of provider to manage a population's health care and/or contract with a
payer organization. - -True
- The GPWW requires the participation of a hospital and the formation of a
group practice. - -False
- EPOs share similarities with: - -PPO's & HMO's
- Commonly recognized HMOs include: - -IPA's, Network & Staff and Group
- PSOs, created by the BBA of 1997, proved to be very popular and
successful. - -False
- Key common characteristics of PPOs include: - -Selected provider panels
Negotiated payment rates
Consumer choice
Utilization management.
- Advantages of an IPA include: - -Broader physician choice for members
More convenient geographic access
Require less start-up capital.
- Capitation is usually defined as: - -prepayment for services on a fixed, per
member per month basis.
- In what model does an HMO contract with more than one group practice
and provide medical services to its members? - -Network Model
, - The integral components of managed care are: - -Wellness & Prevention
- Managed care is best described as: - -a broad and constantly changing
array of health plans employers, unions, and other purchasers of care that
attempt to manage cost, quality and access to that care.
- Prior to the 1970s, HMOs were known as: - -prepaid group practices
- The original impetus of HMOs development came from: - -Providers
seeking patient revenues
Consumers seeking access to healthcare
Employers
- Blue Cross began as a physician service bureau in the 1930s. - -False
- The BBA of 1997 resulted in a major increase in HMO enrollment. - -False
- The Managed care backlash resulted in: - -A reduction in HMO
membership
New federal/state regulations
- PPOs differ from HMOs because they do not accept capitation risk and
enrollees who are willing to pay higher cost sharing may access providers
that are not in the contracted network. - -True
- Health care cost inflation has remained consistent since 1995. - -False
- Managed care plans perform onsite reviews of hospitals and ambulatory
surgical centers. - -False
- Hospital consolidation has been blocked more often than not by the DOJ
and/or the FTC. - -False
- The same methodology used to pay a hospital for inpatient care is usually
also used to pay for outpatient care. - -False
- Fee-for-service payment is the most common method used by HMOs to pay
specialists. - -True
- In markets with high levels of managed care penetration, hospitals are
usually paid using a sliding scare discount on charges method. - -False
- What forms of hospital payment contain no elements of risk sharing by the
hospital? - -Sliding Scale FFS
Answers
An IPA is an HMO that contracts directly with physicians and hospitals. - -
False
- The defining feature of a direct contract model is the HMO contracting
directly with a hospital to provide acute services to its members. - -False
- HMOs are licensed as health insurance companies. - -False
- A PHO is usually a separate business entity requiring the participation of a
hospital and at least some of the hospitals admitting physicians. - -True
- Hospitals purchased physician practices and employed physicians in the
1990s but will no longer do so. - -False
- An IDS can be described as a legal entity consisting of more than one type
of provider to manage a population's health care and/or contract with a
payer organization. - -True
- The GPWW requires the participation of a hospital and the formation of a
group practice. - -False
- EPOs share similarities with: - -PPO's & HMO's
- Commonly recognized HMOs include: - -IPA's, Network & Staff and Group
- PSOs, created by the BBA of 1997, proved to be very popular and
successful. - -False
- Key common characteristics of PPOs include: - -Selected provider panels
Negotiated payment rates
Consumer choice
Utilization management.
- Advantages of an IPA include: - -Broader physician choice for members
More convenient geographic access
Require less start-up capital.
- Capitation is usually defined as: - -prepayment for services on a fixed, per
member per month basis.
- In what model does an HMO contract with more than one group practice
and provide medical services to its members? - -Network Model
, - The integral components of managed care are: - -Wellness & Prevention
- Managed care is best described as: - -a broad and constantly changing
array of health plans employers, unions, and other purchasers of care that
attempt to manage cost, quality and access to that care.
- Prior to the 1970s, HMOs were known as: - -prepaid group practices
- The original impetus of HMOs development came from: - -Providers
seeking patient revenues
Consumers seeking access to healthcare
Employers
- Blue Cross began as a physician service bureau in the 1930s. - -False
- The BBA of 1997 resulted in a major increase in HMO enrollment. - -False
- The Managed care backlash resulted in: - -A reduction in HMO
membership
New federal/state regulations
- PPOs differ from HMOs because they do not accept capitation risk and
enrollees who are willing to pay higher cost sharing may access providers
that are not in the contracted network. - -True
- Health care cost inflation has remained consistent since 1995. - -False
- Managed care plans perform onsite reviews of hospitals and ambulatory
surgical centers. - -False
- Hospital consolidation has been blocked more often than not by the DOJ
and/or the FTC. - -False
- The same methodology used to pay a hospital for inpatient care is usually
also used to pay for outpatient care. - -False
- Fee-for-service payment is the most common method used by HMOs to pay
specialists. - -True
- In markets with high levels of managed care penetration, hospitals are
usually paid using a sliding scare discount on charges method. - -False
- What forms of hospital payment contain no elements of risk sharing by the
hospital? - -Sliding Scale FFS
