HOM 5307 TEST 1 EXAM QUESTIONS
100% CORRECT.
An IPA is an HMO that contracts directly with physicians and hospitals. - ANSWER
False
The defining feature of a direct contract model is the HMO contracting directly with a
hospital to provide acute services to its members. - ANSWER False
HMOs are licensed as health insurance companies. - ANSWER False
A PHO is usually a separate business entity requiring the participation of a hospital and
at least some of the hospitals admitting physicians. - ANSWER True
Hospitals purchased physician practices and employed physicians in the 1990s but will
no longer do so. - ANSWER 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. -
ANSWER True
The GPWW requires the participation of a hospital and the formation of a group
practice. - ANSWER False
EPOs share similarities with: - ANSWER PPO's & HMO's
Commonly recognized HMOs include: - ANSWER IPA's, Network & Staff and Group
PSOs, created by the BBA of 1997, proved to be very popular and successful. -
ANSWER False
Key common characteristics of PPOs include: - ANSWER Selected provider panels
Negotiated payment rates
Consumer choice
Utilization management.
Advantages of an IPA include: - ANSWER Broader physician choice for members
More convenient geographic access
Require less start-up capital.
Capitation is usually defined as: - ANSWER 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? - ANSWER Network Model
The integral components of managed care are: - ANSWER Wellness & Prevention
Managed care is best described as: - ANSWER 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: - ANSWER prepaid group practices
The original impetus of HMOs development came from: - ANSWER Providers seeking
patient revenues
Consumers seeking access to healthcare
Employers
Blue Cross began as a physician service bureau in the 1930s. - ANSWER False
The BBA of 1997 resulted in a major increase in HMO enrollment. - ANSWER False
The Managed care backlash resulted in: - ANSWER 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. - ANSWER True
Health care cost inflation has remained consistent since 1995. - ANSWER False
Managed care plans perform onsite reviews of hospitals and ambulatory surgical
centers. - ANSWER False
Hospital consolidation has been blocked more often than not by the DOJ and/or the
FTC. - ANSWER False
The same methodology used to pay a hospital for inpatient care is usually also used to
pay for outpatient care. - ANSWER False
Fee-for-service payment is the most common method used by HMOs to pay specialists.
- ANSWER True
In markets with high levels of managed care penetration, hospitals are usually paid
using a sliding scare discount on charges method. - ANSWER False
What forms of hospital payment contain no elements of risk sharing by the hospital? -
ANSWER Sliding Scale FFS
100% CORRECT.
An IPA is an HMO that contracts directly with physicians and hospitals. - ANSWER
False
The defining feature of a direct contract model is the HMO contracting directly with a
hospital to provide acute services to its members. - ANSWER False
HMOs are licensed as health insurance companies. - ANSWER False
A PHO is usually a separate business entity requiring the participation of a hospital and
at least some of the hospitals admitting physicians. - ANSWER True
Hospitals purchased physician practices and employed physicians in the 1990s but will
no longer do so. - ANSWER 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. -
ANSWER True
The GPWW requires the participation of a hospital and the formation of a group
practice. - ANSWER False
EPOs share similarities with: - ANSWER PPO's & HMO's
Commonly recognized HMOs include: - ANSWER IPA's, Network & Staff and Group
PSOs, created by the BBA of 1997, proved to be very popular and successful. -
ANSWER False
Key common characteristics of PPOs include: - ANSWER Selected provider panels
Negotiated payment rates
Consumer choice
Utilization management.
Advantages of an IPA include: - ANSWER Broader physician choice for members
More convenient geographic access
Require less start-up capital.
Capitation is usually defined as: - ANSWER 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? - ANSWER Network Model
The integral components of managed care are: - ANSWER Wellness & Prevention
Managed care is best described as: - ANSWER 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: - ANSWER prepaid group practices
The original impetus of HMOs development came from: - ANSWER Providers seeking
patient revenues
Consumers seeking access to healthcare
Employers
Blue Cross began as a physician service bureau in the 1930s. - ANSWER False
The BBA of 1997 resulted in a major increase in HMO enrollment. - ANSWER False
The Managed care backlash resulted in: - ANSWER 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. - ANSWER True
Health care cost inflation has remained consistent since 1995. - ANSWER False
Managed care plans perform onsite reviews of hospitals and ambulatory surgical
centers. - ANSWER False
Hospital consolidation has been blocked more often than not by the DOJ and/or the
FTC. - ANSWER False
The same methodology used to pay a hospital for inpatient care is usually also used to
pay for outpatient care. - ANSWER False
Fee-for-service payment is the most common method used by HMOs to pay specialists.
- ANSWER True
In markets with high levels of managed care penetration, hospitals are usually paid
using a sliding scare discount on charges method. - ANSWER False
What forms of hospital payment contain no elements of risk sharing by the hospital? -
ANSWER Sliding Scale FFS
