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